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医疗专业人员和家属不给予人工营养的艰难决策:生物伦理问题

The Difficult Decision Not to Prescribe Artificial Nutrition by Health Professionals and Family: Bioethical Aspects.

作者信息

Pereira Andrea Z, da Cunha Selma Freire de Carvalho, Grunspun Henrique, Bueno Marco Aurelio Scarpinella

机构信息

Oncology and Hematology Department, Israelita Albert Einstein Hospital, São Paulo, Brazil.

Bioethical Committee, Israelita Albert Einstein Hospital, São Paulo, Brazil.

出版信息

Front Nutr. 2022 Mar 3;9:781540. doi: 10.3389/fnut.2022.781540. eCollection 2022.

Abstract

INTRODUCTION

Bioethics and nutrition are essential issues in end of life, advanced dementia, life-sustaining therapies, permanent vegetative status, and unacceptably minimal quality of life. Even though artificially administered nutrition (AAN), for this type of health condition, does not improve quality of life and extension of life, and there is evidence of complications (pulmonary and gastrointestinal), it has been used frequently. It had been easier considering cardiopulmonary resuscitation as an ineffective treatment than AAN for a healthy team and/or family. For this reason, many times, this issue has been forgotten.

OBJECTIVES

This study aimed to discuss bioethical principles and AAN in the involved patients.

DISCUSSION

The AAN has been an essential source of ethical concern and controversy. There is a conceptual doubt about AAN be or not be a medical treatment. It would be a form of nourishment, which constitutes primary care. These principles should be used to guide the decision-making of healthcare professionals in collaboration with patients and their surrogates.

CONCLUSIONS

This difficult decision about whether or not to prescribe AAN in patients with a poor prognosis and without benefits should be based on discussions with the bioethics committee, encouraging the use of advanced directives, education, and support for the patient, family, and health team, in addition to the establishment of effective protocols on the subject. All of this would benefit the most important person in this process, the patient.

摘要

引言

生物伦理学和营养是临终关怀、晚期痴呆、维持生命治疗、永久性植物状态以及极低生活质量等方面的重要问题。尽管对于此类健康状况,人工给予营养(AAN)并不能改善生活质量或延长生命,且有证据表明存在并发症(肺部和胃肠道方面),但它仍被频繁使用。对于一个健全的医疗团队和/或家庭而言,将心肺复苏视为无效治疗比将AAN视为无效治疗更容易。因此,这个问题常常被忽视。

目的

本研究旨在探讨相关患者的生物伦理原则和人工给予营养问题。

讨论

人工给予营养一直是伦理关注和争议的重要源头。对于人工给予营养是否属于医疗治疗存在概念上的疑问。它可能是一种营养形式,而营养构成初级保健。这些原则应被用于指导医疗专业人员与患者及其代理人共同做出决策。

结论

对于预后不良且无益处的患者是否开具人工给予营养这一艰难决策,应基于与生物伦理委员会的讨论,鼓励使用预先指示,对患者、家庭和医疗团队进行教育与支持,此外还要制定关于该主题的有效方案。所有这些都将使这一过程中最重要的人——患者受益。

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