Rodríguez-Prat Andrea, van Leeuwen Evert
Faculty of Humanities, Universitat Internacional de Catalunya, C/ Immaculada, 22, 08017, Barcelona, Spain.
Department of IQ, Section Ethics, Philosophy and History of Medicine, Radboud University of Nijmegen, Nijmegen, The Netherlands.
Med Health Care Philos. 2018 Mar;21(1):63-75. doi: 10.1007/s11019-017-9785-y.
It is not uncommon for patients with advanced disease to express a wish to hasten death (WTHD). Qualitative studies of the WTHD have found that such a wish may have different meanings, none of which can be understood outside of the patient's personal and sociocultural background, or which necessarily imply taking concrete steps to ending one's life. The starting point for the present study was a previous systematic review of qualitative studies of the WTHD in advanced patients. Here we analyse in greater detail the statements made by patients included in that review in order to examine their moral understandings and representations of illness, the dying process and death. We identify and discuss four classes of assumptions: (1) assumptions related to patients' moral understandings in terms of dignity, autonomy and authenticity; (2) assumptions related to social interactions; (3) assumptions related to the value of life; and (4) assumptions related to medicalisation as an overarching context within which the WTHD is expressed. Our analysis shows how a philosophical perspective can add to an understanding of the WTHD by taking into account cultural and anthropological aspects of the phenomenon. We conclude that the knowledge gained through exploring patients' experience and moral understandings in the end-of-life context may serve as the basis for care plans and interventions that can help them experience their final days as a meaningful period of life, restoring some sense of personal dignity in those patients who feel this has been lost.
晚期疾病患者表达希望加速死亡（WTHD）的情况并不罕见。对WTHD的定性研究发现，这种愿望可能有不同的含义，这些含义只有在患者的个人和社会文化背景中才能被理解，而且不一定意味着采取具体措施结束自己的生命。本研究的出发点是之前对晚期患者WTHD定性研究的系统综述。在这里，我们更详细地分析了该综述中患者的陈述，以考察他们对疾病、临终过程和死亡的道德理解和认知。我们识别并讨论了四类假设：（1）与患者在尊严、自主性和真实性方面的道德理解相关的假设；（2）与社会互动相关的假设；（3）与生命价值相关的假设；（4）与将WTHD表达置于其中的总体背景——医学化相关的假设。我们的分析表明，通过考虑该现象的文化和人类学方面，哲学视角如何能够增进对WTHD的理解。我们得出结论，通过探索患者在临终情境中的经历和道德理解所获得的知识，可以作为护理计划和干预措施的基础，这些计划和措施能够帮助他们将生命的最后时光体验为有意义的时期，在那些感到失去了个人尊严的患者中恢复某种个人尊严感。
