Human Rights Jurisprudence in Hospice Care——Thoughts on the Concept and Boundary of “Death with Dignity”

Death with dignity is the embodiment of the dignity of human life in the context of end-of-life medical care.However,in the development of its concept,it has been alienated into a single way of death and is often confused with the concept of euthanasia.It is therefore a theoretical and practical necessity to re-expand the connotations of death with dignity Death with dignity is the subjective value of dignity reflected in the context of dying.It takes equality,freedom,and virtue as the core,and uses the right to life as its external support.It is projected onto the medical context and incorporates the patient’s right to informed consent.Subject to public interest,legal paternalism,and the principles of public order and good customs,the boundary of the right to death with dignity should be between active treatment and natural death,and active euthanasia in the form of giving up the right to life should not be included in the right to death with dignity.

How College Students Suicide Exists: Three Standpoints of Death

At present,suicide behaviors of college students frequently occur in colleges,but the problem of why college students suicide has always plagued many college educators.From the perspective of Levinas’view of existence,suicide is the last control that people can have over existence.Suicide includes a person’s three mental states:exhaustion,laziness,and boredom,and it can orderly induce three standpoints of death:“I have to die”,“I want to die”,and“I am going to die”.Knowing the problems of suicide is helpful to help college educators better understand the suicidal behavior of college students and help them better carry out the life education of college students.

Long-Term Survival in Traumatic Brain Injury and Near-Death Experience Increases Suicide Risks: A Personal Experience and Related Literature

Background: Traumatic brain injury (TBI) remains a cause of lifelong disability, death, and suicide worldwide. TBI-induced near-death experience (NDE) could increase suicide risks. Objective: We investigated TBI coupled with NDE and posttraumatic stress disorder (PTSD) as a possible indicator of suicide. Methods: A 17-year-old male who sustained an acute severe TBI in a traffic collision, was comatose 14 days, had an NDE awakening from the coma, and, years after rehabilitation, suffered PTSD, clinical depression, and survived a suicide attempt. This personal experience of a TBI-induced NDE and lingering PTSD was acquired directly from the patient by interview. We discuss his case while considering relevant literature. Results: Longitudinal data from 1961 to 2021 generated from the PubMed interface revealed 4056 TBI patients committed suicide. NDE was only reported in one of those cases and, although not a suicide, in the personal experience. Neuropsychological assessment at long-term follow-ups revealed few TBI patients exhibited normal mental/physical functions compared to the general population. Unfavorable GOS scores were risk predictors for neuropsychological/physical impairments later in life, with outcomes of depression, PTSD, poor QOL, and/or suicide. Conclusions: For TBI-NDE survivors, including those with PTSD, long-term periodic neuropsychological follow-ups and psychosocial support may help decrease suicide risks.

COVID-19 Pandemic: Lessons from Peak Years of Influenza &Suicide Deaths by Age in Ten Western Countries 1979-2016: An Alert for Psychiatry and Children’s Services

Background: The IMF fears the COVID-19 pandemic will create an economic down-turn matching the Great Depression. More recent recessions have led to physical and mental health problems including suicide deaths of young adults (15 - 34). We aim to identify risk patterns of mortality by age from influenza and suicide mortality in peak years from 1979 to 2016 to see if there are lessons to be learned for policy makers and psychiatric services. Method: Using WHO mortality data for 1979-2016 peak years of influenza deaths and suicides are identified in ten Western countries. Death rates per million in each age-band are calculated for both sexes and the percentage of the total deaths accruing in each of five age-bands for influenza and suicides. Ratios of influenza to suicide by age in regard to rates and percentages of deaths indicate differential risk mortality and morbidity patterns. Results: Of the ten country’s average Influenza deaths, 95% occurred in people over 55, including 80% - 85% for the over 75’s. Conversely it was 59% of suicides occurred in peoples aged <55 years. Young adults (15 - 34) influenza to suicide ratios were 1:12.1 and 35 - 54 years ratio 1:9.3. Discussion: IMF predicts major unemployment, which is likely to create mental health problems, including suicide as well as worsening child health outcomes linked to relative poverty. These wider inter-related factors should be considered by policy-makers and mental health services. The age patterns of risk of mortality point towards a cumulative summation of morbidity and mortality risks of the socio-economic consequences of the COVID pandemic.

