撤除生命维持干预的伦理学辩护  

Ethical Arguments for Withdrawing Life-sustaining Medical Intervention

作　　者：张迪[1,2] 宁晓红 ZHANG Di;NING Xiaohong(School of Humanities and Social Sciences,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Center for Bioethics,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Gerontology,Peking Union Medical Collge Hospital,Chinese Academy of Medical Sciences&Peking Union Medical Collge,Bejjing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院人文和社会科学学院,北京100730 [2]中国医学科学院北京协和医学院生命伦理学研究中心,北京100730 [3]中国医学科学院北京协和医院老年医学科,北京100730

出　　处：《协和医学杂志》2023年第5期1116-1122,共7页Medical Journal of Peking Union Medical College Hospital

基　　金：中国医学科学院北京协和医学院教学改革项目(2019zlgc0119)。

摘　　要：撤除生命维持干预(life-sustaining medical intervention, LSMI)是临床实践中常见的伦理学问题。本文分别从尊重患者自主性、无效医疗和患者最佳利益三个方面,尝试对临床实践中撤除LSMI的伦理学可辩护性进行梳理和分析,并结合案例提出可操作性建议与对策。笔者认为符合下述任一条件时,撤除LSMI可获得伦理学辩护:(1)患者作出有效同意;(2)LSMI被判定为无效医疗;(3)撤除LSMI符合患者的最佳利益。最后,阐述临床实践中撤除LSMI所面临的挑战及可能的解决途径。Decision to withdraw life-sustaining medical intervention(LSMI)is a common ethical issue in clinical practice.This paper reviews and analyzes the ethical arguments for withdrawing LSMI from three aspects:respect for autonomy,medical futility and patients'best interests.The authors argue that withdrawal of LSMI can be ethically justified when any of the following conditions is met:when patient gives valid consent,LSMI is judged to be medically futile,or it is in the patients'best interests.This paper proposes practical suggestions for the withdrawal of LSMI in clinical practice,and presents several policy suggestions.Finally,the authors identify several challenges of withdrawing LSMI in practice and possible approaches to addressing them.

关 键 词：撤除 生命维持干预 医学伦理 法律 

分 类 号：R-052[医药卫生] R48