Eliott Jaklin A, Olver Ian N
Royal Adelaide Hospital Cancer Research Centre, Royal Adelaide Hospital, Adelaide, Australia.
J Palliat Care. 2003 Summer;19(2):100-6.
This article examines how patients with cancer construct and legitimate do-not-resuscitate (DNR) orders. Semi-structured interviews with 23 outpatients attending an oncology clinic were tape-recorded, transcribed, and analyzed in accordance with discourse-analytic methodology. Results indicate some variability for participants regarding the meaning of DNR orders, which were nonetheless viewed as appropriate and desirable. The patient's subsequent death was legitimated primarily through the invocation of highly valorized discourses within Western society: nature, autonomy, and compassion. Non-compliance with DNR orders, or the instigation of CPR was seen as violating nature, infringing autonomy, and as uncompassionate. The combined effect was to construct dying as a natural event which is the concern of the individual patient and their family, endorsing medical non-intervention in the process. This research provides support, from the patients' viewpoint, for a policy of non-intervention when death is imminent and inevitable, and for those questioning the wisdom of a default policy of initiating CPR on any hospitalized patient, especially those patients inevitably in the process of dying.
本文探讨了癌症患者如何制定和使“不要复苏”（DNR）医嘱合法化。对23名前往肿瘤诊所就诊的门诊患者进行了半结构化访谈，并对访谈内容进行了录音、转录，并按照话语分析方法进行了分析。结果表明，参与者对DNR医嘱的理解存在一定差异，但他们仍认为这些医嘱是恰当且可取的。患者随后的死亡主要通过援引西方社会中备受推崇的话语来合法化：自然、自主性和同情心。不遵守DNR医嘱或实施心肺复苏被视为违背自然、侵犯自主性且缺乏同情心。综合作用是将死亡构建为一个自然事件，这是患者个体及其家人所关心的，从而支持在这个过程中不进行医疗干预。从患者的角度来看，这项研究为在死亡迫在眉睫且不可避免时采取不干预政策提供了支持，也为那些质疑对任何住院患者，尤其是那些不可避免地处于死亡过程中的患者默认实施心肺复苏政策的合理性的人提供了支持。
