Avtor/Urednik		Kornhauser, P
Naslov		Pogled 30 let nazaj: razvoj etične misli na področju intenzivne terapije otroka pri nas
Prevedeni naslov		Looking 30 years back: the evolution of ethical thought in the field of paediatric intensive care in Slovenia
Tip		članek
Vir		Slov Pediatr
Vol. in št.		Letnik 5, št. Suppl 2
Leto izdaje		1998
Obseg		str. 27-32
Jezik		slo
Abstrakt		In the autobiographical introduction, the author recalls his teachers, the paediatricians Ernest Mayerhofer and Marij Avčin, and outlines the impact of various social factors on the development of child health in Slovenia. There follows a short history of the Department of Paediatric Surgery, University Medical Centre Ljubljana/UMC/, and a description of its special features, which are today known in the world as the "Ljubljana model". For the past thirty years, since the first infant in respiratory distress was connected to a ventilator at the Department of Paediatric Surgery, and especially since 1974, when the first modern paediatric intensive care unit/ICU/ was opened at the UMC, paediatric intensivists have been faced with ethical dilemmas in traying to act in the best interest of patient and his family. The author presents two cases from his own experience: a newborn infant with a myelomeningocoele and a pre-school child from a community of Jehova's Witnesses who bled before arrival at the hospital. Professor Janez Milčinski, Slovenia's leading medical deontologist, made important contributions to the development of a specific ethical code for the paediatric ICU. In 1981, the participation of Dr. D. Todres from Harvard School of Medicine in a round-table discussion on ethics in intensive care at the 1st International Congress of Paediatric Intensive Care in Ljubljana and his subsequent lectures at the Department, confirmed tthat our practice in the field of medical ethics was both modern and humane. The Department developed it sown Ethise Committee, composed of a paediatric intensivist, a neurosurgeon and a neurophysiologist, which has made ad hoc decisions on withdrawal of life-sustaining treatment on ethical grounds. The parents were as a rule no consulted in such situations.(Abstract truncated at 2000 characters)
Izvleček		Po avtobiografskem uvodu, kjer se avtor spominja svojih učiteljev pediatrije Ernesta Mayerhoferja in Marija Avčina ter pomena socialnopediatričnih vidikov za razvojotroškega zdravstva na Slovenskem, je podana kratka zgodovina otroškega oddelka kirurije v Ljubljani z oblikovanjem enote za intenzivno terapijo otrok (EIT) v ljubljanskem Kliničnem centru (KC) ter njunih značilnostih, ki so danes tudi mednarodno znane kot "ljubljanski model". Pred tridesetimi leti, ko so na kliniki priključili prvega novorojenčka v dihalnis tiski na umetna pljuča, in zlasti po odprtju prvega, sodobno opremeljenega centra za intenzivno terapijo otrok v KC 1974, so se pediatri-intenzivisti soočili z etičnimi dvomi, na katere so morali sami najti odgovore, kako ukrepati v interesu otroka in njegove družine. Avtor navaja dva primera iz lastne prakse: novorojenca z mielomeningokelo in predšolskega otroka iz ločine Jehovec, ki je bil izkrvavljen sprejet na kliniko. Za oblikovanje lastne doktrine etičnih odločitev v EIT poudrja avtor pomen pogovorov z našim vodilnim medicinskim deontologom profesorjem Janezom Milčinskim. Sodelovanje dr. Davida Todresa, enega vodilnih pediatričnih intenzivistov iz slovite ameriške Harvardske šole pri "okrogli mizi" o etiki v intenzivni terapiji na 1. mednarodnem kongresu otroške intenzivne terapije v Ljubljani leta 1981 in njegovo enomesečno bivanje v Ljubljani z vsakodnevnimi predavanji v centru za intenzivno terapijo otrok v KC sta potrdila, da je naša praksa na področju medicinske etike sodobna in človeška. Na Pediatričnem oddelku kirurških strok KC se je oblikovala lastna etična komisija v sestavi: pediater-intenzivist, nevrokirurg, nevrofiziolog in sprva tudi sodni medicinec, ki je "ad hoc" odločala o presoji brezupnosti bolezni, o opustitvi oživljanja, odklopu od respiratorja in o drugih ukrepih ob bolniku.(Izvleček prekinjen pri 2000 znakih.)
Deskriptorji		INTENSIVE CARE UNITS, PEDIATRIC ETHICS, MEDICAL HUMANISM CHILD ADVOCACY CHILD, HOSPITALIZED CHILD PEDIATRICS