The significance and status quo of hospice 1
Hospice care is a new interdisciplinary subject which is studied by the physiological and psychological characteristics of the patients and the related medical, nursing, social and ethical issues. The purpose is to reduce the psychological burden of patients, relieve the fear and anxiety of patients with pain and death, and to meet the needs of patients' physiological, psychological and social needs, improve the quality of life and maintain the dignity of life. In the final years of life, can be in full of warmth in the atmosphere, calm, quiet, no pain, comfort and dignity to leave the world.
Hospice care in the current situation of our country: one is traditional culture of death taboo, negative view of life and death and filial piety to the development of hospice obstacles; second, the jobholders quality to hospice care implementation of quality control; the third is at present due to the lack of necessary policy support and social support to help the development of hospice care, capital leads to the serious shortage.
On the whole, the development of hospice care in our country starts late, the development is not balanced, the service is not standardized. Both lack of policy support, but also the lack of broad participation of the whole community.
Ethical dilemma in the 2 hospice care
2.1 changes in the standard of death for the "dying" is difficult to define
Hospice care main target is dying patients, so that can not be cured, and survival in severe patients within 6 months of peace and comfort to walk the road of life. In the past, whether patients with "dying", usually the doctor with the heart and lung function are functioning as diagnostic criteria. In recent years, with the progress of modern medical technology and the further understanding of the nature of life, scientists have gradually put forward the concept of brain death and brain death criteria. As a result, the standard of brain death as the standard of medical attention, however, there is a big difference between the standard of brain death and the traditional death. The short term is difficult to be accepted by the public. In addition to the challenges of the traditional ideas of the brain death legislation, these are all the more difficult to define the "dying".
2.2 patient autonomy for the "care" is not required
Autonomy, is the people according to their own needs and will, to determine the behavior of their own choice plan. Autonomy principle stems from the ethics of life. In medical practice, patients' autonomy is one of the most basic rights, which is the important content of the patients' life value and personality dignity. In medical treatment, the patient's autonomy is reflected in: on the one hand, the patient is respect, care and care in the individual dignity, quality of life, psychological feelings and so on. On the other hand, it is the choice of the patients, including the method of examination.
Hospice patients, doctors and patients' families have their own position and requirements, the patient's condition is different, the need for hospice care is different, the degree of hospice care and measures taken by doctors also varies from person to person. This let "in order to pay attention to the actual needs of patients with advanced patients, and try to carry out the wishes of patients and their families to carry out nursing services, and ultimately to achieve the comfort of the patient" as the goal of hospice care to take a different specific decision-making approach.
2.3 prolong life and improve the quality of life is difficult to balance
The attachment of life to life is not only in the expectation of life extension, but also on the improvement of life quality. On the one hand, due to the improvement of people's life quality, the enhancement of health consciousness and the increase of per capita life expectancy, the time of death can be extended. But on the other hand, death is not the choice and avoidance. We must break the shackles of the traditional death terrible ideas, establish a scientific and correct outlook on life and death, and face death and death. In medical treatment options, medical technology can support patients to continue to extend the life, however, this time may greatly reduce the life quality of patients, prolong life and improve the quality of life seems difficult to balance.
3 medical difficulties encountered in hospice care
3.1 chronic diseases
In recent years, the types of chronic diseases are growing, such as cancer, heart disease, etc.. For the vast majority of people, the important is the quality of life, not just the length of time to live.
The increase in the number of patients with chronic diseases resulting in the increase in the number of patients who need hospice care, especially in the elderly patients with chronic diseases is significantly higher than other groups. In addition, the shortage of medical and health resources, distribution of unequal status quo, social medical resources is very difficult to provide clinical treatment for more patients or to provide a balance between hospice services for a few dying patients.
3.2 over medical treatment
Excessive medical treatment refers to the improper medical treatment corresponding to appropriate medical treatment. It mainly contains two elements: the medical behavior of the invalid and the medical expense of the excessive.
