Kremeike Kerstin, Pralong Anne, Boström Kathleen, Bausewein Claudia, Simon Steffen T, Lindner Reinhard, Voltz Raymond
Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
Department of Palliative Medicine, Munich University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
Ann Palliat Med. 2021 Mar;10(3):3594-3610. doi: 10.21037/apm-20-381. Epub 2021 Jan 5.
Desire to die, understood as a broad phenomenon, is common in patients receiving palliative care. Euthanasia ("termination of life on request", §216 German Criminal Code) is currently forbidden in Germany, the legal restrictions with regard to assisted suicide ("assistance of suicide with intent of repeated conduct", §217 German Criminal Code) has recently been repealed by the national Federal Constitutional Court. This dynamically changing legal situation adds to health professionals reported uncertainty in dealing appropriately with a desire to die.
As part of the new extended version of the German Palliative Care Guideline for Patients with Incurable Cancer, evidence and consensus-based statements and recommendations on desire to die were developed by an interdisciplinary and multi-professional working group. The best available evidence was identified through systematic literature searches and by asking experts for further known quantitative as well as qualitative literature. Included publications were assessed as recommended by the Scottish Intercollegiate Guidelines Network (SIGN). Due to the limited availability of high-quality empirical publications related to desire to die, close attention was paid to national clinical expertise to develop recommendations. Consensus for these recommendations was reached at a conference of the guideline group consisting of elected representatives from 61 professional societies and patient associations. Each recommendation was approved by at least 75% of those present.
The expert panel developed and agreed on 21 statements and recommendations on desire to die and related phenomena. A descriptive definition was agreed upon of desire to die as a complex phenomenon with individual causes, manifestations, and consequences. The potential background of desire to die, its meanings, functions and possible interventions are described. The guideline recommends proactively addressing and exploring a potential desire to die as the intervention that should be considered before all others, because evidence from studies on suicidality found no negative effect when asking study participants about suicidality.
The guideline informs health professionals working within the German statutory framework, how to care for and communicate with patients who are receiving palliative care and who express a desire to die.
将求死欲望理解为一种广泛现象，在接受姑息治疗的患者中很常见。安乐死（“应要求终止生命”，《德国刑法典》第216条）目前在德国被禁止，关于协助自杀（“意图反复实施而协助自杀”，《德国刑法典》第217条）的法律限制最近已被国家联邦宪法法院废除。这种动态变化的法律状况加剧了卫生专业人员在适当应对求死欲望方面所报告的不确定性。
作为新版扩展的《德国晚期癌症患者姑息治疗指南》的一部分，一个跨学科和多专业工作组制定了基于证据和共识的关于求死欲望的声明和建议。通过系统的文献检索以及向专家询问其他已知的定量和定性文献来确定最佳现有证据。纳入的出版物按照苏格兰跨学院指南网络（SIGN）的建议进行评估。由于与求死欲望相关的高质量实证出版物数量有限，在制定建议时密切关注了国家临床专业知识。在由61个专业协会和患者协会推选代表组成的指南小组会议上达成了这些建议的共识。每项建议都得到了至少75%与会者的批准。
专家小组制定并就21项关于求死欲望及相关现象的声明和建议达成一致。就求死欲望达成了一个描述性定义，即这是一种具有个体原因、表现和后果的复杂现象。描述了求死欲望的潜在背景、其含义、功能和可能的干预措施。该指南建议主动处理和探究潜在的求死欲望，这是所有其他干预措施之前应考虑的干预措施，因为关于自杀倾向的研究证据表明，询问研究参与者关于自杀倾向时没有负面影响。
该指南告知在德国法定框架内工作的卫生专业人员，如何护理接受姑息治疗且表达求死欲望的患者以及如何与他们沟通。
