Are physicians ethically obligated to address hospice as an alternative to "usual" treatment of advancing end-stage disease?

Frederick A Smith
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Abstract

Hospice care is ideally suited to meet the psychosocial and spiritual needs of dying patients, providing the opportunity to settle financial, property, and inheritance issues; to mend lacerations in important lifetime relationships, including forgiving and asking forgiveness; and to assure a degree of autonomous control over the environment and the social and spiritual processes that attend one's death. Physicians are not only imprecise in prognosticating a patient's time to die, they tend to be over-optimistic in their predictions. A "no" answer to the question, "Would I be surprised if this patient died in the next year?" is a reasonable starting-point for discussing hospice care as a potential treatment plan, now or in the future. Physicians have a duty to present palliative care in hospice as an alternative to the recurrent hospital interventions that are typical in the last six to 12 months of life tor patients who are failing and have declining prospects for one-year survival.

医生是否有道德义务将临终关怀作为晚期疾病 "常规 "治疗的替代方案?
安宁疗护非常适合满足临终病人的社会心理和精神需求,提供机会解决财务、财产和继承问题;修补一生中重要关系的裂痕,包括宽恕和请求宽恕;以及确保在一定程度上自主控制环境以及伴随死亡的社会和精神过程。医生在预测病人的死亡时间时不仅不够精确,而且往往过于乐观。对于 "如果这个病人在未来一年内死亡,我会感到惊讶吗?"这个问题,回答 "不会 "是讨论安宁疗护作为一种潜在治疗方案的合理起点,无论是现在还是将来。医生有责任将临终关怀中的姑息治疗作为一种替代方案,而不是在生命的最后六到十二个月内反复进行的医院干预,因为这些干预对于生命衰竭且一年存活率下降的病人来说是非常典型的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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