The Impact of COVID-19 on Adolescent Suicide Deaths in the State of Maryland

On March 11, 2020, the World Health Organization officially declared the SARS-CoV-2 virus (COVID-19) a worldwide pandemic. As of December 2021, there have been over 278 million cases and 5.4 million deaths reported. One area of concern regarding the pandemic was its potential impact on mental health, and it was feared that the onset of such a devastating pandemic would lead to increased suicide risks among the general population. With suicide being a leading cause of death in adolescents, it is important to assess the potential mental health consequences that the COVID-19 pandemic may impose. Aim: The aim of the study was to analyze the impact of COVID-19 on suicide deaths among adolescents in the state of Maryland from 2019 to 2021. Subjects and Methods: This was a retrospective study of adolescent suicide victims, aged 10-19 years, from January 2019 to December 2021 in the state of Maryland. De-identified data were collected from the statewide medical examiner’s office which is responsible for the medicolegal death investigation in Maryland. Results: A total of 102 adolescent suicide deaths were investigated statewide by the Maryland Office of the Chief Medical Examiner during these 3 years. The number of adolescent suicide cases stayed relatively stable during the COVID-19 pandemic, with slightly more cases during the pre-COVID-19 pandemic period (2019: n = 37;2020: n = 31;and 2022: n = 34). Looking at months of incidence, less cases were reported in March-May 2020 (n = 5), which marks the beginning of the pandemic when compared to the same period in 2019 (n = 13). The number was higher for August-November 2020 (n = 15) than for that of 2019 (n = 8) and 2021 (n = 8). The male-to-female suicide ratio was 3.7:1 (n = 80/22). However, the data exhibited a significant increase in the number of female adolescent suicides, from 8.11% in 2019 (n = 3) to 25.81% in 2020 (n = 8) and 32.35% in 2021 (n = 11). Of the cases examined, more than 50% were white and approximately 27% were African-Americans. The two leading causes of death were hanging (47%) and firearm injuries (29%). Maryland consists of 23 countries and Baltimore City. The majority of adolescent suicides occurred in county residents with only 8.8% of cases in Baltimore City.

Suicide Deaths in China:An Analysis of Forensic Cases

Suicide cases are often encountered during death investigations in forensic medicine.In this study,through a comparative analysis of our own data of 98 suicide cases and previous reports from various forensic institutions in China,we analyzed the risk factors of Chinese suicides and explored the implications thereof from a forensic point of view.Moreover,the age and sex differences,means,causes,and other concerns regarding suicide are discussed along with a review of the literature.

Suicide in Digestive System Cancers: A Scoping Review

Digestive system cancers are important causes of morbidity and mortality worldwide.Cancer patients are more likely to commit suicide.The objective of this scoping review is to provide a comprehensive and updated summary of the existing literature on suicide among patients with digestive system cancers to identify the incidence and risk factors relevant to suicide in these populations.The PRISMA-Scr(Preferred Reporting Items for Systematic reviews and Meta-Analyses extension protocol for scoping reviews)protocol was used.The review was based on relevant articles published prior to January 2022 in databases of Web of Science and PubMed.The authors identified 21 records that met the criteria for inclusion.Among the 21 articles,18(n=85.7%)reported suicide risk factors,21(n=100%)evaluated the incidence of suicide and 16(n=76.2%)involved the variation in suicide rates.Only one study comprehensively reported that the suicide rate for this population was 32.8 per 100,000 years and the standardized mortality ratio(SMR)was 1.91.Most suicides occurred in patients with pancreatic,esophageal,and gastric cancers.The factors associated with suicide in digestive system cancers included male gender,older age,the white race,single status,advanced stage of disease,and cancer metastasis.The most critical time for suicide was in the early post-diagnostic period.It is indispensable to identify suicide in these cancer patients,especially those with high-risk factors.In the future,more prospective research may be needed to provide more reliable support and care to prevent suicide.

不给予或撤除生命维持干预与安乐死、消极安乐死的概念辨析

不给予或撤除生命维持干预是临床实践中常见且棘手的伦理学问题。该问题的讨论应建立在清晰的概念之上,但不给予或撤除生命维持干预常与安乐死、消极安乐死和尊严死等概念混淆,引发误解。重新定义安乐死和消极安乐死具有理论和现实的紧迫性。基于汤姆•比彻姆和阿诺德•戴维森提出的安乐死定义,提出消极安乐死的定义。基于该定义,认为不给予或撤除生命维持干预与消极安乐死为交叉关系。鉴于安乐死概念的争议及其富含的感情色彩,强调讨论生命维持干预的使用时应区分事实与价值,并建议慎用或弃用安乐死与消极安乐死。

