Department of Emergency Medicine, Denver Health Medical Center, CO, USA.
Acad Emerg Med. 2011 Nov;18(11):1201-7. doi: 10.1111/j.1553-2712.2011.01200.x.
Emergency physicians (EPs) are asked to evaluate and treat a growing population of hospice patients who present to the emergency department (ED) for a number of important reasons. Hospice patients pose unique ethical challenges, and "best practices" for these patients can differ from the life-preserving interventions of usual ED care. Having a solid understanding of professional responsibilities and ethical principles is useful for guiding EP management of these patients. In end-of-life care, EPs need to recognize that there are barriers and complexities to the best management of hospice patients, but they need to commit to strategies that optimize their care. This article describes the case of a hospice patient who presented with sepsis and end-stage cancer to the ED. Patient, system, and physician factors made management decisions in the ED difficult. The goal in the ED should be to determine the best way to address terminally ill patient needs while respecting wishes to limit interventions that will only increase suffering near the end of life.
急诊医师（EP）被要求评估和治疗越来越多的临终关怀患者，这些患者因许多重要原因到急诊科就诊。临终关怀患者带来了独特的伦理挑战，并且这些患者的“最佳实践”可能与通常的急诊科治疗中挽救生命的干预措施有所不同。深入了解专业职责和道德原则对于指导 EP 对这些患者的管理非常有用。在临终关怀中，EP 需要认识到临终关怀患者的最佳管理存在障碍和复杂性，但需要致力于优化其护理的策略。本文描述了一位临终关怀患者因败血症和晚期癌症到急诊科就诊的案例。患者、系统和医生因素使 ED 中的管理决策变得困难。ED 的目标应该是确定满足绝症患者需求的最佳方式，同时尊重限制仅在生命末期增加痛苦的干预措施的意愿。
