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Click to View缓和医疗:一门“柔性”学科
北京协和医学院“4+4”医学试点班2021级 李一林
缓和医疗的兴起不仅是医疗体系发展所需,更是对每一个生命的敬畏和尊重。医学有时代无法突破的技术局限性,医生和患者面对无法治愈的疾病时常常存在无力感。而此时,缓和医疗作为一种选择,提醒着我们,医学的使命不仅仅是对患者的施救,还包括对患者痛苦的细微体察和人文关怀。正如特鲁多墓志铭所阐述的那样——有时是治愈,常常是帮助,总是去安慰。
为展现本期主题“缓和医疗理论与实践”的丰富内涵,封面设计最终采用写意与写实结合的方式呈现。画面主体以医护人员双手紧握因疾病消耗而骨瘦嶙峋的患者之手,传达对患者的安慰和关爱,这是临床工作中经常用到的肢体语言,借此展现缓和医疗的理念和本源:以患者为中心,医护主动参与的帮助、照护和关怀。画面背景以一条常青藤环绕,是抽象的蛇杖形象,柔韧的藤蔓展现出缓和医疗中的“柔性”。藤蔓从左至右分别生长着春、夏、秋、冬四个季节的代表性花朵和叶子,可入中药的辛夷代表疗愈,向日葵代表希望,雏菊代表健康长寿与淡然祥和的心态,霜雪中傲然盛开的腊梅象征生命的坚忍,串联起来既代表时间的变换、生命的周期,也代表疾病的历程,同时象征着缓和医疗在疾病不同阶段丰富多元的实践形式。
希望本期封面可以增进更多医务人员和大众对缓和医疗丰富内涵的认识,从而更好地将理念付诸实践,提高患者的生命质量!
Chinese Bimonthly
CN 11-5882/R
ISSN 1674-9081
Articles in press have been peer-reviewed and accepted, which are not yet assigned to volumes /issues, but are citable by Digital Object Identifier (DOI).
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2024, 15(1): 1-2.
doi: 10.12290/xhyxzz.2023-0469
Abstract:
Palliative care is in the ascendant, but the clinical understanding of it is still shallow and may have significant biases. This article introduces the origin of palliative care and explains its connotation and importance, in order to deepen the understanding of medical workers on palliative care and promote the implementation of relevant concepts in clinical practice.
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2024, 15(1): 3-6.
doi: 10.12290/xhyxzz.2023-0521
Abstract:
The concept of modern palliative care originated in the 1960s. It has been highly valued by the World Health Organization, and promoted globally with the "three-step analgesic ladder" as the starting point. China introduced the "three-step analgesic ladder" in 1990, which has been in practice for more than 30 years. This has brought clinical oncology closer to palliative care, thus promoting the progress of palliative care in China. Further development of palliative care in China is expected to significantly improve the survival time and quality of life of cancer patients.
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Abstract:
The Cartesian medical model is leading to overmedicalization all over the world. Modern palliative care, derived from a reflection on the Cartesian medical model, aims to relieve the suffering of critically ill patients and their caregivers. It also focuses on the unnecessary harm of medical technology itself. This paper presents some issues from a case and inspires further thinking and profound understanding of China's palliative care by reviewing the history of relieving suffering, the views and shortcomings of the Cartesian medical model, and the application of life-sustaining treatment and good death.
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2024, 15(1): 12-17.
doi: 10.12290/xhyxzz.2023-0599
Abstract:
With the rapid development of medical technology, human dying process has been technicalized and medicalized, but the pain caused by ageing and terminal disease remains widespread. However, Palliative care can alleviate this kind of pain and improve the quality of life for end-stage patients.Over the years, China has introduced a series of policies and laws to include hospice care in the national health system from the legislative level, most healthcare providers, however, are incompetent and unable to understand and deliver palliative care, resulting in the poor quality of death in China. Integration of palliative care into the health system needs to be gradually implemented, by unifying definitions and principles, advocating palliative care practice in clinical work, initiating education in medical students, developing palliative care networks in primary healthcare system, formulating national-level development indicators, and emphasizing localized development, with the hope of avoiding futile or inappropriate treatments at the end of life.
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2024, 15(1): 18-23.
doi: 10.12290/xhyxzz.2023-0631
Abstract:
Chinese traditional life culture, based on the unity of life and death, has a set of cultural narrative of "Peace" at the end of life. In terms of the fundamental concept, it argues that "Death" is more important than "Health care", and "Good death" is the pursuit of human happiness. In terms of the strategic path, it advocates to abide by the "Etiquette system" and specially designs a set of deathbed etiquette to help people reach a "Good end". In terms of the goal value, it states that "Knowing life" helps "Knowing death" and living well can lead to dying well, thus realizing the immortality of life value. In terms of spiritual beliefs, it emphasizes the acceptance of "Life and death are destined", and transforms "Life limit" into "Mission", thus sublimating the recognition of "Destiny" and accepting death in the belief that "Life never ends".
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2024, 15(1): 24-31.
doi: 10.12290/xhyxzz.2023-0578
Abstract:
With the transformation of medical philosophy, palliative care has become a fundamental component of end-of-life care for patients with life-threatening illnesses, meanwhile ethical issues involved in palliative care are becoming more prominent. This article, through a comprehensive review of both domestic and international ethical research, articulates five crucial ethical issues inherent to palliative care: truth-telling, advance care planning, the use of life-sustaining interventions, palliative sedation, and the relationship between euthanasia, assisted dying, and palliative care. The objective is to offer an ethical perspective for palliative care, help professionals in palliative care to address the critical ethical issues in practice, improve the quality of care for patients and their families, and to inform the development of related legal, regulatory, and policy frameworks.
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Abstract:
This paper, from the "dichotomy" phenomenon of good policy environment and obstruction of actual operation in the development of palliative care service in China, introduces the current laws and regulations and system construction of palliative care service, and analyzes the causes, paths and behaviors of the underlying operation mechanism of China's medical and health care system that objectively hinders the development of palliative care service. It also presents how medical institutions of different natures respond differently to palliative care service. We believe that with the reform of China's health care payment method, the original mechanism will change accordingly and promote the development of palliative care service in many ways.
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2024, 15(1): 37-41.
doi: 10.12290/xhyxzz.2023-0537
Abstract:
There are two controversies about palliative care. One is whether the scope of palliative care should be expanded, and the other is whether the timing of palliative care intervention should be advanced. Regarding the research progress of palliative care, there are currently two consensuses: the target population of palliative care should be expanded to all patients of all ages who suffer from serious illness and serious health-related suffering, palliative care interventions should be integrated into the whole treatment process of serious illness early. However, the expansion of the scope of palliative care targets and the advancement of the timing of intervention have brought new challenges, and there is an urgent need to formulate a new strategic plan and implement it, so as to accelerate the exploration of the development of palliative care that suits China's national conditions. A new understanding of the target group of palliative care and the timing of intervention will help accelerate the development of palliative care in China. This article analyzes and discusses the history, research progress, definition updates, and existing evidence of palliative care, as well as the clinical needs, aiming to provide a reference for the practice of palliative care in China.
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