Ganzini Linda, Goy Elizabeth R, Miller Lois L, Harvath Theresa A, Jackson Ann, Delorit Molly A
Department of Veterans Affairs, Oregon Health and Science University, Portland, Oreg, USA.
N Engl J Med. 2003 Jul 24;349(4):359-65. doi: 10.1056/NEJMsa035086.
Voluntary refusal of food and fluids has been proposed as an alternative to physician-assisted suicide for terminally ill patients who wish to hasten death. There are few reports of patients who have made this choice.
We mailed a questionnaire to all nurses employed by hospice programs in Oregon and analyzed the results.
Of 429 eligible nurses, 307 (72 percent) returned the questionnaire, and 102 of the respondents (33 percent) reported that in the previous four years they had cared for a patient who deliberately hastened death by voluntary refusal of food and fluids. Nurses reported that patients chose to stop eating and drinking because they were ready to die, saw continued existence as pointless, and considered their quality of life poor. The survey showed that 85 percent of patients died within 15 days after stopping food and fluids. On a scale from 0 (a very bad death) to 9 (a very good death), the median score for the quality of these deaths, as rated by the nurses, was 8. On the basis of the hospice nurses' reports, the patients who stopped eating and drinking were older than 55 patients who died by physician-assisted suicide (74 vs. 64 years of age, P<0.001), less likely to want to control the circumstances of their death (P<0.001), and less likely to be evaluated by a mental health professional (9 percent vs. 45 percent, P<0.001).
On the basis of reports by nurses, patients in hospice care who voluntarily choose to refuse food and fluids are elderly, no longer find meaning in living, and usually die a "good" death within two weeks after stopping food and fluids.
对于希望加速死亡的晚期患者，自愿拒绝进食和饮水已被提议作为医生协助自杀的替代方式。做出这种选择的患者报告很少。
我们向俄勒冈州临终关怀项目雇佣的所有护士邮寄了一份问卷并分析结果。
在429名符合条件的护士中，307名（72%）回复了问卷，102名受访者（33%）报告称在过去四年里他们护理过一名通过自愿拒绝进食和饮水而故意加速死亡的患者。护士报告称患者选择停止进食和饮水是因为他们已准备好死亡，认为继续生存毫无意义，且觉得自己生活质量很差。调查显示85%的患者在停止进食和饮水后15天内死亡。在从0（非常糟糕的死亡）到9（非常好的死亡）的评分量表上，护士评定这些死亡质量的中位数得分是8。根据临终关怀护士的报告，停止进食和饮水的患者比通过医生协助自杀死亡的患者年龄更大（74岁对64岁，P<0.001），想要控制死亡情形的可能性更小（P<0.001），接受心理健康专业人员评估的可能性更小（9%对45%，P<0.001）。
根据护士的报告，临终关怀中自愿选择拒绝进食和饮水的患者年龄较大，不再能从生活中找到意义，通常在停止进食和饮水后两周内安详离世。
