Cooke M, Gourlay L, Collette L, Boccellari A, Chesney M A, Folkman S
Department of Medicine, University of California, San Francisco, USA.
Arch Intern Med. 1998 Jan 12;158(1):69-75. doi: 10.1001/archinte.158.1.69.
To determine the extent to which homosexual men dying of the acquired immunodeficiency syndrome (AIDS) receive medication intended to hasten death. To assess the impact on caregivers of administering medications intended to hasten death.
In a prospective study of caregiving partners of men with AIDS (n = 140), characteristics of the ill partner, the caregiver, and the relationship were assessed at baseline and 1 month before the ill partner's death. Three months after the death, caregivers were asked if they had increased their partner's narcotic and/or sedative-hypnotic medication dose and if so, what had been the objective of the increase, and their comfort with their medication decisions.
Of 140 ill partners who died of AIDS, 17 (12.1%) received an increase in the use of medications immediately before death intended to hasten death. Diagnoses and care needs of ill partners who received increases in the use of medications to hasten death did not differ from those of ill partners receiving medication for symptoms. Fourteen increases (10%) in use of medications were administered by caregivers. These caregivers did not differ from those administering medication for symptom control in level of distress, caregiving burden, relationship characteristics, or comfort with the medication decision, but they reported more social support and positive meaning in caregiving.
The decision to hasten death is not a rare event in this group of men. There is no evidence that it is the result of caregiver distress, poor relationship quality, or intolerable caregiving burden; and it does not cause excessive discomfort in the surviving partner. This study, although small, has implications for the policy debate on assisted suicide.
确定死于获得性免疫缺陷综合征（艾滋病）的同性恋男性接受旨在加速死亡药物治疗的程度。评估给予旨在加速死亡的药物对护理者的影响。
在一项对艾滋病男性患者护理伙伴的前瞻性研究中（n = 140），在患病伙伴死亡前的基线期和1个月时评估患病伙伴、护理者的特征以及两者之间的关系。在患病伙伴死亡3个月后，询问护理者是否增加了其伴侣的麻醉药和/或镇静催眠药剂量，如果是，增加剂量的目的是什么，以及他们对用药决定的舒适度。
在140名死于艾滋病的患病伙伴中，17名（12.1%）在死亡前立即增加了旨在加速死亡的药物使用。接受增加旨在加速死亡药物使用的患病伙伴的诊断和护理需求与接受对症治疗的患病伙伴没有差异。14次（10%）药物使用量的增加是由护理者实施的。这些护理者在痛苦程度、护理负担、关系特征或对用药决定的舒适度方面与实施症状控制用药的护理者没有差异，但他们报告在护理中获得了更多的社会支持和积极意义。
在这群男性中，加速死亡的决定并非罕见事件。没有证据表明这是护理者痛苦、关系质量差或难以承受的护理负担导致的结果；而且这也不会给幸存的伴侣带来过度不适。本研究虽然规模较小，但对关于协助自杀的政策辩论具有启示意义。
