面对我们自己的死亡:探讨我们个人的专业立场与我们对千年发展目标的个人观点之间的冲突

Anna Towers
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摘要

自2016年起,加拿大开始合法提供医生管理的安乐死(Medical-Aid-in-Dying,简称MAiD),其适应症不断扩大。加拿大大多数姑息治疗医生自己并不提供MAiD,但会转介给提供这一程序的同事。作者参与了一项关于MAiD的定性研究项目,调查蒙特利尔姑息关怀医生对其角色的看法。该项目的一个有趣发现是,我们个人的个人观点(即当我不可避免地面对自己的死亡时,我希望自己得到什么)与我作为姑息关怀医生的专业观点(即我准备提供什么样的临终关怀,或者我认为病人应该得到什么)可能存在根本性的差异。我们教导我们的受训者(以及社区),死亡在一个人的自然生命结束之前都是有意义的。面临绝症的病人通常表示害怕成为他人的负担。然而,根据病人所爱之人表达的观点,我们认为这种情绪往往没有充分的依据。然而,即使病人接受了最好的姑息治疗,死亡也可能是困难的。我们对什么是有尊严的生命终结以及病人和家属(最终也包括我自己)会经历什么的专业看法可能会有所不同。本讲座将引发我们对这种对立的反思。当我们的专业观点和个人观点发生冲突时,这种内心的分裂会引发怎样的感受? 我是一个不诚实的医生吗?然而...
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Facing our own dying: exploring conflicts between our individual professional stance and our own personal views on MAiD
Physician-administered euthanasia (Medical-Aid-in-Dying or MAiD) has been legally available in Canada since 2016, with ever-widening indications. Most palliative care physicians in Canada do not provide MAiD themselves but will refer to colleagues who provide this procedure. The author was involved in a qualitative research project on MAiD, looking at the views of Montreal-based palliative care physicians regarding their role. One interesting finding from that project is that our own individual personal views (i.e., what I would want for myself when I will inevitably face my own death) versus my professional views as a palliative care physician (i.e., the kind of end-of-life care that I am ready to provide, or what I think patients should receive) may radically differ. We teach our trainees (and the community beyond) that dying can have meaning up to the end of one’s natural life. Patients facing terminal illness commonly express a fear of becoming a burden to others. Yet we teach that this sentiment is often not well-founded, based on the expressed views of the patient’s loved ones. And yet dying can be difficult, even when patients receive the best available palliative care. Our professional view of what constitutes a dignified end-of-life and what patients and families (and I, eventually) will experience may be different. This presentation will spark reflection regarding this dichotomy. What feelings might this inner split provoke, when our professional and personal views conflict with each other?  Am I being a dishonest physician? And yet…
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