Murphy D J, Barbour E
Senior Citizen's Health Center, Presbyterian/St. Luke's Medical Center, Denver, CO 80218.
New Horiz. 1994 Aug;2(3):326-31.
Several issues force us to critically evaluate futile or inappropriate intensive care. These issues include cost control, quality of care, and professional and family integrity. The debate has progressed along three avenues: ethical discourse, prognostic scoring systems, and debate in the courts. Despite these arenas of discussion, a consensus about futile or inappropriate care has not been reached. The healthcare profession and the public need to work together to forge a consensus. We describe one model that facilitates this political process. Guidelines for the Use of Intensive Care in Denver (GUIDe) is a consortium of metropolitan Denver hospitals and other healthcare institutions whose goal is to develop guidelines for the use of futile or inappropriate intensive care. The building of consensus starts with subcommittees (adult intensive care, neonatal intensive care, and long-term care) that present proposals at plenary sessions. Other subcommittees (public liaison and legal subcommittees) facilitate dialogue with the public. Feedback from the plenary sessions, the greater medical community, and the public lead to proposal revisions. We expect to present hospitals with actual guidelines in approximately 3 yrs.
有几个问题促使我们认真评估无效或不适当的重症监护。这些问题包括成本控制、医疗质量以及专业人员和家庭的完整性。这场辩论沿着三条途径展开：伦理讨论、预后评分系统以及法庭辩论。尽管有这些讨论的领域，但对于无效或不适当的治疗仍未达成共识。医疗行业和公众需要共同努力以达成共识。我们描述了一个有助于这一政治进程的模式。《丹佛重症监护使用指南》（GUIDe）是丹佛大都市地区医院和其他医疗机构的一个联盟，其目标是制定关于无效或不适当重症监护使用的指南。共识的形成始于小组委员会（成人重症监护、新生儿重症监护和长期护理小组委员会），这些小组委员会在全体会议上提出建议。其他小组委员会（公共联络和法律小组委员会）促进与公众的对话。全体会议、更广泛的医学界和公众的反馈导致建议的修订。我们预计大约在3年内向医院提供实际的指南。
