试论连体婴儿分离手术伦理审查标准

Ethical Review Standards of Separation Surgery for Conjoined Twins

结合连体婴儿分离术伦理审查实例,将分离手术从伦理角度分为拯救生命和改善生命质量两种,前者要及时进行分离,后者则要在安全性的前提下择期进行分离。安全性评估的重要参考因素包括连体婴儿的类型、分离难度、不良后果与生命质量改善之间的利弊权衡以及既往病例报道。牺牲性分离要符合"救治无效、寄生型连体和危及生命"的伦理原则。分离手术审查还应涉及技术保障到位、知情同意、授权医生选择和处置、隐私保护等内容,以期适应分离手术的特殊性和复杂性,保障其合法性。

The ethical review on a clinical case of separation surgery for conjoined twins was analyzed, through which the separation surgery was divided into two categories from ethical perspective. Comparing to save life surgery needed to be performed in time, the other kind of selective operation on the condition of patients＇ safety is aiming to improve the quality of life. The main indicators of safety assessment include the type of conjoined twins, the difficulty of the separation surgery, evaluation of trade-offs.between adverse effects and the improvement of life quality, as well as the previous case reports. Save life separation surgery should be performed in accordance with the principles of ＂invalid treatment, parasitic twins and threat to life＂. Moreover, the review should also take technical support, informed consent, power of attorney and confidentiality into consideration, so that the legal requirements can be reached according to different kinds of separation surgery with specialty and complexity.