Schuman-Olivier Zev, Brendel David H, Forstein Marshall, Price Bruce H
Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, MA 02139, USA.
Harv Rev Psychiatry. 2008;16(6):339-51. doi: 10.1080/10673220802576917.
This article introduces a structure for standardization in the ongoing debate about the application of palliative sedation for psychological and existential suffering at the end of life. We differentiate the phenomenon of existential distress from the more general one of existential suffering, defining existential distress as a special case of existential suffering that applies to persons with terminal illness. We introduce both a clinical classification system of existential distress based on proximity to expected death and a decision-making process for considering palliative sedation (represented by the mnemonic, TIRED). Neuropsychiatric clinical cases will be used to demonstrate some of the concepts and ethical arguments.
本文介绍了一种在关于临终时针对心理和存在性痛苦实施姑息性镇静的应用的持续辩论中的标准化结构。我们将存在性困扰现象与更普遍的存在性痛苦区分开来，将存在性困扰定义为存在性痛苦的一种特殊情况，适用于绝症患者。我们引入了一种基于与预期死亡的接近程度的存在性困扰临床分类系统以及一个考虑姑息性镇静的决策过程（由助记符TIRED表示）。将使用神经精神科临床病例来阐述一些概念和伦理观点。
