Beca J P, Wells W, Rubio W
Facultad de Medicina, Universidad de Chile.
Rev Med Chil. 1998 Apr;126(4):450-5.
The case of a pregnant patient who had a massive intracraneal haemorrhage at 18 weeks of gestation is presented. Patient's neurological damage evolved to brain death, but the fetus continued in good condition. The decision of withdrawing life support or to continue supporting the mother's life to allow fetal development aroused difficult ethical questions, both to relatives and professionals. This is an exceptional situation of a heart beating cadaver and a non viable fetus whose life depends on the continuation of treatments that are considered as experimental. A good decision should be based on the respect to a body in brain death, the fetal right to life, family's wishes and values, the use of experimental treatments, and the rational use of a public hospital's resources. The conclusion was that the continuation of life support treatments was not an ethical obligation. Withdrawing life support to allow fetal death in this case means foregoing an experimental treatment and to respect family's autonomy and the right of the patient's death with dignity. Similar cases need to be discussed with a multidisciplinary analysis in their own particularity.
本文介绍了一例妊娠18周时发生大量颅内出血的孕妇病例。患者的神经损伤发展为脑死亡,但胎儿状况良好。撤掉生命支持或继续维持母亲生命以促进胎儿发育的决定,给亲属和专业人员都带来了棘手的伦理问题。这是一种特殊情况,即心脏仍在跳动的尸体和一个无法存活的胎儿,其生命依赖于被视为实验性的治疗的持续进行。一个好的决定应该基于对脑死亡身体的尊重、胎儿的生命权、家庭的意愿和价值观、实验性治疗的使用以及公立医院资源的合理利用。结论是,继续进行生命支持治疗并非伦理义务。在这种情况下撤掉生命支持以使胎儿死亡意味着放弃一种实验性治疗,并尊重家庭的自主权以及患者尊严死亡的权利。类似案例需要根据其自身特点进行多学科分析讨论。