Palliative Education and Research Centre, Vrinnevi hospital, Norrköping, Sweden.
Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
BMC Med Ethics. 2023 Aug 9;24(1):61. doi: 10.1186/s12910-023-00943-8.
Thirst and dry mouth are common symptoms in terminally ill patients. In their day-to-day practice, palliative care physicians regularly encounter ethical dilemmas, especially regarding artificial hydration. Few studies have focused on thirst and the ethical dilemmas palliative care physicians encounter in relation to this, leading to a knowledge gap in this area.
The aim of this study was to explore palliative care physicians' experiences of ethical challenges in relation to thirst in terminally ill patients.
A qualitative interview study with an inductive approach was conducted. Sixteen physicians working in four different specialised palliative care units and one geriatric care unit in different hospitals in Sweden were interviewed. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis.
When presented with an ethical challenge relating to thirst, physicians attempted to balance benefits and harms while emphasizing respect for the patient's autonomy. The ethical challenges in this study were: Starting, continuing or discontinuing drips; lack of evidence and traditions create doubt; and lack of interest and time may result in patient suffering.
All physicians in this study reported that "Starting, continuing or discontinuing drips" was the main ethical challenge they encountered, where some were so accustomed to the decision that they had a standard answer ready to offer patients and families. Physicians reported that drips were a symbol of thirst quenching, life and survival but were not necessary in end-of-life care. Others questioned the traditions regarding thirst and emphasised drips in particular.
口渴和口干是终末期患者常见的症状。在日常实践中，姑息治疗医生经常遇到伦理困境，特别是在人工补液方面。很少有研究关注口渴以及姑息治疗医生在这方面遇到的伦理困境，导致该领域存在知识空白。
本研究旨在探讨姑息治疗医生在终末期患者口渴方面所面临的伦理挑战的经验。
采用定性访谈研究方法，采用归纳法。对瑞典四家不同医院的四个专门姑息治疗单位和一家老年护理单位的 16 名医生进行了访谈。访谈内容逐字转录，并采用反思性主题分析进行分析。
当面临与口渴相关的伦理挑战时，医生试图平衡利益和危害，同时强调尊重患者的自主权。本研究中的伦理挑战包括：开始、继续或停止滴注；缺乏证据和传统会产生怀疑；以及缺乏兴趣和时间可能导致患者痛苦。
本研究中的所有医生都报告说，“开始、继续或停止滴注”是他们遇到的主要伦理挑战，其中一些医生对此类决策已经习以为常，以至于他们已经准备好为患者和家属提供标准答案。医生们报告说，滴注是解渴、生命和生存的象征，但在临终关怀中并非必需。其他人则对关于口渴的传统提出了质疑，并特别强调了滴注。
