Bascom Paul B, Tolle Susan W
Division of General Internal Medicine and Geriatrics, L475, Center for Ethics in Health Care, Oregon Health & Science University, Portland, OR 97201, USA.
JAMA. 2002 Jul 3;288(1):91-8. doi: 10.1001/jama.288.1.91.
Studies of dying patients have shown that about half would like the option of physician-assisted suicide (PAS) to be available for possible future use. Those percentages decrease significantly with each step patients take toward action. Studies show that although about 10% of patients seriously consider PAS, only 1% of dying patients specifically request it, and 1 in 10 of those patients actually receive and take a lethal prescription. However, most patients' desires for PAS diminish as their underlying concerns are identified and addressed directly. To help identify concerns motivating a patient's request for PAS, physicians should talk with patients about their expectations and fears, options for end-of-life care, goals, family concerns and burdens, suffering or physical symptoms, sense of meaning and quality of life, and symptoms of depression. A patient with advanced amyotrophic lateral sclerosis (ALS) who requested PAS illustrates how a hasty response may adversely affect patient care and the health care team. Although physicians should remain mindful of their personal, moral, and legal concerns, these concerns should not override their willingness to explore what motivates a patient to make this request. When this approach is taken, suffering can be optimally alleviated and, in almost all cases, the patient's wishes can be met without PAS.
对濒死患者的研究表明，约有一半的患者希望在未来可能有医生协助自杀（PAS）这种选择。随着患者朝着采取行动的每一步迈进，这些比例会显著下降。研究表明，虽然约10%的患者会认真考虑PAS，但只有1%的濒死患者会明确提出请求，而且这些患者中每10人中有1人实际会收到并服用致命处方。然而，随着患者潜在的担忧被识别并直接得到解决，大多数患者对PAS的渴望会逐渐减少。为了帮助识别促使患者请求PAS的担忧，医生应该与患者谈论他们的期望和恐惧、临终关怀的选择、目标、家庭担忧和负担、痛苦或身体症状、意义感和生活质量以及抑郁症状。一名请求PAS的晚期肌萎缩侧索硬化症（ALS）患者说明了仓促回应可能如何对患者护理和医疗团队产生不利影响。虽然医生应该牢记他们个人、道德和法律方面的担忧，但这些担忧不应凌驾于他们探索患者提出此请求背后动机的意愿之上。当采取这种方法时，可以最大程度地减轻痛苦，而且在几乎所有情况下，无需PAS就能满足患者的愿望。
