Riad H, Nicholls A, Neuberger J, Willatts S M, Sells R A, Jones M A, Francis R
Royal Devon and Exeter Hospital.
BMJ. 1995 Mar 18;310(6981):714-5. doi: 10.1136/bmj.310.6981.714.
Elective ventilation describes the procedure of transferring selected patients dying from rapidly progressive intracranial haemorrhage from general medical wards to intensive care units for a brief period of ventilation before confirmation of brain stem death and harvesting of organs. This approach in Exeter has led to a rate of kidney retrieval and transplant higher than has been achieved elsewhere in the United Kingdom, with a stabilisation of numbers on patients on dialysis. Recently doubt has been cast on the legality of our practice of elective ventilation on the grounds that relatives are not permitted to consent to treatment of an incompetent person when that treatment is not in the patient's best interests. We are thus faced with the dilemma of a protocol that is ethical, practical, and operates for the greater good but which may be illegal. This article explores various objections to the protocol and calls for public, medical, and legal debate on the issues.
选择性通气描述了将选定的因快速进展性颅内出血而濒临死亡的患者从普通内科病房转移至重症监护病房，在确认脑干死亡和器官摘取之前进行短时间通气的过程。埃克塞特的这种做法使得肾脏获取和移植的比率高于英国其他地区，同时透析患者的数量也趋于稳定。最近，有人对我们选择性通气做法的合法性提出质疑，理由是当治疗不符合患者的最大利益时，亲属不被允许同意对无行为能力者进行治疗。因此，我们面临着这样一个困境：一项方案在伦理上、实践上都是合理的，并且是为了更大的利益而实施，但可能是非法的。本文探讨了对该方案的各种反对意见，并呼吁就这些问题展开公众、医学和法律层面的辩论。
