Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zurich, Switzerland.
Med Health Care Philos. 2020 Sep;23(3):343-351. doi: 10.1007/s11019-019-09921-7.
Palliative care (PC) names as one of its central aims to prevent and relieve suffering. Following the concept of "total pain", which was first introduced by Cicely Saunders, PC not only focuses on the physical dimension of pain but also addresses the patient's psychological, social, and spiritual suffering. However, the goal to relieve suffering can paradoxically lead to a taboo of suffering and imply adverse consequences. Two scenarios are presented: First, PC providers sometimes might fail their own ambitions. If all other means prove ineffective terminal sedation can still be applied as a last resort, though. However, it may be asked whether sedating a dying patient comes close to eliminating suffering by eliminating the sufferer and hereby resembles physician-assisted suicide (PAS), or euthanasia. As an alternative, PC providers could continue treatment, even if it so far prove unsuccessful. In that case, either futility results or the patient might even suffer from the perpetuated, albeit fruitless interventions. Second, some patients possibly prefer to endure suffering instead of being relieved from it. Hence, they want to forgo the various bio-psycho-socio-spiritual interventions. PC providers' efforts then lead to paradoxical consequences: Feeling harassed by PC, patients could suffer even more and not less. In both scenarios, suffering is placed under a taboo and is thereby conceptualised as not being tolerable in general. However, to consider suffering essentially unbearable might promote assisted dying not only on an individual but also on a societal level insofar as unbearable suffering is considered a criterion for euthanasia or PAS.
姑息治疗（PC）将预防和缓解痛苦作为其核心目标之一。遵循西塞尔·桑德斯（Cicely Saunders）首次提出的“全面疼痛”概念，PC 不仅关注疼痛的身体维度，还解决患者的心理、社会和精神痛苦。然而，缓解痛苦的目标可能会导致对痛苦的禁忌，并暗示产生不利后果。呈现了两种情况：首先，PC 提供者有时可能会辜负自己的雄心壮志。如果所有其他方法都证明无效，终末镇静仍可作为最后的手段，但人们可能会质疑，通过消除痛苦者来镇静临终患者是否接近通过消除痛苦者来缓解痛苦，从而类似于医师协助自杀（PAS）或安乐死。作为替代方案，PC 提供者可以继续治疗，即使迄今为止治疗不成功。在这种情况下，要么是无效的结果，要么患者可能甚至会因持续但无果的干预而遭受痛苦。其次，一些患者可能宁愿忍受痛苦而不愿从中解脱。因此，他们希望放弃各种生物心理社会精神干预。PC 提供者的努力随后导致了矛盾的后果：患者可能会因 PC 而感到困扰，从而遭受更多的痛苦，而不是更少。在这两种情况下，痛苦都受到禁忌的限制，因此被认为是普遍无法忍受的。然而，将痛苦视为本质上无法忍受可能会促进协助死亡，不仅在个人层面上，而且在社会层面上，因为无法忍受的痛苦被认为是安乐死或 PAS 的标准。
