tailieunhanh - Báo cáo khoa học: "Withdrawing may be preferable to withholding"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Withdrawing may be preferable to withholding. | Critical Care June 2005 Vol 9 No 3 Vincent Commentary Withdrawing may be preferable to withholding Jean-Louis Vincent Head Department of Intensive Care Erasme Hospital Free University of Brussels Belgium Corresponding author Jean-Louis Vincent jlvincen@ Published online 4 March 2005 This article is online at http content 9 3 226 2005 BioMed Central Ltd Critical Care 2005 9 226-229 DOI cc3486 See related commentary by Levin and Sprung page 230 http content 9 3 230 Abstract The majority of deaths on the intensive care unit now occur following a decision to limit life-sustaining therapy and end-of-life decision making is an accepted and important part of modern intensive care medical practice. Such decisions can essentially take one of two forms withdrawing - the removal of a therapy that has been started in an attempt to sustain life but is not or is no longer effective - and withholding - the decision not to make further therapeutic interventions. Despite wide agreement by Western ethicists that there is no ethical difference between these two approaches these issues continue to generate considerable debate. In this article I will provide arguments why although the two actions are indeed ethically equivalent withdrawing lifesustaining therapy may in fact be preferable to withholding. Introduction End-of-life decision making for the intensive care unit ICU patient has been a hot topic in recent years with the acknowledgement that such practice is common worldwide 1 and with a new openness among doctors and laypersons regarding the once rather taboo subject of death. Indeed because the majority of ICU deaths now occur following a decision to limit life-sustaining therapy 2-6 it is important that these often difficult ethical areas be discussed openly. Essentially a decision to limit life-sustaining therapy can take one of two forms withholding or withdrawing. Withdrawal of therapy is relatively easily defined as the removal of