Purtilo R B
Creighton University, Center for Health Policy and Ethics, Omaha, Nebraska 68178, USA.
Ann Acad Med Singap. 1995 Mar;24(2):263-7.
The doctor's dilemma regarding life support arises from opportunities in modern medicine to prolong life beyond the wildest dreams of medical doctors in previous eras. The traditional ethical framework based on duties to respect life, do what is best for the patient, be faithful to patients' reasonable expectations and avoid doing harm provides an adequate general guide for practitioners regarding what they are ethically required to do and must refrain from doing. However, a third category, ethical permissibility, allows for conduct that may not be ideal but is the most ethical in life-support dilemmas. Discussions of withholding and withdrawing life support, ordinary and extraordinary measures, proportionality and medical futility are enriching today's ethical debate about ethically permissible conduct in such situations.
医生在生命维持方面面临的困境源于现代医学有能力将生命延长至超越前几代医生最疯狂梦想的程度。基于尊重生命的责任、为患者做最有利之事、忠实于患者合理期望以及避免伤害的传统伦理框架,为从业者提供了关于道德上要求做什么以及必须避免做什么的充分总体指导。然而,第三类,即道德可允许性,允许采取可能并非理想但在生命维持困境中是最符合伦理的行为。关于停止和撤销生命维持、普通和特殊措施、相称性和医疗无效性的讨论,丰富了当今关于此类情况下道德上可允许行为的伦理辩论。