La Puma J, Schiedermayer D L, Gulyas A E, Siegler M
Center for Clinical Medical Ethics, Department of Medicine, University of Chicago Hospitals and Clinics, IL.
Arch Neurol. 1988 Jan;45(1):20-2. doi: 10.1001/archneur.1988.00520250026012.
Physicians may not talk to comatose patients for several reasons. Comatose patients do not seem to hear or respond. Speaking may not affect their clinical outcome; time spent with them takes time away from other, more "viable" patients. Comatose patients may, however, hear; many have normal brain-stem auditory evoked responses and normal physiologic responses to auditory stimuli. Not talking to comatose patients may promote the notion that they are dead or nearly dead; not talking may become a self-fulfilling prophecy, influencing physicians to inappropriately withhold or withdraw therapy. Because comatose patients are especially vulnerable, and because some comatose patients may recover, physicians should consider talking to these patients. Our analysis suggests that families, medical students, and house staff would benefit from the humane example modeled by those clinicians who care for and talk to all patients.
医生可能会出于多种原因而不与昏迷患者交谈。昏迷患者似乎听不到或没有反应。交谈可能不会影响他们的临床结果；与他们相处的时间会占用照顾其他更“有治疗价值”患者的时间。然而，昏迷患者可能是能听到的；许多患者脑干听觉诱发电位正常，对听觉刺激有正常的生理反应。不与昏迷患者交谈可能会助长他们已死亡或濒死的观念；不交谈可能会成为一种自我实现的预言，影响医生不恰当地停止或撤销治疗。由于昏迷患者特别脆弱，且一些昏迷患者可能会康复，医生应该考虑与这些患者交谈。我们的分析表明，家属、医学生和住院医生会从那些照顾并与所有患者交谈的临床医生树立的人文榜样中受益。
