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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Is treatment futile for an extremely premature infant with giant omphalocele?
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Is treatment futile for an extremely premature infant with giant omphalocele?

机译：对于患有巨大的食管膨出的极早产儿，治疗无效吗？

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摘要

Doctors have no ethical obligation to provide futile treatment. This has been true since the time of Hippocrates who warned physicians not to treat patients who were "overmastered by their disease." This principle remains valid today but, as the Society for Critical Care Medicine notes, it is difficult to identify treatment as absolutely futile in all but a few clinical situations. Far more common, they note, are "treatments that are extremely unlikely to be beneficial, are extremely costly, or are of uncertain benefit." These, they say, "may be considered inappropriate and hence inadvisable, but should not be labeled futile." So what should doctors do when they have a case that seems close to the futility threshold but does not, perhaps, quite cross it? In such cases, is it appropriate to make unilateral decisions to withhold life-sustaining treatment even if the family objects? Or should treatment be provided knowing that it might cause pain and suffering to an infant with no likelihood of benefit? To address these questions, we present a case of an extremely premature infant with a giant omphalocele and ask 3 neonatologists, Dr Dalia Feltman of Evanston Hospital, Dr Theophil Stokes of the Walter Reed Medical Center, and Dr Jennifer Kett, a neonatologist and fellow in bioethics at Seattle Children's Hospital, to comment.
机译：医生没有道德义务提供徒劳的治疗。自希波克拉底（Hippocrates）发出警告以来，这就是事实，即他警告医生不要治疗“因疾病过度掌握”的患者。该原则在今天仍然有效，但是，正如重症医学会所指出的那样，很难确定除少数几种临床情况外，治疗绝对无效。他们指出，更为普遍的是“极不可能带来益处，成本极高或不确定的治疗方法。”他们说，这些“可能被认为是不合适的，因此是不可取的，但不应被认为是徒劳的”。那么，如果医生的病例似乎接近无效阈值，但可能还没有完全超过无效阈值，该怎么办？在这种情况下，即使家人反对，也应单方面决定不给予维持生命的治疗？还是应该在不知道可能会给婴儿带来痛苦和痛苦的情况下提供治疗，而无可能受益？为了解决这些问题，我们介绍了一个极端的早产儿，患有巨大的食管膨出，并请了3位新生儿科医生，埃文斯顿医院的Dalia Feltman博士，沃尔特·里德医疗中心的Theophil Stokes博士和新生儿科医生兼研究员Jennifer Kett博士。西雅图儿童医院的生物伦理学发表评论。

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