Hunka S A
Intensive Crit Care Nurs. 1993 Jun;9(2):82-7. doi: 10.1016/0964-3397(93)90048-3.
Every day throughout the UK medical professionals working within Intensive Therapy Units (ITUs) are faced with the ethical dilemma of whether it is right to withhold extraordinary treatments from patients. Within this case study an ethical dilemma arises from the question: 'Is it morally sound to treat this patient who, we knew, would have refused our care had he been able to give a written legally binding request not to receive extraordinary medical therapy?' This paper concentrates on the ethical decision-making process and seeking to find a solution to an everyday dilemma within moral philosophy. Personal and professional values and the prima facie principle of non-maleficence within which the doctrine of ordinary and extraordinary means, the doctrine of double effect and the slippery slope argument are discussed in their context relevant to an ITU situation. The nurse's role as patient advocate is addressed as the case study highlights the difficulties encountered in fulfilling this responsibility. It is hoped that the issues raised will help in clarifying how a real ethical dilemma for all the ITU team can be addressed and so help others faced with similar dilemmas. The decision-makers within this dilemma were the patient, family, and the ITU multidisciplinary team. The term extraordinary treatment is understood within biomedical ethics to encompass all medicines, therapies, and operations, which cannot be obtained or used without excessive expense, pain or other physical inconvenience, or which, if used, would not offer a reasonable hope of benefit.
在英国，重症监护病房（ITU）的医学专业人员每天都面临着一个伦理困境，即不给患者进行特殊治疗是否正确。在本案例研究中，一个伦理困境源于这样一个问题：“对于这个我们知道如果他能够给出一份具有法律约束力的书面请求拒绝接受特殊医疗治疗就会拒绝我们治疗的患者，进行治疗在道德上是否合理？” 本文着重于伦理决策过程，并试图在道德哲学中找到解决日常困境的方法。文中讨论了个人和职业价值观以及不伤害的首要原则，在这一背景下探讨了普通与特殊手段原则、双重效果原则和滑坡论证，这些都与重症监护病房的情况相关。案例研究突出了护士作为患者代言人履行这一职责时遇到的困难，因此文中阐述了护士的这一角色。希望提出的这些问题将有助于阐明重症监护病房团队如何应对真正的伦理困境，从而帮助其他面临类似困境的人。在这个困境中，决策者包括患者、家属和重症监护病房的多学科团队。在生物医学伦理学中，特殊治疗这一术语被理解为涵盖所有那些如果没有过度的费用、痛苦或其他身体不便就无法获得或使用的药物、治疗方法和手术，或者那些即使使用也不会带来合理受益希望的情况。
