O'Connell L J
Park Ridge Center, Chicago, USA.
Health Prog. 1996 Nov-Dec;77(6):16-20.
Americans increasingly believe there are material solutions to all problems. Though we once accepted death as a part of life, we now think that--with enough technology--death can be controlled and postponed. Throughout this century, we have moved the dying process from the home to institutional settings. But institutions have a tendency to push all care to its logical end, which leads to alienation, fragmentation, and diminishment. Alienation is the result of the isolation and regimentation found in acute and skilled nursing care facilities. When care givers are indifferent to patients' pain, or do not know how to control it, they further impair the ability of dying persons to interact with others. Care for the dying person, "system by system, organ by organ," as is typical in institutional settings, fragments the dying process into a series of medical events. And, finally, institutionalized care often results in a diminishment of respect by care givers, who may come to view the dying person more as an object of academic interest than as a human whose spiritual needs may transcend physical ones. Such behavior has begun to show us the human costs of denying death and is contributing to a reawakening of spirituality in this country. The devastating effects of alienation, fragmentation, and diminishment can be ameliorated by a heightened sensitivity to the dying person's spiritual needs. With the proper supports, the dying process can be relocated from institutions to the home. Specialized training can educate healthcare professionals about palliative care and human needs at the end of life. We can rehumanize dying persons by first rehumanizing their care givers, specifically addressing the issues of stress and burnout on the job. Ultimately, the way we give care at the end of life reflects broader issues in U.S. culture. Only when communitarian values replace individualistic ones will resources be reallocated in a manner that best serves the most people. Only then will physicians, nurses, and other care givers receive rewards for supporting the dying person when tests and treatment are no longer needed.
美国人越来越相信所有问题都有物质层面的解决办法。虽然我们曾经将死亡视为生命的一部分，但现在我们认为——凭借足够的技术——死亡是可以控制和推迟的。在整个本世纪，我们已将临终过程从家中转移到机构场所。但机构往往会将所有护理推向其逻辑终点，这会导致疏离、破碎和贬低。疏离是急性和专业护理机构中存在的隔离和严格管理的结果。当护理人员对患者的痛苦漠不关心，或者不知道如何控制它时，他们会进一步削弱垂危者与他人互动的能力。在机构环境中典型的“逐个系统、逐个器官”地照顾垂危者，会将临终过程碎片化，变成一系列医疗事件。最后，机构化护理往往会导致护理人员的尊重减少，他们可能会开始将垂危者更多地视为学术研究对象，而不是一个精神需求可能超越身体需求的人。这种行为已开始向我们展示否认死亡所带来的人力成本，并促使这个国家的灵性重新觉醒。对垂危者精神需求的更高敏感度可以缓解疏离、破碎和贬低所带来的毁灭性影响。在适当的支持下，临终过程可以从机构转移到家中。专业培训可以让医疗保健专业人员了解临终关怀和生命末期的人类需求。我们可以通过首先使护理人员人性化，具体解决工作中的压力和倦怠问题，来使垂危者重新获得人性。最终，我们在生命末期提供护理的方式反映了美国文化中更广泛的问题。只有当社群主义价值观取代个人主义价值观时，资源才会以最能服务大多数人的方式重新分配。只有到那时，当不再需要进行检查和治疗时，医生、护士和其他护理人员因支持垂危者而获得奖励。
