Division of General Internal Medicine, Department of Medicine, University of Colorado Denver School of Medicine, Academic Office 1, Box B180, 12631 E 17th Ave, Aurora, CO 80045, USA.
JAMA. 2010 Jan 27;303(4):349-56. doi: 10.1001/jama.2009.2015. Epub 2010 Jan 5.
Mrs H is an 86-year-old woman with progressive congestive heart failure and multiple chronic conditions who is experiencing worsening function and quality of life despite maximum medical therapies. She seeks advice regarding control over the circumstances of the end of her life, be it by suicide or under hospice care. Typical of US populations older than 65 years with multiple chronic health conditions and functional decline who are facing the end of life, Mrs H's concerns are particularly about quality of life, not being a burden on loved ones, and maintaining control. As she demonstrates, psychological, existential, and social factors, particularly fear of being a burden, are more common reasons for desiring hastened death than those related directly to physical symptoms. Hospice, which provides a multidisciplinary approach to care at the end of life, can assist Mrs H and her family in making decisions that are consistent with her goals.
H 女士是一位 86 岁的女性，患有进行性充血性心力衰竭和多种慢性疾病，尽管接受了最大程度的医学治疗，但她的功能和生活质量仍在不断恶化。她寻求关于控制生命终末期情况的建议，无论是通过自杀还是在临终关怀护理下。像美国 65 岁以上有多种慢性健康状况和功能下降并面临生命终末期的人群一样，H 女士特别关注生活质量、不成为亲人的负担和保持控制。正如她所展示的那样，心理、存在和社会因素，特别是害怕成为负担，是她渴望加速死亡的更常见原因，而不是与身体症状直接相关的原因。临终关怀为生命终末期提供了一种多学科的护理方法，可以帮助 H 女士和她的家人做出符合她目标的决策。
