Hudson Peter L, Schofield Penelope, Kelly Brian, Hudson Rosalie, O'Connor Margaret, Kristjanson Linda J, Ashby Michael, Aranda Sanchia
Centre for Palliative Care, St Vincent's Hospital and The University of Melbourne, Victoria, Australia.
Palliat Med. 2006 Oct;20(7):703-10. doi: 10.1177/0269216306071814.
It is not uncommon for patients with advanced incurable disease to express a desire to hasten their death. Health professionals often have difficulty responding to such statements, and find it challenging to ascertain why these statements are made. Health professionals may struggle to determine whether a 'desire to die' statement (DTDS) is about a request for hastened death, a sign of psychosocial distress, or merely a passing comment that is not intended to be heard literally as a death wish. Given the lack of guidelines to assist health professionals with this issue, we have prepared multidisciplinary recommendations for responding to a DTDS, underpinned by key principles of therapeutic communication and a systematic review of empirical literature. Where the relevant literature was lacking, the recommendations were drafted by the authors (clinicians and/ or academics from the following disciplines: nursing, medicine, psychiatry, psychology, sociology, aged care and theology), based on their expert opinion. Multiple drafts of the recommendations were circulated to the authors for refinement until consensus was reached. Strategies for advancing the evidence base for the maturation of guidelines in this area are offered.
晚期不治之症患者表达希望加速死亡的愿望并不罕见。医疗专业人员往往难以回应此类表述，并且难以确定做出这些表述的原因。医疗专业人员可能难以判断“求死表述”（DTDS）是关于加速死亡的请求、心理社会困扰的迹象，还是仅仅是一句随口一说、并非字面意义上表达死亡愿望的评论。鉴于缺乏协助医疗专业人员处理这一问题的指南，我们依据治疗性沟通的关键原则和对实证文献的系统综述，编写了多学科应对“求死表述”的建议。在相关文献不足的情况下，建议由作者（来自护理、医学、精神病学、心理学、社会学、老年护理和神学等学科的临床医生和/或学者）根据他们的专业意见起草。建议的多个版本在作者之间传阅以进行完善，直至达成共识。本文还提供了推进该领域指南成熟的证据基础的策略。
