姑息医学总体原则和伦理学思考.pptVIP

姑息医学:总体原则和伦理学思考 Palliative Care: General principles Ethical considerations 罗伯特 · 吐温克劳斯 Robert Twycross April 2005 姑息医学的基本焦点 关怀患癌病的人 而不是 只对付人所患的癌症 这个微小的理念变化，使得关怀模式产生了极大的差异 Essential Focus in Palliative Care The PERSON with cancer rather than The person with CANCER A small change which makes a big difference 患病与疾病 姑息关怀就是进行“姑息缓解” “姑息缓解”的目的不是进行根治 “姑息缓解”的目的不是为了幸存 “姑息缓解”是我们所要做的一切 Palliative Care is about Healing The aim of healing is not to be cured The aim of healing is not to survive The aim of healing is to become whole “姑息缓解”是要维持和恢复正常的关系Healing is about Restoring Right Relationships with self 与自身的关系 with other people 与他人的关系 with the environment 与环境的关系 with God 与上帝的关系 姑息关怀服务是多功能专家之间的一种伙伴关系 与疾病的关系，专家就是医生和其他健康职业者 与所患疾病产生影响的关系，专家就是病人和亲属 Palliative care is a partnership between experts In relation to the disease, the expert is the doctor other health professionals In relation to the impact of the illness, the expert is the patient the family 伙伴关系 尊重：以平等的关系,视为同类的一个成员来对待病人 坦诚相待的交流 聆听和解释 参与决定：采纳病人的意见，并优先考虑病人的自主权 优良的交流是成功的关键 Partnership Respect: treat patients as fellow human beings, as equals Honesty in communication Listen explain Shared decision-making: take the patient’s views priorities into account Good communication is the key to success 评 估“处理前先诊断”基于对可能性的预测和病程的识别 Evaluation ‘Diagnosis before treatment’ Based on probability pattern recognition 核心的伦理学原则Cardinal Ethical Principles Respect patient’s autonomy 尊重病人的自主权 Beneficence (do good) 行善（做好事） Non-maleficence (do no harm) 不作恶（不伤害） Justice (fair use of resources) 公正（公平应用资源） 绝对的伦理学原则 坦诚相待的交流 尊重生命 接受不可避免的死亡 Implicit Ethical Principles Honesty in communication Respect for life Acceptance of inevitability of death 伦理学思考 处理病人，而不只是治疗症状 把病人作为一个仍有价值的人 整体关怀的重要性；注重躯体的，心理的，社会和宗教的关怀 多功能职业团队的必要性 Ethical Considerations Treat the patient, not just the symptom Regard the patient as a person to b