基于健康照护视角的优逝量表编制及信效度测评

目的编制符合我国社会文化特点的优逝量表,为我国患者的死亡质量测评提供科学工具。方法以本土化优逝内涵为基本框架,通过文献回顾和质性访谈形成基于健康照护视角的优逝量表维度和条目池。通过专家函询、预调查形成测试版量表。采用方便取样法,邀请742名离世患者亲属对量表信效度进行测评。结果探索性因子分析提取7个公因子,累积方差贡献率为63.03%;验证性因子分析构建一阶模型,χ^(2)/df=2.353,RMSEA=0.056,IFI=0.900,GFI=0.847,NFI=0.838,CFI=0.899。总量表的Cronbach′sα系数为0.937,除躯体安适维度[Cronbach′sα系数为0.412,组合信度为0.443,平均提取方差值(AVE)为0.215]外,其他6个维度Cronbach′sα系数为0.738~0.919,组合信度为0.757~0.912,AVE为0.445~0.635。结论优逝量表总体上具备较好的信效度,可用于测量我国患者的死亡质量,但躯体安适维度仍需进行进一步完善。

An Analysis of Hamlet’s “To be,or not to be”

Some experts think Hamlet’s soliloquy "To be,or not to be..." shows Hamlet was thinking about the advantages and disadvantages of committing suicide. Analyzing the soliloquy itself and the whole play,this essay will prove this famous soliloquy was discussing the matter of life and death.

安宁疗护视域下中华传统文化特色优逝概念分析

聚焦安宁疗护领域,采用Rodgers演化概念分析法对中华文化背景下优逝相关文献进行分析,阐述优逝概念的发展史和应用、定义与特征、影响因素及其带来的影响、测量指标和工具,并进行进一步讨论。优逝是指在个人足够长寿的前提下,个体无主观痛苦体验、无牵挂、平静地走向死亡,同时在死亡过程中得到了家人尤其是子女和孙辈的照料和陪伴,实现道德的圆满和超越。中华传统文化背景下优逝的特征包括非直接表达的身心痛苦被“读懂”和妥善处理、基于德性而非自主性的临终尊严建构、对孝道和家庭情感性连结的重视、进行后事安排并实现代际传承、注重离世时刻生命的完整性实现,具有鲜明的中华传统文化特色,未来需进一步剖析优逝概念的内涵和外延,助力本土化优逝理论和实践体系的发展。

论我国生前预嘱制度构建的可行性

生前预嘱制度的推广和应用具有必要性与可行性。生前预嘱制度的构建尚需要解决订立主体的范围、订立的形式、适用对象、适用的限制等问题。首先,生前预嘱的主体应当为完全民事行为能力人,从年龄和精神两个层次判断。其次,生前预嘱的形式应当为要式,且应当为书面形式。再次,生前预嘱的适用对象应当包括永久性植物状态患者和阿尔茨海默症患者。最后,生前预嘱的适用还应当有一定的限制,其适用范围不宜过宽并且不能危害到他人合法利益或者是社会公共利益。

生前预嘱的合法化与适用问题研究

生前预嘱不同于安乐死、协助自杀,契合保护预嘱人医疗自主权、死亡尊严的现实需求,其合法化具有充足的法理依据;其订立主体应当为完全民事行为能力人,且其文本内容系预嘱人的真实意思表示,不违反法律、行政法规的强制性规定或者公序良俗;其适用情形不宜限制过严,应予扩大解释--一是预嘱人罹患阿尔茨海默症或处于永久性植物状态时,均应认定其符合生前预嘱的适用情形;二是不应对孕妇的生前预嘱设置排除或部分排除条款,而应尊重孕妇的医疗自主权,且胎儿利益不得绝对优先于孕妇的自主权。

生前预嘱制度的适用与完善构想

2022年,深圳市出台的《深圳经济特区医疗条例》引发了关于生前预嘱的广泛讨论。生前预嘱制度作为引入概念经常与其他概念相混淆,很有必要对其进行区分和界定。目前,我国生前预嘱制度尚不完善,由于生前预嘱制度能够从伦理和法理上保障临终患者的意思自主和死亡尊严,提高处于终末期生命状态患者的生命质量。因此,我们应在借鉴国外经验的基础上对我国生前预嘱制度进行完善性的构想,推动健康中国战略的实施。

善终理念下我国尊严死立法的现实阻碍与价值分析

尊严死是近年来备受社会关注的热点问题之一,在缓解临终患者的身心痛苦、提高死亡质量、减少医患冲突和医疗资源浪费等方面起着重要作用。无意义的治疗不仅不能挽救患者的生命,而且还会加重患者所遭受的折磨,让患者无法有尊严地迎接死亡。我国作为世界上老年人口最多的国家,尊严死的立法顺应了时代和人民的需求,体现了善终理念的要求,能够有效提高老年人及临终患者的生存质量。尊严死是对生命权及人格尊严的保护,彰显了患者意思自治等民法的精神和原则,是对我国伦理道德的传承和发展。

