Meier D E, Morrison R S, Cassel C K
Mount Sinai School of Medicine, New York, New York, USA.
Ann Intern Med. 1997 Aug 1;127(3):225-30. doi: 10.7326/0003-4819-127-3-199708010-00008.
Although most deaths in the United States occur in hospitals, data suggest that hospitals and physicians are not equipped to handle the medical and psychosocial problems of dying patients. In this article, we review the barriers to achieving a peaceful death, including inadequate medical professional education on palliative care, and public and professional uncertainty about the difference between foregoing life-sustaining treatment and active euthanasia, and health professionals' difficulty recognizing when patients are dying and the associated sense that death is a professional failure. Other barriers include fiscal constraints on the length of stay, the number of nurses available to care for dying patients, legal and regulatory constraints on obtaining opioid prescriptions, and a segregated system of hospice care that requires patients to be separated from familiar health care providers and settings in order to receive palliative care at the end of life. Identifying the opportunities that can improve the delivery of palliative care at the end of life is the first step toward developing corrective approaches. Strategies that enhance these opportunities are proposed.
尽管美国的大多数死亡事件发生在医院，但数据表明，医院和医生并未做好应对临终患者医疗和心理社会问题的准备。在本文中，我们审视了实现安详死亡的障碍，包括姑息治疗方面医学专业教育不足、公众和专业人士对放弃维持生命治疗与主动安乐死之间差异的不确定性，以及卫生专业人员难以识别患者何时濒临死亡以及随之而来的认为死亡是专业失败的观念。其他障碍包括住院时长的财政限制、照顾临终患者的护士数量、获取阿片类药物处方的法律和监管限制，以及临终关怀的隔离体系，该体系要求患者与熟悉的医疗服务提供者和环境分离，以便在生命末期接受姑息治疗。识别可改善临终姑息治疗提供情况的机会是制定纠正措施的第一步。本文还提出了增强这些机会的策略。
