Abstract:
Comatose survivors of cardiac arrest may die following withdrawal of life-sustaining therapy (WLST) due to poor neurologic prognosis. Family members, acting as surrogate decision makers, are frequently asked to decide whether the patient should continue to receive ongoing life-sustaining therapy such as mechanical ventilation in this context of risk of death following removal. Sometimes, physicians and family members disagree about what is in the patient\'s best interest, and this conflict causes distress for both families and medical personnel.This article examines themes recorded in the medical records of 24 cardiac arrest patients at Columbia University Medical Center (CUMC) whose families chose to pursue continued life support despite physician recommendations for withdrawal. In documented conversations between patients\' families and their providers, the most prominent themes included faith in miracles, the inappropriateness of \"playing God,\" the value of more time with the patient, and differences in how providers and family members perceived the patient\'s status.
摘要:
由于不良的神经系统预后,心脏骤停的昏迷幸存者可能在停止维持生命的治疗(WLST)后死亡。家庭成员,作为代理决策者,经常被要求决定患者是否应继续接受持续的生命维持治疗,例如在移除后死亡风险的背景下进行机械通气。有时候,医生和家庭成员不同意什么是病人的最大利益,这场冲突给家庭和医务人员带来了痛苦。本文研究了哥伦比亚大学医学中心(CUMC)24名心脏骤停患者的医疗记录中记录的主题,尽管医生建议退出,但他们的家人还是选择了继续维持生命。在病人家属和他们的提供者之间记录在案的对话中,最突出的主题包括对奇迹的信仰,扮演上帝的不恰当,“与病人有更多时间的价值,以及提供者和家庭成员如何感知患者状态的差异。