什么是美好的死亡?批判性话语政策分析。

IF 2 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES BMJ Supportive & Palliative Care Pub Date : 2024-12-19 DOI:10.1136/bmjspcare-2019-002173
Erica Borgstrom
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引用次数: 0

摘要

摘要美好死亡的概念是生命末期关怀政策的一个激励因素;本文研究了英国生命末期关怀(EOLC)政策对美好死亡的定义:方法:对 2008 年至 2016 年间发布的政策文件和政策宣传材料进行批判性话语分析:结果:政策明确将美好的死亡定义为具有以下特征:作为个体受到有尊严的对待和尊重;没有疼痛和其他症状;在熟悉的环境中以及在亲密的家人和/或朋友的陪伴下。对 54 份文件进行的批判性话语分析发现,对美好死亡的描述不仅仅是结果或事件,还包括许多过程。一个更宽泛的定义包括:临终者得到全面的临终关怀;临终者得到有尊严的对待和尊重;死亡不是突然和意外的;人们做好了准备,最好已经做了一些预先护理计划;人们意识到有人即将死亡,并公开讨论此事;在了解临终者的偏好后,所有相关人员都要努力实现这些偏好;死亡地点很重要;临终者的家人参与其中,并考虑到遗属的需求:这项分析表明了当前在生命周期护理政策中围绕良好死亡的论述的复杂性,其重点往往在于护理而非死亡。政策应侧重于概述高质量的临终关怀是什么样的,而不是假定 "好的死亡 "是一个合适的结果声明。
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What is a good death? A critical discourse policy analysis.

Objective: The concept of a good death is a motivating factor for end of life care policy; this article examines what English end-of-life care (EOLC) policy defines as a good death.

Methods: Critical discourse analysis of policy documents and policy-promoting materials published between 2008 and 2016.

Results: Policy explicitly defines a good death as having the following attributes: being treated as an individual, with dignity and respect; being without pain and other symptoms; being in familiar surroundings and being in the company of close family and/or friends. Critical discourse analysis of 54 documents found that rather than just being an outcome or event, descriptions of what makes a death good also include many processes. A more extended definition includes: the person receives holistic EOLC; the dying person is treated with dignity and respect; the death is not sudden and unexpected; people are prepared and have ideally done some advance care planning; people are aware that someone is dying and openly discuss this; on knowing the dying person's preferences, all involved are to work towards achieving these; the place of death is important; the person's family are involved and the needs of the bereaved are considered.

Conclusion: This analysis indicates the complex nature of the current discourses around good death in EOLC policy, which often focuses on care rather than death. Policy should focus on outlining what quality end-of-life care looks like, rather than assume 'good death' is a suitable outcome statement.

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来源期刊
BMJ Supportive & Palliative Care
BMJ Supportive & Palliative Care Medicine-Medicine (miscellaneous)
CiteScore
4.60
自引率
7.40%
发文量
170
期刊介绍: Published quarterly in print and continuously online, BMJ Supportive & Palliative Care aims to connect many disciplines and specialties throughout the world by providing high quality, clinically relevant research, reviews, comment, information and news of international importance. We hold an inclusive view of supportive and palliative care research and we are able to call on expertise to critique the whole range of methodologies within the subject, including those working in transitional research, clinical trials, epidemiology, behavioural sciences, ethics and health service research. Articles with relevance to clinical practice and clinical service development will be considered for publication. In an international context, many different categories of clinician and healthcare workers do clinical work associated with palliative medicine, specialist or generalist palliative care, supportive care, psychosocial-oncology and end of life care. We wish to engage many specialties, not only those traditionally associated with supportive and palliative care. We hope to extend the readership to doctors, nurses, other healthcare workers and researchers in medical and surgical specialties, including but not limited to cardiology, gastroenterology, geriatrics, neurology, oncology, paediatrics, primary care, psychiatry, psychology, renal medicine, respiratory medicine.
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