ECMO技术的临床伦理问题探析

On Clinical Ethics of ECMO

体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)技术可以短期替代患者的心肺功能,它被视为一种重塑生死的医疗技术。然而,ECMO技术在积极影响临床实践的同时,也带来系列临床伦理问题,包括启用ECMO技术前的适应性和非适应性评估、ECMO设备的撤除以及患者意愿。医师应运用实践智慧针对特定个案做出符合伦理要求的临床判断,医患共享决策可以弥补低确定性的医疗情境中知情同意的不足之处,使得患者有机会去充分认知、思考自己的实际境况,进而自主地参与医疗决策。实践智慧是处理ECMO临床伦理难题的有效路径。

Extracorporeal membrane oxygenation(ECMO)is seen as a medical technology that can reshape life and death,because it can temporarily replace heart and lung function in patients.However,while ECMO has a positive impact on clinical practice,it has also brought a series of clinical ethical issues,including adaptive and non-adaptive assessment before the use of ECMO,removal of ECMO,and patient willingness.Physicians should use practical wisdom to make clinical judgments for specific cases under ethical requirements.Doctor-patient shared decision making can compensate for the deficiency of informed consent in low certainty medical situation,then patients are given chances to fully absorb and consider their conditions,and actively participate in medical decision making.Practical wisdom is an effective way to deal with the clinical ethical problems of ECMO.