tailieunhanh - Báo cáo khoa học: "Ethics review: ‘Living wills’ and intensive care – an overview of the American experience"

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: Ethics review: ‘Living wills’ and intensive care – an overview of the American experience. | Available online http content 11 4 219 Review Ethics review Living wills and intensive care - an overview of the American experience Andrew RJ Tillyard Specialist Registrar Intensive Care Department Royal Cornwall Hospital Truro TR1 5LJ UK Corresponding author Andrew RJ Tillyard arjtillyard@ Published 11 July 2007 Critical Care 2007 11 219 doi cc5945 This article is online at http content 11 4 219 2007 BioMed Central Ltd Abstract Withdrawal and limitation of life support in the intensive care unit is common although how this decision is reached can be varied and arbitrary. Inevitably the patient is unable to participate in this discussion because their capacity is limited by the nature of the illness and the effects of its treatment. Physicians often discuss these decisions with relatives in an attempt to respect the patient s wishes despite evidence suggesting that the relatives may not correctly reflect the patient s desires. Advance decisions commonly known as living wills have been proposed as a way of facilitating the maintenance of an individual s autonomy when they become incapacitated. Others have argued that legalising advance decisions is euthanasia by the back door. In October 2007 in England and Wales advance decisions will become legally binding as part of the 2005 Mental Capacity Act. This has been the case in the USA for many years. The purpose of the present review is to examine the published literature regarding the effect of advance decisions in relation to the provision of adult critical care. Introduction Autonomy competence and capacity are limited by the nature of the critical illness or by the effects of treatment. Withdrawing life-support in the intensive care unit ICU is common and is often made without the direct involvement of the patient whose preferences regarding end-of-life treatment are usually unknown 1 2 . Physicians therefore frequently consult relatives regarding the appropriateness of .