Department of Reproduction and Society at the International Center for Health, Law and Ethics, Haifa University, Tel Aviv, Israel.
Bioethics. 2010 Mar;24(3):134-44. doi: 10.1111/j.1467-8519.2009.01790.x.
In the latter half of the 20th century, Western medicine moved death from the home to the hospital. As a result, the process of dying seems to have lost its spiritual dimension, and become a matter of prolonging material life by means of medical technology. The novel quandaries that arose led in turn to medico-legal regulation. This paper describes the recent regulation of dying in Israel under its Dying Patient Law, 2005. The Law recognizes advance directives in principle, but limits their effect and form through complex medico-legal artifices. It reflects a culture that places high value on both scientific medicine and the sanctity of life as such, and illustrates a medical culture that pitches battle against death. At the same time, the Law constructs the will of the individual in a medico-legal language that is alien to the lay person. The paper suggests an alternative approach to advance care planning that is patient-centred and addresses the psycho-social needs of the individual in terms of her relational autonomy. From this perspective, advance care planning becomes an opportunity to extract the patient from the medical context and allow her to speak about her approaching death with close ones in her own terms of reference. To this end, there is a need for facilitation of an intimate encounter where patients can speak about their concerns with their loved ones. The paper also presents a methodological approach of attentive listening, which can be applied across diverse cultures and circumstances.
20 世纪后半叶，西医将死亡从家庭转移到了医院。结果，死亡的过程似乎失去了精神层面，而成为了通过医疗技术延长物质生命的问题。随之而来的新的困境导致了医疗法律的规范。本文描述了 2005 年以色列《临终病人法》对临终的最新规范。该法律原则上承认预先指示，但通过复杂的医疗法律手段限制了其效力和形式。它反映了一种既高度重视科学医学又重视生命本身的神圣性的文化，展示了一种与死亡作斗争的医疗文化。同时，该法律用一种与非专业人士的语言相去甚远的医疗法律语言来构建个人的意愿。本文提出了一种以患者为中心的预先护理计划的替代方法，解决了个人在关系自主性方面的心理社会需求。从这个角度来看，预先护理计划成为了一个让患者脱离医疗环境的机会，让她能够用自己的参考框架与亲近的人谈论她即将到来的死亡。为此，有必要促进亲密的会面，让患者能够与他们所爱的人谈论他们的担忧。本文还提出了一种注意力倾听的方法，这种方法可以适用于不同的文化和环境。
