De Ridder D, Gastmans C
Medical-Nursing Department, White and Yellow Cross, Ad. Lacomblélaan, Brussels, Belgium.
Nurs Ethics. 1996 Dec;3(4):305-16. doi: 10.1177/096973309600300404.
The purpose of this paper is to examine the possibilities and limitations of an ethical and practical approach to terminal dehydration. We have argued that dehydration among terminally ill patients offers an important key to a better understanding of the dying process, and that the caregivers' reactions can lead to a deepening of holistic palliative care. This article makes clear that the moral question of terminal dehydration can only be treated by an interdisciplinary approach. Therefore, before studying the question of the most humane course possible, we must first understand the meaning of dehydration and its repercussions for the dying patient. Inspired by an attitude of respect for a good dying process, we have suggested that it is possible to put forward as a general guideline that medical therapy should be progressively reduced when it has been determined that a patient has reached the terminal stage, or is in an irreversible deteriorating process. We describe the critical somatic, social, psychological, moral and spiritual points, which make up an ethical approach to terminal dehydration (TD). In the total care of the irreversibly terminally ill patient, tolerating TD can be an expression of an authentic and caring involvement in the dying patient's welfare.
本文的目的是探讨对末期脱水采取符合伦理且切实可行的方法的可能性与局限性。我们认为，绝症患者的脱水现象为更好地理解死亡过程提供了一个重要关键，而且护理人员的反应能够推动整体姑息治疗的深化。本文明确指出，末期脱水的道德问题只能通过跨学科方法来处理。因此，在研究尽可能人道的做法这一问题之前，我们必须首先了解脱水的含义及其对濒死患者的影响。受尊重良好死亡过程这一态度的启发，我们建议，可以提出这样一条总体指导原则：当确定患者已进入末期或处于不可逆转的恶化过程时，应逐步减少医学治疗。我们描述了构成末期脱水（TD）伦理方法的关键躯体、社会、心理、道德和精神要点。在对不可逆转的末期患者的全面护理中，容忍末期脱水可以体现出对濒死患者福祉的真诚且关切的投入。
