Cowley L T, Young E, Raffin T A
Stanford University Center for Biomedical Ethics, Stanford University School of Medicine, CA 94305-5204.
Crit Care Med. 1992 Oct;20(10):1473-82. doi: 10.1097/00003246-199210000-00018.
To provide a historical perspective, from ancient Greece to the middle of the 20th century, on ethical issues and principles commonly associated with medical care for the dying in Western civilization.
Writings of noted philosophers, historians, ethicists, and physicians, as well as published legal and ethical guidelines. INFORMATION EXTRACTION: The sources used highlight the origins of various ethical principles associated with care of the dying. They also identify the opinions of prominent individuals throughout the history of medical ethics.
Devotion to medical beneficence, concern for the quality of life, and respect for the sanctity of life are all expressed in the earliest medical and philosophical writings of ancient Greece. With regard to care of the dying, these considerations led to a wide acceptance of avoiding or terminating treatment in hopeless cases. They also led to active debate regarding medicine's role in hastening the dying process. The rise of Christianity during the Middle Ages markedly suppressed such debate by strongly reinforcing the principle of sanctity of life. Later, the optimism of the enlightenment added the hope of prolonging life. Finally, modern advances in medical science have made that hope a reality of complex ethical dimensions.
Ethical debates regarding appropriate care for the dying are as old as medicine itself. Although beneficent concerns have characterized the medical community in almost every period of history, tensions have repeatedly arisen as diverse religious and philosophical ideologies have produced varying standards to define such beneficence. In the Christian world, the sanctity of life was often extolled as the paramount standard. For the ancient Greeks and Romans, and again in many post-Renaissance philosophies, quality of life considerations assumed equal or greater importance. Modern life-prolonging technologies heighten the debate by allowing these two standards to dramatically conflict, particularly in the critical care setting.
提供从古希腊到20世纪中叶西方文明中与临终医疗护理相关的伦理问题及原则的历史视角。
著名哲学家、历史学家、伦理学家和医生的著作，以及已发表的法律和伦理准则。信息提取：所使用的资料突出了与临终护理相关的各种伦理原则的起源。它们还确定了医学伦理史上杰出人物的观点。
对医疗慈善的奉献、对生活质量的关注以及对生命神圣性的尊重，都在古希腊最早的医学和哲学著作中有所体现。关于临终护理，这些考量导致在无望的情况下广泛接受避免或终止治疗。它们还引发了关于医学在加速死亡过程中所起作用的激烈辩论。中世纪基督教的兴起通过大力强化生命神圣原则显著压制了此类辩论。后来，启蒙运动的乐观主义增添了延长生命的希望。最后，现代医学科学的进步使这一希望成为具有复杂伦理维度的现实。
关于临终适当护理的伦理辩论与医学本身一样古老。尽管在几乎每个历史时期，慈善关怀都是医学界的特征，但随着不同的宗教和哲学意识形态产生不同的标准来界定这种慈善，紧张关系屡屡出现。在基督教世界，生命的神圣性常常被颂扬为首要标准。对于古希腊人和罗马人，以及在许多文艺复兴后的哲学中，对生活质量的考量同样重要或更为重要。现代延长生命的技术加剧了这种辩论，因为这两个标准会产生巨大冲突，尤其是在重症监护环境中。
