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Journal of perinatology : official journal of the California Perinatal Association v.37 no.2, 2017년, pp.208 - 213   SCIE
본 등재정보는 저널의 등재정보를 참고하여 보여주는 베타서비스로 정확한 논문의 등재여부는 등재기관에 확인하시기 바랍니다.

International variations in application of the best-interest standard across the age spectrum

Laventhal, N (Department of Pediatrics and Communicable Diseases, 8-621 Mott C&W Hospital, University of Michigan School of Medicine, Ann Arbor, MI, USA ) ; Verhagen, A A E (Department of Pediatrics, University Medical Center Groningen, University of Groningen, The Netherlands ) ; Hansen, T W R (Oslo University Hospital, Department of Neonatology, Division of Child and Adolescent, Clinical Ethics, Oslo, Norway ) ; Dempsey, E (University of Oslo, Institute of Clinical Medicine, Faculty of Medicine, Oslo, Norway ) ; Davis, P G (INFANT Centre, Cork University Maternity Hospital, University College, Cork, Ireland ) ; Musante, G A (The Royal Women's Hospital, Melbourne, VIC, Australia ) ; Wiles, A (The University of Melbourne, Parkville, Melbourne, VIC, Australia ) ; Meadow, W (Department of Maternal and Child Health Hospital Universitario Austral–Universidad Austral, Buenos Aires, Argentina ) ; Janvier, A (Rosalind Franklin University Chicago Medical School, Chicago, IL, USA ) ;
  • 초록  

    Objective:Ethically and legally, assertions that resuscitation is in a patient’s best interest should be inversely correlated with willingness to forego intensive care (and accept comfort care) at the surrogate’s request. Previous single country studies have demonstrated a relative devaluation of neonates when compared with other critically ill patients.Study Design:In this international study, physicians in Argentina, Australia, Canada, Ireland, The Netherlands, Norway and the United States were presented with eight hypothetical vignettes of incompetent critically ill patients of different ages. They were asked to make assessments about best interest, respect for surrogate autonomy and to rank the patients in a triage scenario.Results:In total, 2237 physicians responded (average response rate 61%). In all countries and scenarios, participants did not accept to withhold resuscitation if they estimated it was in the patient’s best interest, except for scenarios involving neonates. Young children (other than neonates) were given high priority for resuscitation, regardless of existing disability. For neonates, surrogate autonomy outweighed assessment of best interest. In all countries, a 2-month-old-infant with meningitis and a multiply disabled 7-year old were resuscitated first in the triage scenario, with more variable ranking of the two neonates, which were ranked below patients with considerably worse prognosis.Conclusions:The value placed on the life of newborns is less than that expected according to predicted clinical outcomes and current legal and ethical theory relative to best interests. Value assessments on the basis of age, disability and prognosis appear to transcend culture, politics and religion in this domain.


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