School of Psychiatry, Faculty Medicine & Ageing Futures Institute, University of New South Wales, Capacity Australia (CP), Sydney, Australia.
Marie Curie Palliative Care Research Unit, Division of Psychiatry, University College London (ELS), London, United Kingdom.
Am J Geriatr Psychiatry. 2021 Oct;29(10):1041-1046. doi: 10.1016/j.jagp.2021.05.015. Epub 2021 May 30.
The human right to a good death and dying well is as important as the right to life. At stake at the end of life are human rights to dignity, autonomy, self-determination and respect for will and preferences, equitable access to quality health care that is needs-based, and respect for family and relationships. Older people with dementia, those with serious mental illness, and those with intellectual disability are vulnerable to "bad deaths" due to violations of these rights. In this paper we explore why this is so and examine existing and potential solutions. A human rights-approach to end-of-life care and policy for older persons with mental health conditions and psychosocial disability is one that is needs-based, encompassing physical and mental health, palliative care, social, and spiritual support services provided in the context of inclusive living. Most importantly, end of life care must be self-determined, and not "one size fits all." An important remedy to existing violations is to strengthen human rights frameworks to cater specifically to older persons' needs with a UN convention on the rights of older persons. Finally, as health professionals we have important contributions to make at the coalface by accepting our responsibilities in the area of death and dying. With the concept of the palliative psychiatrist gaining traction and recognition that death is our business, we add that human rights is also our business.
人类享有善终和临终尊严的权利与生命权同样重要。在生命末期，人们的尊严、自主权、自我决定以及意愿和偏好得到尊重、基于需求获得公平的优质医疗保健、以及家庭和人际关系得到尊重的权利都受到了威胁。患有痴呆症的老年人、患有严重精神疾病的人和智力残疾者由于这些权利受到侵犯，容易遭受“糟糕的死亡”。在本文中，我们探讨了为什么会这样，并研究了现有的和潜在的解决方案。基于人权的老年人心理健康和社会心理残疾者临终关怀和政策是一种基于需求的方法，包括身体和心理健康、姑息治疗、社会和精神支持服务，这些服务是在包容的生活环境中提供的。最重要的是，临终关怀必须是自我决定的，而不是“一刀切”。加强人权框架，专门满足老年人的需求，并制定一项关于老年人权利的联合国公约，是纠正现有侵犯行为的重要补救措施。最后，作为卫生专业人员，我们在临终关怀领域承担着重要的责任，我们通过接受这一责任，在临终关怀领域做出了重要贡献。随着姑息精神病学家概念的普及以及认识到死亡是我们的业务，我们补充说，人权也是我们的业务。
