国家职业资格考试培训小型钻井工程精要.pptVIP

Medical Futility: clarity or confusion? Jay M. Baruch, MD Chairman, Ethics Committee Memorial Hospital of Rhode Island Faculty, Center for Biomedical Ethics Brown Medical School Objectives Examine the various definitions of medical futility Consider what’s at the heart of disagreements involving futility judgments Address moral positions of stakeholders, and common pitfalls in “futility” discussions Explore strategies HECs can use to facilitate medically and ethically sound solutions Case 1 86-year-old woman in PVS requiring ventilator support, repeated courses of antibiotics, frequent airway suctioning, tube feedings, air flotation bed and biochemical monitoring Medical team suggested to family that treatment be withdrawn because not benefiting the patient. Husband, son, and daughter insist txm’t continue. Patient’s treatment preferences unknown. Helga Wanglie case Husband said physicians should not play G-d Helga would not be better off dead Removing life-support evidence of moral decay in our civilization Miracle could occur Hospital went to court to get permission to withdraw treatment Husband’s role as surrogate and his judgment took precedent over team’s view of “nonbeneficial” txm’t. Angell M.The case of Helga Wanglie. NEJM 1991;325: 511-512. Miles SH. Informed demand for “nonbeneficial treatment. NEJM 1991;325:512-515. Case 2 72-year-old with past medical history of DM, anemia, renal insufficiency, CVA, CAD, PVD, Parkinsons, heal ulcers, three hip replacements fell and broke her hip in May 1989. Prior to surgery, experienced multiple grand mal seizures. Afterwards, was posturing, rigid, unresponsive to noise or pain. Per neurology, chance functional recovery dismal. Family refused DNR Tracheostomy and gastrostomy tube placed More seizures, arrhythmias, GI bleeding, DIC, muscle wasting. Chance neurological recovery nil. Gilgunn v. MGH ICU attending--after multiple meetings with family, ethics consults, and involvement with hospital attorney--weaned pat