Abiven M
Service des soins Palliatifs, l'Hôpital de la Cité Universitaire, Paris.
Bull Acad Natl Med. 1999;183(5):881-5, 886-7.
Insofar as they take into account, not only the physical needs of the dying, but also their psycho-affective ones, Palliative Care are, with time, becoming a full-fledged area of medical specialization, the one which deals with the last phase of life. In order to be really efficient, that medical activity requires to resort to numerous skills: those of doctors, nurses, psychologists, physiotherapists..., which implies setting up suitable structures. Historically, Palliative Care have developed within specialized units: the Palliative Care Units; such units should, now, only be seen as centres for research and teaching. But, as time goes one, Palliative Care should, in fact, be practised wherever patients are dying: i.e., in hospitals, provided the staff are adequately trained and even, if need be, with the help of Mobile Palliative Care Teams; at home where general practioners, helped by a real network of professionals, could then manage to give the patients who wish to do so, the opportunity to die at home. Such practise of Palliative Care makes attitudes of therapeutic obstinacy irrelevant. Moreover when Palliative Care are practised, patients practically never ask for euthanasia.
姑息治疗不仅考虑临终者的身体需求,还考虑其心理情感需求,随着时间的推移,它正成为一个成熟的医学专业领域,即处理生命最后阶段的领域。为了真正有效,这项医疗活动需要借助多种技能:医生、护士、心理学家、物理治疗师等的技能,这意味着要建立合适的架构。从历史上看,姑息治疗是在专门的单位发展起来的:姑息治疗单元;现在,这样的单位应仅被视为研究和教学中心。但是,随着时间的推移,事实上,只要有患者临终,就应该提供姑息治疗:即在医院,如果工作人员接受了充分培训,甚至在必要时借助移动姑息治疗团队;在家庭中,全科医生在真正的专业人员网络的帮助下,可以设法为希望在家中去世的患者提供在家中去世的机会。这种姑息治疗的做法使治疗固执的态度变得无关紧要。此外,当实施姑息治疗时,患者几乎从不要求安乐死。