Misbin R I, O'Hare D, Lederberg M S, Holland J C
Department of Psychiatry, Memorial Sloan-Kettering Cancer Center, New York, NY.
N Y State J Med. 1993 Mar;93(3):165-8.
We reviewed the case records of 141 patients (134 with cancer and seven with acquired immunodeficiency syndrome) who died at Memorial Sloan-Kettering Cancer Center between July 11 and September 19, 1991. Do-not-resuscitate orders had been written on 115 (85.8%) of the patients with cancer and all of the patients with acquired immunodeficiency syndrome. The do-not-resuscitate orders appeared to be valid, in that evidence of informed consent was documented in all but two of the cases. Six additional patients who died had family consent not to resuscitate, although no do-not-resuscitate orders were written. Two other patients died unexpectedly. The remaining 11 patients all received aggressive attempts at resuscitation, which were felt to be medically appropriate in all but two cases. The interval between the do-not-resuscitate order and death was between zero and 60 days, with an average of 8.4 days and a median of 6 days; it exceeded 20 days in 14 cases. We attribute the high degree of compliance with the New York State do-not-resuscitate law observed in this study to an intensive program of consultation and education begun in 1987 by the Ethics Committee of Memorial Sloan-Kettering Cancer Center.
我们回顾了1991年7月11日至9月19日期间在纪念斯隆-凯特琳癌症中心死亡的141例患者（134例癌症患者和7例获得性免疫缺陷综合征患者）的病历。115例（85.8%）癌症患者和所有获得性免疫缺陷综合征患者均已下达了不予复苏医嘱。这些不予复苏医嘱似乎是有效的，因为除两例之外，所有病例均有知情同意的记录。另外6例死亡患者虽未下达不予复苏医嘱，但家属同意不进行复苏。另有2例患者意外死亡。其余11例患者均接受了积极的复苏尝试，除两例之外，其余病例的复苏尝试均被认为在医学上是适当的。不予复苏医嘱下达至死亡的间隔时间为0至60天，平均为8.4天，中位数为6天；14例患者的间隔时间超过了20天。我们将本研究中观察到的对纽约州不予复苏法的高度遵守归因于纪念斯隆-凯特琳癌症中心伦理委员会于1987年启动的一项强化咨询和教育计划。
