Krakauer E L, Penson R T, Truog R D, King L A, Chabner B A, Lynch T J
Hematology-Oncology Department, Massachusetts General Hospital, Boston 02114-2617, USA.
Oncologist. 2000;5(1):53-62. doi: 10.1634/theoncologist.5-1-53.
Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded the Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. The case presented is of a young man dying of recurrent epithelioid hemangioendothelioma, distressed with stridor and severe pain, whose poorly controlled symptoms were successfully treated with an infusion of propofol, titrated to provide effective comfort in the last few hours of the patient's life. The tenet of double effect, which allows aggressive treatment of suffering in spite of foreseeable but unintended consequences, is reviewed. The patient's parents were invited and contributed to the Rounds, providing compelling testimony to the power of the presence of clinicians at the time of death and the importance of open communication about difficult ethical issues.
1995年，马萨诸塞州总医院（MGH）的癌症患者肯尼斯·B·施瓦茨在去世前不久，在MGH创立了肯尼斯·B·施瓦茨中心。施瓦茨中心是一个非营利组织，致力于支持和推进富有同情心的医疗服务，为患者提供希望，为护理人员提供支持，并促进康复过程。该中心主办施瓦茨中心研讨会，这是一个每月举行的多学科论坛，护理人员在此反思患者、其家人和护理人员所面临的重要社会心理问题，并从其他工作人员那里获得见解和支持。所呈现的病例是一名年轻男子，死于复发性上皮样血管内皮瘤，因喘鸣和剧痛而痛苦不堪，其控制不佳的症状通过输注丙泊酚成功得到治疗，在患者生命的最后几个小时进行滴定以提供有效的舒适感。文中回顾了双重效应原则，即允许不顾可预见但非故意的后果积极治疗痛苦。患者的父母被邀请参加研讨会并发表意见，有力地证明了临床医生在患者死亡时在场的力量以及就棘手的伦理问题进行开放沟通的重要性。
