Ludwig H
II. Medizinische Universitätsklinik, Wien.
Wien Klin Wochenschr. 1990 Oct 12;102(19):556-60.
The Hippocratic oath, which includes refraining from the prescription of deadly drugs or giving advice on suicide still remains the cornerstone of medical ethics. Therefore, any active fostering of the dying process has to be strictly rejected. Nevertheless, in caring for cancer patients, many borderline situations arise in which serious decisions about the continuation of a treatment regimen are called for--decisions basically equating to a choice between prolonging life or allowing death. As long as the patient is able to do so, he himself must decide and the physician has to respect his decision. However, often the patient is unable to determine his own fate. No easy general recommendations can be offered for such situations. The physician has to consider the specific characteristics of the disease and take into account the patient's individual needs. Then, for each case anew, a careful, conscientious decision has to be made and the physician must take personal responsibility for its consequences. In spite of treatment successes, death cannot be conquered, but only postponed. This knowledge helps the physician to recognize more clearly the realistic possibilities of medical aid and to empathically help the dying patient.
希波克拉底誓言，其中包括禁止开致命药物或提供自杀建议，仍然是医学伦理的基石。因此，任何积极促进死亡过程的行为都必须被严格拒绝。然而，在照顾癌症患者时，会出现许多临界情况，需要就治疗方案的继续做出严肃决定——这些决定基本上等同于在延长生命和允许死亡之间做出选择。只要患者能够做到，他自己必须做出决定，医生必须尊重他的决定。然而，患者往往无法决定自己的命运。对于这种情况，无法给出简单的一般性建议。医生必须考虑疾病的具体特征，并考虑患者的个人需求。然后，针对每个病例，都必须做出谨慎、尽责的决定，医生必须对其后果承担个人责任。尽管治疗取得了成功，但死亡无法被征服，只能被推迟。这种认识有助于医生更清楚地认识到医疗援助的现实可能性，并以同理心帮助濒死患者。
