Department of Biomedical Ethics, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan.
AJOB Empir Bioeth. 2024 Oct-Dec;15(4):301-311. doi: 10.1080/23294515.2024.2336907. Epub 2024 Apr 8.
According to some medical ethicists and professional guidelines, there is no ethical difference between withholding and withdrawing life-sustaining treatment. However, medical professionals do not always agree with this notion. Patients and their families may also not regard these decisions as equivalent. Perspectives on life-sustaining treatment potentially differ between cultures and countries. This study compares Japanese physicians' and citizens' attitudes toward hypothetical cases of withholding and withdrawing life-sustaining treatment.
Ten vignette cases were developed. A web-based questionnaire was administered to 457 citizens and 284 physicians to determine whether they supported withholding or withdrawing treatment.
In a case where a patient had an advance directive refusing ventilation, 77% of the physicians and 68% of the citizens chose to withhold treatment. In a case where there was an advance directive but the patient's family requested treatment, 55% of the physicians and 45% of the citizens chose to withhold the ventilator. When a family requested withdrawal of the ventilator but patient wishes were unknown, 19% of the physicians and 48% of the citizens chose to withdraw the ventilator. However, when the patient had also indicated their wishes in writing, 49% of the physicians and 66% of the citizens chose to withdraw treatment. More physicians were prepared to withdraw dialysis (84%) and artificial nutrition (81%) at a patient's request than mechanical ventilation (49%).
A significant proportion of Japanese physicians and citizens were reluctant to withhold or withdraw life-sustaining treatment, even in cases where the patient had indicated their wishes in writing. They were more likely to withhold than withdraw treatment, and more likely to withdraw artificial nutrition than mechanical ventilation. Japanese physicians gave significant weight to family views about treatment but were less likely to agree to withdraw treatment than citizens, indicating a potential source of conflict in clinical settings.
根据一些医学伦理学家和专业准则， withholding 和 withdrawing 生命维持治疗并无伦理差异。然而，医疗专业人员并不总是认同这一观点。患者及其家属可能也不认为这些决策是等同的。对生命维持治疗的看法可能因文化和国家而异。本研究比较了日本医生和公民对 withholding 和 withdrawing 生命维持治疗的假设病例的态度。
设计了 10 个病例描述。通过网络向 457 名公民和 284 名医生发放问卷，以确定他们是否支持 withholding 或 withdrawing 治疗。
在患者有拒绝通气的预先指示的情况下，77%的医生和 68%的公民选择 withholding 治疗。在有预先指示但患者家属要求治疗的情况下，55%的医生和 45%的公民选择 withholding 呼吸机。当家属要求 withdrawal 呼吸机但患者意愿未知时，19%的医生和 48%的公民选择 withdrawal 呼吸机。然而，当患者也书面表明其意愿时，49%的医生和 66%的公民选择 withdrawal 治疗。更多的医生愿意应患者要求 withdrawal 透析（84%）和人工营养（81%），而不是机械通气（49%）。
相当一部分日本医生和公民不愿意 withholding 或 withdrawing 生命维持治疗，即使在患者书面表明其意愿的情况下也是如此。他们更倾向于 withholding 而不是 withdrawal 治疗，更倾向于 withdrawal 人工营养而不是机械通气。日本医生非常重视家属对治疗的看法，但与公民相比，他们不太愿意同意 withdrawal 治疗，这表明在临床环境中可能存在潜在的冲突源。
