Man wins battle to keep receiving life support
http://www.100md.com
《英国医生杂志》
EDITOR—Some will be appalled at the recent ruling in the case of Leslie Burke against the General Medical Council1 and see it as opening the floodgates to patients demanding all sorts of treatments that theoretically prolong life but are expensive and possibly dangerous, as well as undermining the specialist role of medical professionals in making expert decisions.
The emotive nature of feeding and hydration means that we, the doctors, may not use evidence as the basis for our clinical decisions and, as the Disability Rights Commission rightly points out, we risk using personal judgments based on factors such as quality of life.1 No doubt the GMC guidelines were created in good faith, but they make it possible for doctors to wield excessive paternalistic power and to leave the patient feeling vulnerable, as Mr Burke clearly felt himself to be.
Feeding and hydration should be kept separate from other medical treatment, or doctors should be careful to use the same yard sticks for implementing feeding and hydration as for any other treatment. Doctors must be seen to be making their decisions on the basis of fact and evidence as far as possible.
Studies show that feeding may not be helpful in cachexia-anorexia syndrome and dementia but has a role in stroke.2-4 Studies have also shown that clinicians are slow in making the assessments and initiating the treatment.5 Until more data on the role of feeding and hydration in different disease processes exist, thirst and hunger in a patient must be addressed as any other symptom.
Doctors' role is to treat patients safely and to the best of their ability, be the intent curative or palliative. Their role is not to prolong dying or save the state the burden of long term care for someone with a severe disability, however poor that person's quality of life is perceived to be.
Rosemarie Anthony-Pillai, specialist registrar in palliative medicine
Sue Ryder Care—St John's Hospice, Moggerhanger, Bedfordshire MK44 3RJ roseap@doctors.org.uk
Competing interests: None declared.
References
Dyer O. Man wins battle to keep receiving life support. BMJ 2004;329: 309. (7 August.)
Thomas DR. Distinguishing starvation from cachexia. Clin Geriatr Med 2002;18(4): 883-91.
Sanders DS, Alan JA, Bardhan KD. Percutaneous endoscopic gastrostomy: an effective strategy for gastrostomy feeding in patients with dementia. Clin Med 2004;4: 235-41
Bath PM, Bath FJ, Smithard DG. Interventions for dysphagia in acute stroke. Cochrane Database Syst Rev 2000;(2): CD000323.
Rodrigue N, Cote R, Kirsch C, Germain C, Coutier C, Fraser R. Meeting the nutritional needs of patients with severe dysphagia following a stroke: an interdisciplinary approach. Axone 2002;23(3): 31-7.
The emotive nature of feeding and hydration means that we, the doctors, may not use evidence as the basis for our clinical decisions and, as the Disability Rights Commission rightly points out, we risk using personal judgments based on factors such as quality of life.1 No doubt the GMC guidelines were created in good faith, but they make it possible for doctors to wield excessive paternalistic power and to leave the patient feeling vulnerable, as Mr Burke clearly felt himself to be.
Feeding and hydration should be kept separate from other medical treatment, or doctors should be careful to use the same yard sticks for implementing feeding and hydration as for any other treatment. Doctors must be seen to be making their decisions on the basis of fact and evidence as far as possible.
Studies show that feeding may not be helpful in cachexia-anorexia syndrome and dementia but has a role in stroke.2-4 Studies have also shown that clinicians are slow in making the assessments and initiating the treatment.5 Until more data on the role of feeding and hydration in different disease processes exist, thirst and hunger in a patient must be addressed as any other symptom.
Doctors' role is to treat patients safely and to the best of their ability, be the intent curative or palliative. Their role is not to prolong dying or save the state the burden of long term care for someone with a severe disability, however poor that person's quality of life is perceived to be.
Rosemarie Anthony-Pillai, specialist registrar in palliative medicine
Sue Ryder Care—St John's Hospice, Moggerhanger, Bedfordshire MK44 3RJ roseap@doctors.org.uk
Competing interests: None declared.
References
Dyer O. Man wins battle to keep receiving life support. BMJ 2004;329: 309. (7 August.)
Thomas DR. Distinguishing starvation from cachexia. Clin Geriatr Med 2002;18(4): 883-91.
Sanders DS, Alan JA, Bardhan KD. Percutaneous endoscopic gastrostomy: an effective strategy for gastrostomy feeding in patients with dementia. Clin Med 2004;4: 235-41
Bath PM, Bath FJ, Smithard DG. Interventions for dysphagia in acute stroke. Cochrane Database Syst Rev 2000;(2): CD000323.
Rodrigue N, Cote R, Kirsch C, Germain C, Coutier C, Fraser R. Meeting the nutritional needs of patients with severe dysphagia following a stroke: an interdisciplinary approach. Axone 2002;23(3): 31-7.