Cronin Antonia J
NIHR Biomedical Research Centre, Guy's and St. Thomas' NHS Foundation Trust and MRC Centre for Transplantation, King's College, London, UK.
J Ren Care. 2014 Sep;40 Suppl 1:16-22. doi: 10.1111/jorc.12082.
Advances in modern medical technology have gone so far that it is now possible for machinery to keep people alive. To some extent this has led to a misperception in society that death can almost always be postponed because life-sustaining extracorporeal machinery of some sort or another, for example a dialysis machine, can prevent it. However, for some, being kept alive connected to a dialysis machine for four hours three times a week does not represent or even come close to an existence or quality of life they consider valuable. It may even cause unnecessary distress. This may be because they have reached a point at the end of their lives where they would like the focus of their treatment or care to become that which enables them to live as well as possible until they die. In these circumstances treatment and care should properly be that which enables the supportive and palliative care needs of both patient and family to be identified and met throughout the last phase of life and into bereavement. Identifying and acknowledging the importance of such a paradigm shift in the delivery of healthcare, and above all facilitating it, includes taking on the responsibility, incumbent upon us all, to address the ethical issues that are brought into focus. In this paper, I examine some of these issues. I consider the ways in which underlying theoretical ethical principles have informed the development of professional guidance and highlight the dynamic relationship this guidance has with the law. Finally, I demonstrate the ways in which it can be usefully applied to inform and assist clinical decision-making. Key challenges for BAME groups are addressed.
现代医学技术的进步已经达到了如此程度，以至于现在机器能够维持人们的生命。在某种程度上，这在社会上导致了一种误解，即死亡几乎总是可以推迟的，因为某种形式的维持生命的体外机器，例如透析机，可以防止死亡。然而，对于一些人来说，每周三次连接透析机四小时来维持生命，并不代表甚至远远达不到他们所认为有价值的生存或生活质量。这甚至可能造成不必要的痛苦。这可能是因为他们已经到了生命的尽头，希望治疗或护理的重点变成让他们在去世前尽可能地好好生活。在这种情况下，恰当的治疗和护理应该是能够在生命的最后阶段直至丧亲之痛期间，识别并满足患者和家属的支持性及姑息性护理需求。识别并承认在医疗保健提供方面这种范式转变的重要性，尤其是促成这种转变，包括承担起我们所有人都应承担的责任，去解决那些成为焦点的伦理问题。在本文中，我将审视其中的一些问题。我会思考基本的理论伦理原则对专业指南发展的影响方式，并强调该指南与法律之间的动态关系。最后，我将展示它如何能有效地应用于为临床决策提供信息和帮助。文中还探讨了少数族裔群体面临的关键挑战。
