Controverses éthiques concernant l'abstention et l'arrêt des thérapeutiques en réanimation.
Traduction en anglais : Ethical debate on decisions to forgo treatment in medical intensive care units.
Responses of twelve intensive care specialists investigated by questionnary and five concrete clinical cases concerning foregoing or discontinuing intensive care for patients are analysed.
Modalities of medical decision based on ethical procedures are described.
Frequency of following situations are : refusing admission in intensive care unit, 22% of patients proposed, limitation of cares (refusing to treat infection for example) 3.8% of admitted patients, withholding cares (dialysis for example) 2.1%, withdrawing mechanical ventilation 2.3%, injection of lethal drugs 0.6%. Discontinuation of cares was decided in 8.8% of patients admitted in ICU.
The main alleged reasons for such decisions were (quoted each on 10) : quality of life before admission : 7.8, quality of life after admission : 7, life expectancy before admission : 7.4, life expectancy after admission : 8.2, and opinion of the medical staff : 8.9, while previous psychiatric disease, attempt of suicide and financial cost for only 2,0.9, and 1.7 respectively.
Preventives measures (Do Not Reanimated Orders, advance directives), legal consequences, gravity scores and roles of relatives in decision making are analysed.
Necessity of debate and guidelines provided by the intensive care specialists are an urgent need in France.
Mots-clés Pascal : Ethique, Prise décision, Arrêt traitement, Réanimation, Débat, Etude cas, Homme
Mots-clés Pascal anglais : Ethics, Decision making, Treatment withdrawal, Resuscitation, Debate, Case study, Human
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0213883
Code Inist : 002B30A09. Création : 16/11/1999.