常规和危机护理标准下体外膜氧合的伦理学。

Q3 Medicine
Journal of Clinical Ethics Pub Date : 2022-01-01
Gina M Piscitello, Mark Siegler, William F Parker
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引用次数: 0

摘要

体外膜氧合(ECMO)是一种心脏和/或肺衰竭的生命支持形式,与其他形式的生命支持相比,具有独特的伦理挑战。当采用传统的护理标准时,ECMO的伦理挑战就会存在,当建立“危机护理标准”时,在ECMO绝对稀缺的时期,伦理挑战就会加剧。当传统的护理标准适用时,我们建议,出于技术上无效的原因,或者当患者有终末期、短期预后无法通过ECMO治疗时,在伦理上允许不将患者置于ECMO。在危机护理标准下,从伦理上允许扩大排除标准,对恢复可能性较低的患者也保留ECMO,以最大限度地挽救生命的总数。在传统护理标准下,违背患者意愿单方面退出ECMO是不道德的,但在危机护理标准下,增加社会中其他人获得ECMO的机会是合乎道德的。ECMO只有在真正稀缺的情况下才应该进行配给,分配协议应该对公众透明。当配给必须在危机护理标准下进行时,监督机构必须评估ECMO分配中的不公平现象,并经常作出改变以改善任何不公平现象。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Ethics of Extracorporeal Membrane Oxygenation under Conventional and Crisis Standards of Care.

Extracorporeal membrane oxygenation (ECMO) is a form of life support for cardiac and/or pulmonary failure with unique ethical challenges compared to other forms of life support. Ethical challenges with ECMO exist when conventional standards of care apply, and are exacerbated during periods of absolute ECMO scarcity when "crisis standards of care" are instituted. When conventional standards of care apply, we propose that it is ethically permissible to withhold placing patients on ECMO for reasons of technical futility or when patients have terminal, short-term prognoses that are untreatable by ECMO. Under crisis standards of care, it is ethically permissible to broaden exclusionary criteria to also withhold ECMO from patients who have a low likelihood of recovery, to maximize the overall number of lives saved. Unilateral withdrawal of ECMO against a patient's preferences is unethical under conventional standards of care, but is ethical under crisis standards of care to increase access to ECMO to others in society. ECMO should only be rationed when true scarcity exists, and allocation protocols should be transparent to the public. When rationing must occur under crisis standards of care, it is imperative that oversight bodies assess for inequities in the allocation of ECMO and make frequent changes to improve any inequities.

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来源期刊
Journal of Clinical Ethics
Journal of Clinical Ethics Medicine-Medicine (all)
CiteScore
1.40
自引率
0.00%
发文量
31
期刊介绍: The Journal of Clinical Ethics is written for and by physicians, nurses, attorneys, clergy, ethicists, and others whose decisions directly affect patients. More than 70 percent of the articles are authored or co-authored by physicians. JCE is a double-blinded, peer-reviewed journal indexed in PubMed, Current Contents/Social & Behavioral Sciences, the Cumulative Index to Nursing & Allied Health Literature, and other indexes.
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