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[麻醉与麻醉学的175年——迈向“无意识的人权”]

[175 years of anesthesia and narcosis-Towards a "human right to unconsciousness"].

作者信息

Lewandowski K, Kretschmer B, Schmidt K W

机构信息

Anästhesiologie und operative Intensivmedizin, Charité (extern), Berlin, Deutschland.

Justus-Liebig-Universität, Gießen, Deutschland.

出版信息

Anaesthesist. 2021 Oct;70(10):811-831. doi: 10.1007/s00101-021-01043-1. Epub 2021 Sep 16.

Abstract

The Ether Day, a key moment in the history of mankind, commemorates its 175th anniversary on 16 October 2021. On that day the dentist William T. G. Morton successfully gave the first public ether anesthesia in Boston. From then on it was possible to save people from pain with justifiable risk and at the same time to protect them from psychological damage by inducing unconsciousness. The German philosopher Peter Sloterdijk, one of the most renowned and effective philosophers of our times, deduced that from then on humans, to some extent, had a right to unconsciousness when in psychophysical distress. This postulate unfolded from his concept of "anthropotechnics" developed around 1997, meaning the idea of treating human nature as an object of possible improvements. According to Sloterdijk, in favorable cases a synthesis of man and technology can result in a significant improvement of human capabilities in the sense of "enhancement", i.e. an increase, an improvement or even an expansion of intellectual, physical or psychological possibilities, as it were in a transgression of the human (so-called transhumanism). Man should go into vertical tension, i.e. strive for higher aims and exploit his inherent potential, he should not dwell in the horizontal. This is not meant as an appeal but as an imperative: "You must change your life!". In this context modern anesthesia may prove helpful: be operated on by others in order to undergo an enhancement. Or, in its most extreme form, the operation in the "auto-operational curved space", a person can even operate on himself as has been dramatically demonstrated by Rogozov, a young Russian physician and trainee surgeon who successfully performed a self-appendectomy under local anesthesia at the Novolazarevskaya Antarctic Station in 1961; however, the implementation of this idea is a long way off. On the one hand, many countries lack qualified personnel in sufficiently large numbers to perform even vital operations with patients under anesthesia. On the other hand, over the decades it has become clear that anesthesia is obviously beneficial for mankind in that it offers relief from pain and psychological stress but that it can also often show its dark side: substance abuse, use of anesthetics in torture and in executions. In addition, the role of anesthetics in resuscitation, palliative care, and allaying executions is unclear or controversial. Finally, the necessary formal legal steps to acknowledge a "human right to unconsciousness" have not yet been implemented.

摘要

2021年10月16日,人类历史上的关键节点——乙醚日迎来了它的175周年纪念日。在那一天,牙医威廉·T·G·莫顿在波士顿成功实施了首例公开的乙醚麻醉。从那时起,人们就有可能在合理风险下使他人免受疼痛折磨,同时通过诱导昏迷来保护他们免受心理伤害。德国哲学家彼得·斯洛特戴克是我们这个时代最著名、最有影响力的哲学家之一,他推断,从那时起,人类在身心痛苦时在某种程度上有权进入无意识状态。这一假设源于他在1997年左右提出的“人类技术学”概念,即把人性视为可能得到改善的对象的理念。按照斯洛特戴克的说法,在有利的情况下,人与技术的融合能够在“增强”意义上显著提升人类能力,也就是在智力、身体或心理可能性方面实现增长、改善甚至扩展,仿佛是对人类的一种超越(即所谓的超人类主义)。人类应该进入纵向张力状态,即追求更高目标并挖掘自身内在潜力,而不应停留在横向层面。这并非一种呼吁,而是一道命令:“你必须改变你的生活!”在这种背景下,现代麻醉可能会有所帮助:让他人为自己实施手术以实现增强。或者,以其最极端的形式,在“自动手术弯曲空间”中进行手术,一个人甚至可以给自己做手术,1961年,年轻的俄罗斯内科医生兼实习外科医生罗戈佐夫在新拉扎列夫斯卡亚南极科考站成功地在局部麻醉下为自己切除阑尾,就戏剧性地证明了这一点;然而,这一想法的实现还任重道远。一方面,许多国家缺乏足够数量的合格人员来为接受麻醉的患者实施哪怕是至关重要的手术。另一方面,几十年来已经很清楚的是,麻醉显然对人类有益,因为它能缓解疼痛和心理压力,但它也常常展现出其阴暗面:药物滥用、在酷刑和处决中使用麻醉剂。此外,麻醉剂在复苏、姑息治疗以及减轻处决痛苦方面的作用尚不明确或存在争议。最后,承认“无意识人权”所需的必要正式法律步骤尚未实施。

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