Information asymmetry in medical market, the hospital and the third party supply, due to the doctor to the patient and the doctor psychological induction and medical market competition reasons, the medical staff for avoid responsibility, to reduce the risk and the implementation of the patients beyond the standardized diagnosis and treatment range, and avoid medical behavior of high risk patients with or at risk of procedures that the defensive medical behavior and the medical insurance is not standardized.
In the decision to continue treatment or giving up treatment for the patients with severe patients, the patients and their families are the most likely to prolong the psychological needs of patients and their families.
3.3 the doctor-patient relationship is not harmonious
The relationship between doctors and patients is the main relationship in medical practice. The doctor through his medical help patients relieve pain, regain health, everything is a center with the patient. But in fact, in the traditional biomedical model, the treatment of heavy "sick" light "people". People are sick, the need for doctors to learn medical knowledge and medical technology to make the final judgment of the examination results.
With the rapid development of high-tech medicine today, the doctor is more dependent on a variety of sophisticated medical equipment. In such a relationship, for the final diagnosis and treatment of patients, the medical treatment is difficult to focus on the subjective feelings of pain, easy to ignore the patient's loneliness, fear, dignity and other psychological feelings, and is committed to the use of life, cell repair and other issues of the Ministry of the solution, which is contrary to the purpose and objectives of hospice.
4 establish the correct concept, realize the hospice care
4.1 managers should establish a sense of service, strengthen the guidance of ideas, create a harmonious environment for human care
In recent years, the pace of development of China's medical and health industry is gradually accelerating, the overall point of view, the rapid development of medical and health industry. But there are some problems, such as hospice care, and other prominent medical problems need to solve, the huge number of patients and limited medical care resources, the proportion of serious imbalance, the contradiction between doctors and patients, combined with the change of disease spectrum and cause of death, hospital, medical personnel service consciousness of the lack of other reasons, to the effective implementation of hospice care has caused many obstacles. Therefore, medical and health management should establish the service consciousness, further strengthen the service concept of "putting the patient in the first place", improve the service quality and ability of the hospital and health care workers, pay more attention to and improve the understanding of hospice care, update the idea. Through the hospital as a platform, the mass media as a means of communication, and actively promote the service of medical care, humanistic care of the new service concept, to the actual action to guide the medical staff into the ward, approached patients, and strive to create a harmonious atmosphere of the humanities environment, so that every person who needs hospice care.
4.2 doctors should establish the overall medical concept, grasp the ethical standards of good and evil
Under the guidance of general medicine, the medical treatment should be based on the principle of "taking people as the center", and try our best to meet the needs of patients. And for dying patients, the more need for the overall care of the group, to establish the overall medical concept is undoubtedly their great concern and gospel.
It is an inevitable dilemma in the process of the implementation of the critical point of life, although there may be a doctor's decision to make the decision. Medical ethics of medical professional ethics requirements, that is, in fact, human nature glory of refraction, the specific situation can not be generalized, in the heart of every healer must specific solutions to specific problems, but goodness when forever.
4.3 the public should establish a correct view of disease and death, and promote the formation of new ideas of hospice care.
The correct view of disease is to establish the overall concept, to accept its irreversible nature. In daily life people have a kind of belief, is the conviction that disease by medicine can cure, firmly believe that a new drug will work like a charm. In fact, many diseases are once a disease, it will be accompanied by a lifetime. Although the development of medical technology has been developing rapidly, but there are still unknown diseases and areas of medical science, so it is a correct view of the disease. Life, aging, disease, death is the natural law of human beings, death is just a process of life. It is the natural law of life to be treated correctly and realize that death is the natural law of life.
Therefore, the implementation of the modern life view education, Let dying that death of the significance and life significance, the endangered the dead to overcome the fear of death, learning "prepare to die, in the face of death, acceptance of death", [7] so as to promote the dying Guan Huaixin philosophy of the formation.
Referring to
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