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唐僧肉和预遗嘱 [复制链接]

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发表于 2014-8-10 10:28:46 |显示全部楼层
网友金雕信息:北京准备推行"安宁缓和医疗".据我所知"安宁缓和医疗"即美国早已提出的"姑息疗法",在美国一些州早已立法规定"老年人有要求姑息疗法的权利",是有法律保证的。中国不立法的结症在于过渡抢救有高额利润回报的,低则几十万,高达数百上千万,结果大多家破人亡,一人得病全家返贫。危急病人是"唐僧肉",无论是医院,医药部门都不希望失去抢吃"唐僧肉"的机会,因此医疗部门的各个层次都高度排斥有"姑息疗法"部分内容的"我的五个愿望"遗嘱的推广和执行!这是一场人权和利益的博弈!

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发表于 2014-8-10 22:48:28 |显示全部楼层
期待立法!

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发表于 2014-8-11 08:37:27 |显示全部楼层







!!!!!

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发表于 2014-8-11 18:26:32 |显示全部楼层
姑息疗法:延长生命,减轻痛苦<百度文摘>

译者: 静思静舍

发表时间:2011-03-05浏览量:2590评论数:0挑错数:0

世界卫生组织为晚期癌症患者的姑息治疗提出如下定义:“对所患疾病已经治疗无效的患者积极地、全面地医疗照顾。对疼痛,其他症状以及心理的、社会的和精神的问题的控制是首要的。 姑息性治疗的目的是使患者和家属获得最佳生活质量。姑息性治疗的很多方面也可与抗癌治疗一起应用于疾病过程的早期”。


Palliative care prolongs life, reduces suffering

姑息疗法:延长生命,减轻痛苦


By Liz Szabo,, USA TODAYUpdated Feb 22, 2011 8:50 PM

  Liz Szabo 《今日美国》更新时间:2011/2/22  8:50


There are no secret passwords in medicine, no mysterious handshakes or signals to use when seeking the best care for a serious illness.

人们寻求严重疾病的良方,但医学中并没有什么秘密口令,也没有什么秘密的手势或暗号可用。


But experts say two words come close: palliative care.

然而,一些专家认为有两个词几乎可以打开医学的密码:姑息治疗。


Many people have never heard of palliative care, a comprehensive service that aims to relieve suffering in people with serious illnesses, such as cancer, lung disease or kidney failure.

很多人对姑息治疗法闻所未闻,这是一种综合一系列治疗的疗法,旨在帮助身患癌症、肺病或肾衰竭等重病的人减轻痛苦。



Some patients — and even many doctors — confuse palliative medicine with hospice, a form of palliative care for people in the last six months of life. Other patients mistakenly worry that doctors won't work as hard to cure them if they ask for palliative care, says Gail Cooney, former president of the American Academy of Hospice and Palliative Medicine.

美国临安宁疗法和姑息疗法研究中心的前任主席盖尔·库尼说,一些患者,甚至许多医生都还对具有安宁疗效的姑息疗法心存怀疑。这种疗法适用于那些生命仅剩半年的患者。还有部分病人误以为,如果自己要求接受姑息治疗的话,医生就不会尽心治疗自己了。


Those notions could change in light of recent research.

这些观点会随着新研究的开展而改变。

A study of 151 patients published last summer in The New England Journal of Medicine showed that getting early palliative care — in addition to regular medical treatment — helpedpeople with lung cancer live three months longer, compared with those given standard care.

去年夏天《新英格兰医学杂志》上发表了一项相关的研究结果:这项以151名患者为对象的研究显示,除了常规的医疗措施外,早早地接受姑息治疗可以让肺癌患者比那些接受医院标准治疗的患者多活三个月。


In comparison, chemo can give newly diagnosed lung cancer patients an extra two to three months of life, says study co-author Thomas Lynch, director of the Yale Cancer Center.

托马斯·林奇,耶鲁大学癌症研究中心主任,也是上述研究报告的撰写人之一谈到,相比之下,化疗可以让早期肺癌患者多活两到三个月。

"If this was a drug, this would be on the front page of every paper in the country, talking about 'New advance in lung cancer,' " Lynch says.

他说:“如果这是一种药的话,全国凡是谈及“肺癌研究新进展”的文章都会把它列在首页上推荐。”


But palliative care patients didn't just live longer. They also lived better, with less depression and a higher quality of life, he says.

