Stolick Matt
Department of Philosophy, University of Findlay, Findlay, Ohio, USA.
Am J Hosp Palliat Care. 2003 Jul-Aug;20(4):269-73. doi: 10.1177/104990910302000408.
This paper is intended to emphasize the existence of prognostic uncertainty in providing survival estimates while also providing a method for caring to those who want to authentically help dying patients. Facing one's own mortality helps one compassionately be there for dying patients. The transforming experience of death as essential to one's self as human being, recognizing that one is living a story with death necessarily a part, promises to overcome the tendency to deny the existential meaning of death for dying patients. This tendency manifests itself through dishonesty about medicine's limitations in creating prognoses, and specifically survival estimates, as well as in holding only a curative and not palliative goal of treatment. This tendency will be replaced by honest and compassionate actions with those in the process of dying. Representing this change is a focus on the patient as person, living a certain lifestyle, and defining himself by significant events and relationships in the past, present, and future. Death and dying become meaningful through incorporation into the story and style that is the patient. This meaning that is facilitated by caregivers and created by patients is central to achieving a "good death."
本文旨在强调在提供生存预估时预后存在不确定性,同时为那些真心希望帮助临终患者的人提供一种关怀方法。直面自身的死亡有助于人们富有同情心地陪伴临终患者。将死亡视为对自我作为人类至关重要的转变性体验,认识到自己正经历着一个必然包含死亡的故事,有望克服否认临终患者死亡存在意义的倾向。这种倾向表现为对医学在制定预后尤其是生存预估方面的局限性不诚实,以及只持有治疗的治愈性目标而非姑息性目标。这种倾向将被与临终者的诚实且富有同情心的行动所取代。体现这种变化的是关注患者作为个体,其过着特定的生活方式,并由过去、现在和未来的重大事件及人际关系来定义自己。死亡和临终通过融入患者的故事和风格而变得有意义。这种由护理者促成、患者创造的意义对于实现“善终”至关重要。