姑息照顾与新冠病毒肺炎大流行（柳叶刀）

译者：杨辉教授

来源：YangHui-Monash公众号

译者的话：

任何翻译文字，说到底，只是一种解释。译文通常只能表达一种含义，而原文却可能还有其他层次的含义。原文是提示性质的，译文则不能做到这一点。于是原文中的丰富含义，在翻译过程中大部分丢失了。无论一个译本如何力求完美，它总是不及原著。五世纪佛教高僧鸠摩罗什曾说，翻译工作恰如嚼饭喂人。如果一个人自己不能吃饭，要吃别人的唾余，所吃到嘴里的当然没有原来那饭的香味和鲜味。

《中国哲学简史.中国哲学的精神》冯友兰

我把原味和唾余都摆上桌。借用冯友兰先生的话，说到底，译文只是我的一种解释，源于我的个人认知。

Palliative care and the COVID-19 pandemic

姑息照顾与新冠病毒肺炎大流行

（Lancet Editorial）

柳叶刀杂志社论

Palliative care services are under-resourced at the best of times. The 2017 Lancet Commission on Palliative Care and Pain Relief described the widespread lack of access to inexpensive and effective interventions as a travesty of justice. And these are not the best of times. As health systems become strained under COVID-19, providing safe and effective palliative care, including end-of-life care, becomes especially vital and especially difficult.

即便是在最好的时候，姑息照顾服务的资源也是不足的。2017年柳叶刀杂志的姑息照顾和疼痛缓解委员会，将人们不能普遍获得廉价有效的姑息照顾和临终关怀的现象，描述为对正义的嘲弄。当下，不是最好的时光。医疗卫生系统在COVID-19的肆虐下，承付着越来越大的重压。提供安全和有效的姑息照顾（包括临终关怀）变得尤为重要，也特别艰难。

Some doctors, short of resources, might have to decide who can receive critical care and who cannot. For patients who won’t survive, high-quality palliative care needs to be provided at least. But COVID-19 makes this more difficult. Time is short when patients deteriorate quickly, health professionals are overworked, isolation is mandated, and families are advised not to touch or even be in the same room as loved ones. This scenario will be compounded most in low-income and middle-income countries where shortages of both critical care and palliative care services are greatest. Continuing community-based palliative care is also harder to do safely. Many patients who need it are at heightened risk from COVID-19, protective equipment is running short, and surging deaths could overwhelm usual service provision.

在资源匮乏的情况下，某些医生可能要不得已地决定谁接受重症监护治疗，谁不接受重症监护治疗。对于无法继续生存的病人，至少要给他们提供高质量的姑息照顾。但是，COVID-19使这点奢望变得更加困难。病人状况迅速恶化、医护人员超常工作，隔离措施必须要做，家属被告知不能碰任何东西，甚至不能在一个房间里与即将离世的亲人告别。在重症监护和姑息照顾服务资源最为短缺的中低收入国家，这种情况最为复杂。在社区里也很难继续提供安全的姑息照顾服务。许多需要姑息照顾的病人，也是面临COVID-19的高危险人群。防护设备将要告罄，死亡人数激增，这使得平时的医疗服务提供系统在疫时不堪重负。

WHO has issued guidance on how to maintain essential health services during the pandemic, highlighting immunisation, maternal care, emergency care, and chronic diseases among others, but there was no mention of palliative care. This was an oversight. Indeed, palliative care ought to be an explicit part of national and international response plans for COVID-19. Practical steps can be taken: ensure access to drugs (such as opioids) and protective equipment, consider a greater use of telemedicine and video, discuss advance care plans, provide better training and preparation across the health workforce, and embrace the role of lay carers and the wider community.

世界卫生组织发布了大流行期间维持基本卫生服务的指南，重点强调免疫接种、孕产妇保健、急诊服务、慢性病管理等，但未提及姑息照顾。这是一个疏忽。很显然，姑息照顾应该是各国和国际上应对COVID-19的计划中明确的一部分。可以采取实际步骤：要确保获得药物（如阿片类药物）和防护设备，要考虑更多地使用远程医疗和视频，要讨论生前预嘱计划，要给整个卫生工作人员提供更好的培训和准备，并要接受非专业照顾者和更广泛社区所发挥的作用。

A pandemic is a cause and powerful amplifier of suffering, through physical illness and death, through stresses and anxieties, and through financial and social instability. Alleviation of that suffering, in all its forms, needs to be a key part of the response.

大流行通过躯体上的染病和死亡、通过心理上的压力和焦虑、通过财务和社会上的动荡，给人类带来苦难，并放大了人类的痛苦。采用各种形式减轻人间的苦难，这应该成为对策的关键部分。

原文 Published: April 11, 2020DOI:https://doi.org/10.1016/S0140-6736(20)30822-9