Quinn Kieran L, Grossman Daphna L
Department of Medicine, Divisions of General Internal Medicine and Palliative Care, University of Toronto, Toronto, Canada.
Department of Medicine, Sinai Health System and University Health Network, 60 Murray Street, 2nd Floor Room 404, Toronto, Ontario, M5T 3L9, Canada.
Isr J Health Policy Res. 2020 Aug 24;9(1):43. doi: 10.1186/s13584-020-00401-5.
The timing of palliative care initiation may be more appropriately directed using a needs-based approach, instead of a prognostically driven one. Jewish Law or Halachah ("the way") upholds a strong commitment to the sanctity of life and teaches that the duty to prolong life supersedes the duty to end suffering prematurely, unless one is expected to imminently die. This intersection of palliative care and a reliance on prognostic triggers with an individual's observance of religious traditions complicates matters nearing the end-of-life. A recent pilot study by Sternberg et al. of 20 patients with advanced dementia in Israel found that home hospice care significantly reduced distressing symptoms, caregiver burden and hospitalization and teaches us important lessons about some of the essential elements to providing excellent palliative care at home, including the 24/7 availability of healthcare providers outside of the emergency department. In light of specific religious practices, palliative care should strive to incorporate a patient's specific religious observance as part of high-quality end-of-life care.
姑息治疗开始的时机或许更适合采用基于需求的方法来确定，而非由预后因素驱动。犹太律法或哈拉卡（“方式”）秉持对生命神圣性的坚定承诺，并教导延长生命的责任优先于过早结束痛苦的责任，除非预计某人即将死亡。姑息治疗与依赖预后指标以及个人对宗教传统的遵循之间的这种交叉，使得临终时的情况变得复杂。斯特恩伯格等人近期在以色列针对20名晚期痴呆患者开展的一项试点研究发现，居家临终关怀显著减轻了痛苦症状、照顾者负担并减少了住院次数，还让我们了解到在家中提供优质姑息治疗的一些关键要素，包括急诊科之外的医疗服务提供者随时待命。鉴于特定的宗教习俗，姑息治疗应努力将患者的特定宗教仪式纳入高质量的临终关怀之中。
