Siegler M
N Engl J Med. 1975 Oct 23;293(17):853-7. doi: 10.1056/NEJM197510232931705.
Hanging of crepe refers to one type of strategy employed by physicians in communicating prognoses to families of critically ill patients. This approach offers the bleakest, most pessimistic prediction of the patient's outcome, presumably in an effort to lessen the family's suffering if the patient dies of his illness. Certain similarities exist between this technic and that used by Pascal, the 17th-century philosopher, in formulating his wager on the belief in God, in that both attempt to develop "no-lose" strategies, in which chances for "winning" are maximized. A detailed analysis of these strategies indicates that neither is truly "no-lose," and that both contain inherent disadvantages. Prognostication, an alternative approach to physician-family communication, appears to be strategically and morally superior to the hanging-of-crepe strategy.
告知最坏消息是医生向重症患者家属传达预后情况时采用的一种策略。这种方法对患者的预后给出了最黯淡、最悲观的预测,大概是为了在患者因病死亡时减轻家属的痛苦。这种技巧与17世纪哲学家帕斯卡提出关于上帝信仰的赌注时所采用的技巧存在某些相似之处,即两者都试图制定“无损失”策略,将“获胜”的机会最大化。对这些策略的详细分析表明,两者都并非真正的“无损失”,且都存在内在缺陷。预断作为医生与家属沟通的另一种方法,在策略和道德层面似乎都优于告知最坏消息的策略。