icu

从伦理和实际情况考虑，对临终监护从治疗转为缓解

　　 Transitioning Care From Cure to Palliation at the End of Life: Ethical and Practical Considerations
Andrew Shaw, MB, FRCA
Introduction
　　End-of-life care means different things to different people. For the patient, who has the greatest stake (but often the least decision-making capacity) in obtaining high-quality care, it is about ensuring that the transition from life to death occurs peacefully and without discomfort or loss of dignity. For the family, it is a time of reflection and sadness in which members experience a sense of loss. It may also be a time of regret and guilt over previous missed opportunities. For intensive-care providers, end-of-life situations occur regularly and are considered part of the job. There is thus an intrinsic difference between the experience of the staff and the family -- an experience that may occur very few times in the life of the family member, but very often in the life of the staff member. Because of this difference, it is very important for end-of-life caregivers to be engaged enough to convey the real sense of care and loss that most staff members report after a patient's death, but not so engaged that the caregiver becomes unable to deal with the additional personal burden that may accompany the loss of the patient. The following report reviews the recommendations of the Ethics Committee of the Society of Critical Care Medicine (SCCM) for end-of-life care in the intensive care unit (ICU), which were published in the journal Critical Care Medicine in December 2001,[1] and presented at the 32nd Critical Care Congress in San Antonio, Texas in February, 2003, by Daniel Thompson, MD,[2] of Albany Medical College, Albany, New York, and April Howard, RN, CCRN, CCRC,[3] of Wake Forest University School of Medicine, Winston-Salem, North Carolina.
　

　Preparation of Those With a Stake in the Process
　　Ensuring the Patient's Comfort
　　Principles of Titration
　　Removal of Life-Sustaining Treatments
Conclusions
　　High-quality care at the end of life is just as important as accurate diagnosis and effective treatment. It is not difficult to do well, but it may not be intuitive either. Junior staff should be taught the principles of good end-of-life care by example; and this should not be delegated because of something else that seems more important. I have summarized the SCCM Ethics Committee guidelines for end-of-life care and added some personal perspective from experience in a cancer hospital. Readers are encouraged to review the guidelines in their entirety for more detailed information.[1]
References
1. Truog RD, Cist AF, Brackett SE, et al. Recommendations for end-of-life care in the intensive care unit: The Ethics Committee of the Society of Critical Care Medicine. Crit Care Med. 2001;29:2332-2348.
2. Thompson D. Ethics panel: What about end-of-life care? Transitioning from curing to palliation care. Program and abstracts of the 32nd Critical Care Congress; January 28-February 2, 2003; San Antonio, Texas.
3. Howard A. Ethics panel: What about end-of-life care? Transitioning from curing to palliation care. Program and abstracts of the 32nd Critical Care Congress; January 28-February 2, 2003; San Antonio, Texas.
4. Singer PA, Martin DK, Kelner M. Quality end-of-life care: patients' perspectives. JAMA. 1999;281:163-168.
5. Hickey M. What are the needs of families of critically ill patients? A review of the literature since 1976. Heart Lung. 1990;19:401-415.
6. Asch DA. The role of critical care nurses in euthanasia and assisted suicide. N Engl J Med. 1996;334:1374-1379.
7. Danis M, Federman D, Fins JJ, et al. Incorporating palliative care into critical care education: principles, challenges, and opportunities. Crit Care Med. 1999;27:2005-2013.
8. Brody H, Campbell ML, Faber-Langendoen K, Ogle KS. Withdrawing intensive life-sustaining treatment -- recommendations for compassionate clinical management. N Engl J Med. 1997;336:652-657.
9. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995;274:1591-1598.