van Tol Donald G, Kouwenhoven Pauline, van der Vegt Bea, Weyers Heleen
Department of General Practice, University Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands.
J Med Ethics. 2015 Mar;41(3):240-4. doi: 10.1136/medethics-2013-101624. Epub 2014 Mar 4.
In order to relieve intractable suffering of a terminal patient, doctors may decide to continuously sedate a patient until the end of life. Little research is done on the role the family plays during the process of continuous sedation. This study aims to get a view of doctors' experiences with continuous sedation, and the role of the family throughout that process. We held in-depth interviews with 48 doctors (19 general practitioners, 16 nursing home doctors and 18 medical specialists). Participants were selected varying in experience and opinions concerning end-of-life decisions. Dutch physicians experience the role of family in continuous sedation as important and potentially difficult. Difficulties may rise especially during the final stages when the patient is no longer conscious and family members are waiting for death to come. Disagreement may arise between physician and family, concerning the dignity of the dying process or the question whether the sedated patient is suffering or not. Some physicians report they hastened the dying process, in order to relieve the families' suffering.
为了缓解晚期患者的顽固性痛苦，医生可能会决定持续对患者进行镇静，直至生命结束。关于家庭在持续镇静过程中所起的作用，相关研究甚少。本研究旨在了解医生在持续镇静方面的经验，以及家庭在整个过程中所起的作用。我们对48名医生（19名全科医生、16名养老院医生和18名医学专家）进行了深入访谈。参与者的选择在临终决策的经验和观点方面各有不同。荷兰医生认为家庭在持续镇静中的作用很重要，但也可能存在困难。尤其是在患者不再有意识、家庭成员等待死亡降临的最后阶段，困难可能会加剧。医生和家庭之间可能会在临终过程的尊严问题，或者接受镇静的患者是否痛苦等问题上产生分歧。一些医生报告说，他们加速了死亡进程，以减轻家庭的痛苦。
