Spiritual issues arise frequently in the care of dying patients, yet health care professionals may not recognize them, may not believe they have a duty to address these issues, and may not understand how best to respond to their patients' spiritual needs. The case of a patient with a strong religious belief in a miraculous cure of metastatic pancreatic cancer is used to explore how better understanding of this belief and more explicitly spiritual conversation with the patient by his treating team might have provided opportunities for an improved plan of care. This article distinguishes spirituality from religion; describes the salient spiritual needs of patients at the end of life as encompassing questions of meaning, value, and relationship; delineates the role physicians ought to play in ascertaining and responding to those needs; and discusses the particular issue of miracles, arguing that expectations of miraculous cure ought not preclude referral to hospice care.

译文

精神问题经常出现在垂死患者的护理中,但是医疗保健专业人员可能不认识他们,可能不相信他们有责任解决这些问题,并且可能不了解如何最好地满足患者的精神需求。以强烈信仰宗教信仰的患者奇迹般地治疗转移性胰腺癌的案例为例,探讨了如何更好地理解这一信仰,以及治疗团队与患者进行更明确的精神对话,可能会为改善护理计划提供机会。本文将灵性与宗教区分开来;描述生命终了时患者的主要精神需求,包括意义,价值和关系问题;描述医生在确定和响应这些需求中应发挥的作用;并讨论了奇迹的特殊问题,认为对奇迹疗法的期盼不应排除转诊临终关怀的可能性。

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