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首页> 外文期刊>The American journal of hospice and palliative care >Who decides? An ethics case consult for Terri Schiavo.
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Who decides? An ethics case consult for Terri Schiavo.

机译：谁决定？向Terri Schiavo咨询道德案例。

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What lessons might we take away as palliative care clinicians or ethics consultants? I might summarize as follows: As has been widely discussed elsewhere, the importance of advance directives, designation of proxy decision makers, and nuanced discussions with those potential proxies is of utmost importance--even for young adults. Be as clear as possible about diagnosis and prognosis. Rely on those with the greatest expertise and the least potential conflict of interest. Be honest about the limits of medical certainty and the diagnostic and prognostic possibilities. Separate reality from what loved ones or special interest advocates might wish were the reality. Efforts to resolve disputes among families or between families and care providers ought to remain private, and focus on the patient at hand rather than broader social or political agendas. Ethics committees or independent mediators work toward "win-win" outcomes and may help avoid the polarized, "winner-take-all" approach of litigation. Medical facts are not value-free and do not add up to a universally agreed-upon conclusion in the manner of a mathematical equation, but are viewed and interpreted through the lens of each participant's perspective. In the space of this essay, I can offer only a brief nod to the field of narrative ethics, but the interested reader will find a rich body of literature regarding this concept on which to base his or her own ethical conclusions regarding this case.
机译：作为姑息治疗临床医生或伦理顾问，我们可以汲取哪些教训？我可以总结如下：正如在其他地方已广泛讨论的那样，预先指示，指定代理决策者以及与这些潜在代理进行细微讨论的重要性至关重要，即使对于年轻人也是如此。尽可能明确诊断和预后。依靠那些拥有最专业知识和最少潜在利益冲突的人。对医学确定性的局限性以及诊断和预后的可能性保持诚实。与亲人或特别利益拥护者可能希望的现实分开的是现实。解决家庭之间或家庭与护理提供者之间的纠纷的努力应保持私密性，并着眼于患者，而不是更广泛的社会或政治议程。道德委员会或独立调解员致力于实现“双赢”结果，并可能有助于避免采取两极化的“赢家通吃”的诉讼方式。医学事实不是没有价值的，并且不会以数学方程式的形式加在一起得到普遍认可的结论，而是通过每个参与者的视角来观察和解释的。在本文的范围内，我只能对叙事伦理学领域做个简短的致谢，但是有兴趣的读者会发现有关该概念的丰富文献，可以根据他或她对本案的伦理结论。

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