Current practices in managing end-of-life existential suffering.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2023-06-01 Epub Date: 2023-04-10 DOI:10.1097/SPC.0000000000000646

Michelle Di Risio, Alison Thompson

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Abstract

Purpose of review: Within the context of palliative care, existential suffering (ES) can be an exclusive source of suffering or intertwined with physical pain and/or psychological and spiritual suffering. With newly emerging modalities for addressing this phenomenon and its increasing salience given that many patients cite ES as a significant contributing factor to requests for hastened death, a review of recent interventions for addressing ES at the end of life is timely.

Recent findings: This review of newer approaches to dealing with ES in the palliative context suggests some promising new modalities and pharmacological interventions, such as brain stimulation and the use of psychedelics. The use of other pharmacological interventions, such as palliative sedation and lethal injections, solely for the alleviation of existential distress remains ethically controversial and difficult to disentangle from other forms of suffering, not least because a clear clinical definition of ES has yet to emerge in the literature.

Summary: The evaluation of end-of-life (EOL) ES mitigating tools should also consider how broader contexts, such as institutional arrangements and barriers, and cultural factors may influence the optimal management of dying persons' ES in the palliative care setting.

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管理临终生存痛苦的当前做法。

审查目的：在姑息治疗的背景下，生存痛苦（ES）可能是痛苦的唯一来源，也可能与身体痛苦和/或心理和精神痛苦交织在一起。鉴于许多患者认为ES是导致加速死亡的重要因素，新出现的解决这一现象的方式及其日益突出的重要性，对最近在生命结束时解决ES的干预措施进行审查是及时的。最近的发现：这篇关于在姑息治疗背景下处理ES的新方法的综述提出了一些有前景的新模式和药物干预措施，如脑刺激和迷幻药的使用。仅仅为了缓解生存痛苦而使用其他药物干预措施，如姑息镇静和致命注射，在伦理上仍然存在争议，并且很难将其与其他形式的痛苦区分开来，尤其是因为文献中尚未出现ES的明确临床定义。总结：对临终ES缓解工具的评估还应考虑更广泛的背景，如制度安排和障碍，以及文化因素，如何影响姑息治疗环境中临终患者ES的最佳管理。

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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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.