事实上,接受姑息来疗法的患者不仅仅是延长了生命,他们还因为少了一些绝望,生活质量得到提高而活得更好了。

Tailored to the patient

因患施医


It's never too early to ask about the service, doctors say.

许多医生建议,越早要求接受姑息治疗对病情越有利。


People can begin palliative care as soon as they're diagnosed with a serious illness, even if they still hope to be cured, says Thomas Smith, medical director of palliative care at Virginia Commonwealth University's Massey Cancer Center in Richmond.

弗吉尼亚联邦大学梅赛癌症研究中心(位于里士满)的医药主任托马斯·史密斯说,一旦被确诊为得了重症,患者就可以开始接受姑息疗法,即便所患的不是不治之症。


Teams that provide palliative care focus on talking to patients, trying to understand people's values and tailor care to the patients' goals, Cooney says.

库尼也说道,提供姑息疗法的团队主要是同病人交谈,试着去理解病人的价值观,然后根据病人想达到的效果实施治疗方案。

These teams — which often include psychologists, social workers, pharmacists, nutritionists and chaplains — also coordinate treatment, which can be especially important if people are being seen at more than one center, says Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

新罕布什尔州利巴嫩的达特茅斯-希契科克医疗中心姑息治疗部主任 Ira Byock介绍道,姑息疗法团队通常由心理学家、社会工作者、药剂师、营养师和牧师组成,同时也结合医院的治疗,因为如果病人的病情很复杂的话,医院的治疗也是非常重要的。


The teams also support caregivers, who have a critical role in patients' health.

姑息治疗团队中也需要包括家庭护理,这对病人的健康非常关键。

'People need to ask for it'

患者需主动要求


Because of her work, Cooney knew to ask for palliative care when she was diagnosed with advanced ovarian cancer nearly three years ago.

三年前,库尼被诊断出得了晚期卵巢癌。她因为工作的原因,知道主动要求接受姑息疗法。


"I wanted it all," says Cooney, 58, who's also the assistant medical director of Hospice of Palm Beach County in Florida. "I received very aggressive chemo. But I used a program of palliative care to control my symptoms and allow me to tolerate the chemo."

58岁的库尼是佛罗里达州棕榈滩县安宁疗护医院的医疗助理总监,她说:“我希望接受姑息疗法。之前我接受了副作用很强的化疗,姑息疗法帮我控制住了病情,我才受得了化疗。”

In addition to undergoing surgery and chemo at a hospital, Cooney sought palliative care through an outpatient center, the Sari Asher Center for Integrative Cancer Care in Palm Beach.

除了在医院接受手术和化疗,库尼通过一个门诊中心—棕榈滩癌症康复医院的Sari Asher中心获得了姑息治疗。

Though about 80% of large hospitals offer some kind of palliative care, there are fewer ways for patients to get support outside the hospital, where cancer patients today receive much of their care, Cooney says.

虽然80%的大医院都会或多或少地提供一些有关姑息疗法的信息,但除了棕榈滩癌症康复医院外,病人在其他医院很少能获得支持。如今许多癌症患者都在这里接受治疗。


She used both acupuncture and conventional drugs to avoid nausea and felt well enough to indulge in milkshakes to keep up her strength and weight.

库尼采用针刺疗法,同时服用一些常规的药物来遏制恶心,这样她才吃的下去奶昔,以此来保持体力和体重。


Palliative care helped with many aspects of cancer therapy, which put her in remission for two years, Cooney says.

她说姑息疗法对癌症治疗过程中的各个方面都有助益,两年来她的病情已经得到缓解。


She joined an ovarian cancer support group, received one-on-one counseling with an oncology social worker and met with a nurse educator to better understand the many drugs she was taking.

她还加入了一个卵巢癌患者帮助中心,获得一对一咨询一位肿瘤学社会工作者的机会,还可以跟一位护理教育者交流,从而更好地了解她正在服用的药物。   


After her cancer began growing again last fall, Cooney resumed intravenous chemo and hopes for a good response.

去年秋天,她的癌症复发,她再次接受静脉化疗,希望可以控制住病情。

Cooney says she wishes that more patients and their caregivers knew to ask for palliative care. "People think, 'My doctor will ask if I need it,' " Cooney says. "But people need to ask for it. It can be tough to challenge a doctor. But if people begin asking and advocate for themselves, generally doctors will say OK."

