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[临终决策]

[End-of-life Decisions].

作者信息

Erbguth F J, Erbguth L

出版信息

Dtsch Med Wochenschr. 2016 Sep;141(20):1484-1496. doi: 10.1055/s-0042-114087. Epub 2016 Oct 4.

Abstract

End-of-life decisions in neurology have repeatedly given occasion for controversies. Often these are based on lack of knowledge of the juridical and ethical framework conditions. This review describes the juridical-ethical basis for the implementation and continuation, and for withholding and withdrawal of life-sustaining measures, in particular, the significance of medical indication and patient's will. The different forms of assisted dying ("Sterbehilfe"), namely homicide by request, assisted suicide, palliative symptom relief and treatment withdrawal are characterized. The "Principles of the German Medical Association" in end-of-life situations are illustrated. Specific features of neurological treatment scenarios are discussed such as the preclinical and clinical emergency and acute situation, the decompensation of stable chronic severe brain injury situations, and chronically progressive neurodegenerative diseases. In the latter situations, an early "Advance Care Planning" could contribute to improved end-of-life decision-making.

摘要

神经病学领域的临终决策一再引发争议。这些争议往往源于对法律和伦理框架条件的缺乏了解。本综述描述了实施和延续、以及 withholding 和 withdrawal 维持生命措施的法律伦理基础,特别是医学指征和患者意愿的重要性。对不同形式的辅助死亡(“Sterbehilfe”)进行了特征描述,即应要求杀人、协助自杀、姑息性症状缓解和治疗撤减。阐述了德国医学协会在临终情况下的“原则”。讨论了神经治疗场景的具体特征,如临床前和临床紧急及急性情况、稳定的慢性严重脑损伤情况的失代偿,以及慢性进行性神经退行性疾病。在后一种情况下,早期的“预立医疗计划”有助于改善临终决策。

文中“withholding”和“withdrawal”在医学语境下可能有特定含义,这里直接保留英文未翻译,因为准确翻译需结合更专业的医学知识背景,单纯从文本看暂无法准确给出完全符合医学专业的中文表述。

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