Luce J M
Division of Pulmonary and Critical Care Medicine, School of Medicine, University of California, San Francisco, USA.
New Horiz. 1997 Feb;5(1):30-7.
The withholding and withdrawal of life support are processes by which various medical interventions either are not given to or are taken away from patients, with the expectation that they will die as a result. The propriety of withholding and withdrawal of life support has been supported by ethical statements from groups such as the Task Force on Ethics of the Society of Critical Care Medicine, and by a series of legal decisions beginning with the Quinlan case. Surveys of healthcare professionals indicate that most ICU physicians withhold and withdraw life support on a regular basis, that they consider these processes ethically equivalent, that they recommend withholding and withdrawal of life support based upon prognosis (which may be expressed as futility), and that they consider patient and surrogate wishes to be most important in deciding to forego life-sustaining treatment, but place these wishes in the context of their own assessment of prognosis. Observational studies show that: withholding and withdrawal of life support occur frequently, the frequency has increased over the past several years in some ICUs, patients and families generally agree with physician recommendations to limit care or request such limitation, disagreements sometimes occur on this issue, withdrawal of life support occurs more commonly than withholding of life support in most ICUs, cardiopulmonary resuscitation is the therapy most frequently withheld, mechanical ventilation is the therapy most frequently withdrawn, this withdrawal process usually is gradual, and it usually is facilitated by the administration of sedatives and analgesics. Clinical information such as this is helping to define a standard of care in the area of withholding and withdrawal of life support.
停止和撤除生命支持是指对患者不给予或撤除各种医疗干预措施，预期患者会因此死亡的过程。停止和撤除生命支持的合理性得到了诸如危重病医学会伦理特别工作组等组织的伦理声明以及一系列始于昆兰案的法律判决的支持。对医疗保健专业人员的调查表明，大多数重症监护病房医生会定期停止和撤除生命支持，他们认为这些过程在伦理上是等效的，他们基于预后（可表述为无意义）建议停止和撤除生命支持，并且他们认为患者及其代理人的意愿在决定放弃维持生命治疗时最为重要，但会将这些意愿置于他们自己对预后的评估背景下。观察性研究表明：停止和撤除生命支持的情况经常发生，在一些重症监护病房中，其频率在过去几年有所增加，患者和家属通常同意医生限制治疗或要求这种限制的建议，在这个问题上有时会出现分歧，在大多数重症监护病房中，撤除生命支持比停止生命支持更常见，心肺复苏是最常被停止的治疗方法，机械通气是最常被撤除的治疗方法，这种撤除过程通常是渐进的，并且通常通过给予镇静剂和镇痛药来促进。此类临床信息有助于界定停止和撤除生命支持领域的护理标准。
