Harvard Pilgrim Health Care Institute, Boston, Massachusetts 02215, USA.
J Pain Symptom Manage. 2011 Oct;42(4):643-8. doi: 10.1016/j.jpainsymman.2011.07.001. Epub 2011 Sep 1.
The gold standard for end-of-life care is home hospice. A case is presented in which a patient dying of irreversible small bowel obstruction from metastatic cancer insisted on remaining in the acute care hospital for care when alternative sites of care, including a skilled nursing facility and residential hospice, were available to her and covered by her health insurance plan. The ethical issues raised by this case are discussed from the perspective of the patient, the clinical team, the hospital, and the insurance company. Over the past decade, hospital-based palliative care consultation and general inpatient hospice care have sought to improve the quality of dying in the hospital. To the extent that such efforts have been successful, they may result in increasing demand for the hospital as the site for terminal care in the future.
临终关怀的金标准是家庭临终关怀。本文介绍了一个案例，一位因转移性癌症导致不可逆转的小肠梗阻而死亡的患者坚持留在急性护理医院接受治疗，而其他可供选择的治疗地点，包括熟练护理设施和住宅临终关怀，都可以为她提供，并由她的健康保险计划覆盖。本文从患者、临床团队、医院和保险公司的角度讨论了这个案例引发的伦理问题。在过去的十年中，基于医院的姑息治疗咨询和一般住院临终关怀服务一直在努力提高医院临终关怀的质量。在这些努力取得成功的程度上，它们可能会导致未来对医院作为临终关怀场所的需求增加。