库尼说,她希望更多的患者及他们的家庭护理懂得主动去要求接受姑息疗法.她说:“患者认为‘如果我需要这种疗法的话,我的医生会告诉我的’,可事实上,患者得自己去要求。因为让医生主动的话他们还有为难之处,如果病人自己要求,一般情况下医生都会同意的。”


Saving money

节省治疗费用


Palliative care also could help cut spiraling medical costs, Smith says. Studies show it can save hundreds of dollars a day, keeping patients out of the hospital or expensive intensive-care units.

史密斯说姑息疗法可以让患者省下一大笔医药费。研究显示,因为姑息疗法可以让患者在院外接受治疗,或者不必住在费用高昂的重症病房,每天可以省下数百美元。


Kaiser Permanante, an integrated system in which the same company operates hospitals and insurance plans, found that people cared for by a palliative team live just as long as or longer than others and had fewer symptoms.

Kaiser Permanante是棕榈滩癌症康复医院构建的一个综合性医疗系统,其中有医院,有保险项目。该系统研究发现,接受姑息疗法的患者可以和接受医院常规治疗的患者活得一样长,甚至更长,并且症状要少得多。


Their caregivers also experience a lighter burden because the programs address their needs as well, Smith says.

在这里输入译文史密斯说,照顾患者的人也少了很多负担,因为姑息疗法团队会解决患者的许多需求。


"No death panels here — exactly the opposite," he says.

他说:“我们这里的死亡人数没有增加,事实正好相反。”


In spite of these benefits, palliative programs struggle to reach everyone who might need them, Smith says. That's because few health systems are as coordinated as Kaiser, he says.

他还介绍道,姑息疗法的各种项目虽然于患者有利,但要让每一位有此类需要的患者都活得治疗还很有难度,主要是因为像Kaiser Permanante这么完备的医疗系统还很少。


The bottom line

利弊得失
史密斯说:“如果可以获得更多的家庭和教会支持那就好极了。大多数治疗团队没法为这部分出资。”


In most cases, the cost savings from palliative care are spread throughout the system — saving money for Medicare, for example — instead of returning money to individual hospitals or programs, Smith says. So in the short term, individual hospitals may lose money, even if the country overall saves money.

大多数情况下,从姑息疗法中省下来的钱还是要用到健康系统中去,比如,用于患者的医疗保健,而不是把钱退还给医院或实施治疗的项目组,所以在短期内,虽然国家整体上可以节省开支,但个别的医院会有所损失。


"It would be terrific to have more family support, more chaplain support," he says. "Most programs don't have any way to pay for that."

The Massey Cancer Center pays for a psychologist partly by reducing physician salaries, Smith says. His team also does fundraising to pay for a chaplain, who he says "is critical to help people come to terms with their illness and often the end of life."

史密斯说:“如果可以获得更多的家庭和教会支持那就好极了。大多数治疗团队没法为这部分出资。”

梅赛癌症中心通过降低医师的部分工资聘请了一位心理学家。史密斯的医疗团队还集资请了一位牧师,他说:“牧师对重症患者,对那些徘徊在生死边缘的人来说是非常关键的。”


Without enough resources for everyone, palliative care programs often give first priority to people with advanced or fast-moving cancers, such as pancreatic tumors, Byock says.

Byock说,由于资源缺乏,姑息疗法项目团队通常只能优先考虑晚期癌症患者以及癌细胞扩散得特别快的患者,比如胰腺肿瘤患者。


"Even the most robust palliative care programs have limited resources," he says. "If someone has a serious diagnosis and they have only the 'ordinary' level of stress, we'd likely not see them."

他说:“即便是最完备的姑息疗法项目组也面临着资源不足的问题。所以当某位患者被确诊患了某种重症,但严重程度只是‘一般’的话,我们很有可能先不考虑他。”


But patients shouldn't give up.

无论如何,病人自己不应该放弃。


"It really does take one-on-one advocacy," Byock says. "You have to be savvy enough to ask for it. Just say, 'We want the best care for our loved one.' "

Byock说:“这种疗法的确需要患者自己向医生要求。你自己得有意识去主动要求,你只要对医生说‘为了爱我的人,我想要接受最好的治疗’。”
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