Tsang John Y C
Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada.
Clin Med Insights Circ Respir Pulm Med. 2010 Jul 12;4:15-23.
As medical science continues to advance, patients nowadays with progressive cardiopulmonary diseases live to older ages. However, they too will eventually reach their unsustainable physiological limit and many die in poor health and discomfort prior to their demise. Regrettably many physicians have not kept pace in dealing with the inevitable end-of- life issues, along with modern technological developments. Without proper guidance, ill-informed patients often face unnecessary anxiety, receive futile resuscitation at the expense of their dignity and public cost which has and will become increasingly overwhelming according to our current demographic trends. In any health care reform, experts often suggest that difficult questions will have to be asked but the solutions are at least partly in the logistical details. From time to time, we see an isolated "Do Not Resuscitate" or DNR order in the chart, which is not always followed by thoughtful discussion on the boundary of care, either simultaneously or known to be followed up soon. This paper attempts to begin asking some of these difficult questions, point out the fallacies of this order and expose the weaknesses in the present state of entitlement by public demand if physicians retreats more from the discussion. The solution does not lie in asking the questions but in changing the practice pattern in real life on a continuous basis, hopefully to be eventually accepted by most, if not all.
随着医学科学不断进步，如今患有进行性心肺疾病的患者寿命延长。然而，他们最终也会达到无法承受的生理极限，许多人在去世前健康状况不佳且饱受不适折磨。遗憾的是，许多医生未能跟上现代技术发展的步伐，应对不可避免的临终问题。在没有适当指导的情况下，信息不足的患者常常面临不必要的焦虑，接受徒劳的复苏，这损害了他们的尊严，也造成了公共成本的增加，而且根据当前的人口趋势，这种情况已经且将变得越来越难以承受。在任何医疗改革中，专家们常说必须提出一些棘手的问题，但解决方案至少部分在于后勤细节。我们不时会在病历中看到孤立的“不要复苏”（DNR）医嘱，但其之后并不总是紧接着就对护理界限进行深入讨论，无论是同时进行还是很快跟进。本文试图开始提出其中一些难题，指出该医嘱存在的错误观念，并揭示如果医生更多地回避讨论，公众需求在当前权利状态下的薄弱之处。解决方案不在于提出问题，而在于持续改变现实生活中的实践模式，希望最终能被大多数人（即便不是所有人）接受。
