Meran Johannes G, Späth-Schwalbe Ernst
Krankenhaus der Barmherzigen Brüder Wien, Oesterreich.
Onkologie. 2009;32 Suppl 3:29-33. doi: 10.1159/000228652. Epub 2009 Sep 25.
Optimal care for elderly cancer patients requires empathy and alertness about impaired autonomy and an exceptional quality of care. Specific to geriatric oncology is the particular need of attention and care for the patients. Most important from a conceptual point of view is to identify that this will result in additional demands. To care for these patients will require more time as any intervention must be adapted to age specific capabilities. The difficult task of shared decision-making should be preferably based on the quality of life assessment of the individual patient and their needs. The process of assessing quality of life is in itself already an act of enhancing autonomy, because it respects the individual's subjectivity. Many ethical questions arise between the contradictory contexts of paternalism and autonomy. There are conditions to be met and limits of autonomy to be considered, which differ for the elderly patients because of their vulnerability and particular dependencies. As the elderly patient is closer to death and dying, questions of care in these situations are frequently more pressing. It is important to distinguish actively intended euthanasia from the goals and concerns of modern palliative care in order to enable dying with dignity.
老年癌症患者的最佳护理需要同理心，需要警惕患者自主权受损，需要具备卓越的护理质量。老年肿瘤学的特殊之处在于对患者给予特别关注和护理的特殊需求。从概念角度来看，最重要的是要认识到这会带来额外的需求。护理这些患者需要更多时间，因为任何干预措施都必须根据特定年龄的能力进行调整。共同决策这项艰巨任务最好基于对个体患者生活质量的评估及其需求。评估生活质量的过程本身就是增强自主权的行为，因为它尊重个体的主观性。在家长主义和自主权这两种相互矛盾的背景下会出现许多伦理问题。存在需要满足的条件和需要考虑的自主权限制，老年患者因其脆弱性和特殊依赖性而有所不同。由于老年患者更接近死亡，在这些情况下的护理问题通常更为紧迫。为了实现有尊严地离世，必须积极区分主动安乐死与现代姑息治疗的目标和关注点。
