College of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, Kansas City, MO, USA.
Departments of Internal Medicine & Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
Yale J Biol Med. 2022 Sep 30;95(3):399-403. eCollection 2022 Sep.
Early initiation of end-of-life (EOL) conversations has been shown to improve patient agency in dying, increase early access to hospice care, and facilitate a dignified death. Despite the benefits of early initiation, EOL conversations do not occur as readily as physicians or patients wish. While medicine is commonly considered both a science and an art, increasing medicalization may narrow a clinician's focus towards procedures or specialized clinical frameworks rather than a patient's end-of-life wishes. Since physicians are ambassadors of clinical knowledge and are trusted patient advocates, it is important they facilitate EOL conversations early in the dying process. Patients desire their physicians to convene these conversations. However, physicians are often hesitant to do so. Notable theologians, philosophers, and physicians offer a broad framework outlining the importance of physician-led EOL conversations.
早期开展临终(EOL)谈话已被证明可以提高患者在临终时的自主权,增加早期获得临终关怀的机会,并促进有尊严的死亡。尽管早期开展临终谈话有诸多益处,但实际情况并不像医生或患者所希望的那样容易进行。虽然医学通常被认为既是一门科学也是一门艺术,但日益增加的医学化可能会使临床医生的注意力集中在程序或专门的临床框架上,而不是患者的临终愿望上。由于医生是临床知识的传播者,也是患者信任的拥护者,因此他们在临终过程中尽早进行 EOL 对话非常重要。患者希望他们的医生来进行这些对话。然而,医生往往犹豫不决。著名的神学家、哲学家和医生提供了一个广泛的框架,概述了医生主导的 EOL 对话的重要性。