Sengupta Jaydeep, Chatterjee Suhita Chopra
Department of Humanities & Social Sciences, Indian Institute of Technology Kharagpur, West Bengal 721302, India.
Department of Humanities & Social Sciences, Indian Institute of Technology Kharagpur, West Bengal 721302, India.
J Crit Care. 2017 Jun;39:11-17. doi: 10.1016/j.jcrc.2016.12.017. Epub 2016 Dec 24.
This study critically examines the available policy guidelines on integration of palliative and end-of-life care in Indian intensive care units to appraise their congruence with Indian reality.
Six position statements and guidelines issued by the Indian Society for Critical Care Medicine and the Indian Association of Palliative Care from 2005 till 2015 were examined. The present study reflects upon the recommendations suggested by these texts.
Although the policy documents conform to the universally set norms of introducing palliative and end-of-life care in intensive care units, they hardly suit Indian reality. The study illustrates local complexities that are not addressed by the policy documents. This include difficulties faced by intensivists and physicians in arriving at a consensus decision, challenges in death prognostication, hurdles in providing compassionate care, providing "culture-specific" religious and spiritual care, barriers in effective communication, limitations of documenting end-of-life decisions, and ambiguities in defining modalities of palliative care. Moreover, the policy documents largely dismiss special needs of elderly patients.
The article suggests the need to reexamine policies in terms of their attainability and congruence with Indian reality.
本研究严格审查了印度重症监护病房中关于姑息治疗和临终关怀整合的现有政策指南，以评估其与印度实际情况的契合度。
研究了印度重症医学学会和印度姑息治疗协会在2005年至2015年期间发布的六份立场声明和指南。本研究对这些文本提出的建议进行了反思。
尽管政策文件符合在重症监护病房引入姑息治疗和临终关怀的普遍设定规范，但它们几乎不符合印度的实际情况。该研究说明了政策文件未涉及的当地复杂性。这包括重症监护医生和内科医生在达成共识决策时面临的困难、死亡预后的挑战、提供 compassionate care（此处可能有误，推测为“关怀护理”）的障碍、提供“特定文化”的宗教和精神护理、有效沟通的障碍、记录临终决策的局限性以及姑息治疗方式定义的模糊性。此外，政策文件在很大程度上忽视了老年患者的特殊需求。
本文建议有必要根据政策的可实现性及其与印度实际情况的契合度重新审视这些政策。
