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[重症监护医学中的伦理边界决策]

[Ethical boundary decisions in intensive care medicine].

作者信息

Scherr Benedikt Florian, Buehler Philipp Karl

机构信息

Zentrum für Intensivmedizin, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Schweiz.

University of Zurich, Zürich, Schweiz.

出版信息

Inn Med (Heidelb). 2024 Oct;65(10):967-975. doi: 10.1007/s00108-024-01781-5. Epub 2024 Sep 23.

Abstract

BACKGROUND

Ethical decision-making is a cornerstone of intensive care and emergency medicine. In acute scenarios, clinicians often face rapid, high-stakes decisions concerning life and death, made more challenging by time constraints and incomplete information. These decisions are further complicated by economic constraints, limited resources, and evolving technological capabilities.

QUESTION

What decision-making aids and factors can be employed in ethical borderline cases within intensive care medicine?

RESULTS

Fundamental ethical principles such as patient autonomy, beneficence, non-maleficence, and justice form the basis for medical treatment decisions. Evaluating the patient's will through advanced directives or proxy consensus is crucial, although advanced directives can be ambiguous. Assessing quality of life is increasingly important, with instruments such as the Clinical Frailty Scale (CFS) being utilized. For older patients, a holistic approach is recommended, focusing on overall health rather than chronological age. In patients with advanced underlying diseases, a multidisciplinary dialogue is essential.

DISCUSSION

Decision-making in intensive care medicine requires careful consideration of medical, ethical, and individual factors. Despite advances in artificial intelligence and prognostic models, human judgment remains crucial. During periods of resource scarcity, ethically sound triage protocols are required. The challenge lies in applying these principles and factors in clinical practice while respecting the individuality of each patient.

摘要

背景

伦理决策是重症监护和急诊医学的基石。在急性情况下,临床医生经常面临有关生死的快速、高风险决策,时间限制和信息不完整使这些决策更具挑战性。经济限制、资源有限和技术能力不断发展进一步加剧了这些决策的复杂性。

问题

在重症监护医学的伦理边缘案例中可以采用哪些决策辅助工具和因素?

结果

诸如患者自主权、行善、不伤害和公正等基本伦理原则构成了医疗决策的基础。通过预先指示或代理人共识评估患者的意愿至关重要,尽管预先指示可能含糊不清。评估生活质量变得越来越重要,诸如临床衰弱量表(CFS)等工具正在得到应用。对于老年患者,建议采用整体方法,关注整体健康而非实际年龄。对于患有晚期基础疾病的患者,多学科对话至关重要。

讨论

重症监护医学中的决策需要仔细考虑医学、伦理和个体因素。尽管人工智能和预后模型取得了进展,但人类判断仍然至关重要。在资源稀缺时期,需要符合伦理的分诊方案。挑战在于在临床实践中应用这些原则和因素的同时尊重每个患者的个性。

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[Ethical boundary decisions in intensive care medicine].[重症监护医学中的伦理边界决策]
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