生前预嘱设立与实施的德国经验及借鉴

德国民法典规定生前预嘱的设立人应当是有决定能力的成年人,但是“成年人”的限制受到质疑。有效的生前预嘱应当包含双重内容,即治疗状况描述和医疗救治措施。这两项内容要满足确定性要求,否则生前预嘱不发生效力。在生前预嘱实施阶段监护人或委托人和医生要审查,是否存在生效力的生前预嘱,生前预嘱中确定的内容是否符合病人的生命情势和医治情势,设立人在生前预嘱中作出的“同意”或者“不同意”是否符合他当下的真实意思。德国生前预嘱立法的经验可以为我国提供借鉴:转变传统观念、加强基础理论研究、开展学科交叉研究。

尊严死的幸福指向

尊严死是尊重临终主体对生命的自主选择权,不采取无意义的创伤性医疗手段,减轻临终主体的病痛程度,保留其生命尊严。让临终主体的生命无外在干预的情况下自然消逝。在这种语境下的死亡过程,能够从功利主义的苦乐原理、效果论、功利原则三个维度获得道德诠释,有着明显的幸福指向。既指向临终主体的主观幸福,又回应了临终主体利益相关者所面临的道德难题,指明了在临终状态时死亡与幸福的可匹配性。并与中华传统文化价值观相契合,有着其“应该”性和正当性。对促进尊严死合法化,健全和完善我国民生伦理体系具有积极意义。

自杀与其它伤害死亡全国性对照研究

目的 :了解国内的自杀现状及其特征。方法 :用自制的意外死亡研究问卷按“心理解剖”的调查方法从全国 2 0个农村和 3个城市疾病监测点抽取 895例自杀和 70 1例其它伤害死亡案例。对每个案例的家属及周围知情者单独进行持续约 3小时的调查。结果 :自杀案例中 67%为服毒自杀 (大多数为存放在家中的物品 ) ;63 %自杀当时有精神障碍 (3 9 8%为抑郁症 ) ;2 7%有过自杀未遂 ;91%从未看过精神科医生 ;近一年最常见的负性生活事件为经济困难 (4 0 % )、患急重病 (3 8% )或夫妻不和 (3 5 % ) ;自杀前两天内 2 5 %有突出的人际关系冲突 ;自杀当时 10 %有他人在现场。与其它伤害死亡者比较自杀者女性多、年龄偏大、读书年限少、家庭收入低并出现慢性和急性负性生活事件多。结论 :我国自杀为多因素相互作用的结果 ,相当一部分属于冲动行为 ,与其它国家比自杀当时患精神障碍的比例低。

珠海市户籍人群自杀死亡流行病学特征

目的了解珠海市人群自杀死亡流行特征及自杀模式,为自杀干预提供决策依据。方法应用2003-2005年珠海市户籍居民病伤死亡原因监测资料,描述珠海市人群自杀死亡的流行病学特征。结果2003-2005年间珠海市户籍人群平均自杀死亡率为6.43/10万,标准化率为6.61/10万,是继交通事故之后的第二位伤害死亡原因;其中男性和女性、农村和城市标准化率分别为8.69/10万和4.68/10万、9.03/10万和5.05/10万,男性高于女性（U=3.47,P〈0.01）,农村高于城市（U=3.45,P〈0.01）;3年平均自杀死亡率随着年龄的增长而增加,60岁以上增加明显,且多为老年男性;自杀方式以自缢和服毒居多,占所有自杀死亡的80%。结论珠海市户籍人群平均自杀死亡率低于全国平均水平;其自杀模式既具有中国人群的自杀模式特征,农村高于城市,且主要为自缢和服毒;又具有国外自杀模式特征,男性明显高于女性,且多发生在老年男性人群。

2002-2006年浙江省居民自杀死亡及相关危险行为分析

目的分析浙江省近5年来自杀死亡特征及相关危险行为因素,为自杀预防和控制提供信息。方法采用浙江省公共卫生监测系统2002-2006年死亡监测资料,运用ICD-10死因分类,比较不同地区、不同年龄性别的自杀水平和变化趋势。结果浙江省2002-2006年自杀平均死亡率为9.28/10万,农村(11.27/10万)高于城市(5.72/10万),男性(10.33/10万)高于女性(8.19/10万),自杀死亡率随年龄增加而升高,65岁以上老年人达到34.69/10万。自杀方式以服农药和自缢居多,占80.50%,职业以农民为主,占83.59%,自杀发生时间以春夏居多,占55.63%。有40.60%家庭存放农药,随意放置占25.32%。结论浙江省自杀死亡率低于全国水平;自杀预防重点人群为老年人和青壮年,重点地区为农村。应针对重点人群,开展以规范农药管理、完善社会保障体系、强化健康教育等为主的综合干预措施。