Quyền lợi của bệnh nhân ở nước Mỹ được tôn trọng tối đa, nhất là quyền tự quyết định (autonomy) về những vấn đề liên quan đến sức khoẻ của mình. Khi một người bị bệnh được giải thích rõ ràng về bệnh lý của mình, người ta có toàn quyền lựa chọn muốn được chữa bệnh hay không, và chọn lựa hình thức chữa bệnh nào mình muốn. Dĩ nhiên khi người ta còn tỉnh, người ta có thể tự quyết định tương đối dễ dàng, nhưng nếu người ta bị bệnh quá nặng không còn tỉnh trí nữa thì ai sẽ quyết định cho mình trong vấn đề chữa bệnh? Ðây là những trường hợp rất khó xử xảy ra thường xuyên trong bệnh viện khi người ta bị bệnh nặng và trở nên lú lẫn hay hôn mê: đến một lúc nào đó phổi không còn thở nữa, tim không còn đập nữa, bác sĩ phải cấp cứu cho vào máy thở, nhưng không thể biết ý riêng của bệnh nhân có muốn thế hay không, vì kéo dài đời sống bệnh nhân khi không có khả năng hồi phục nhiều khi lại là một cực hình cho bệnh nhân mà thôi.
Ðối với người Tây phương, người ta thường có ý kiến hướng dẫn rõ ràng qua những chúc thư về sức khoẻ viết sẵn khi còn khỏe và tỉnh táo. Ðối với người Việt Nam chúng ta, điều này chưa được phổ biến rộng rãi và cũng không được tán thưởng. Có lẽ người ta sợ xui xẻo vì nói về cái chết của mình khi còn sống. Nhưng có làm trong bệnh viện mới thấy nhiều cảnh chua sót, chẳng hạn như những trường hợp người bệnh bị bệnh quá nặng không còn cách chữa nữa, đến khi ngưng tim phổi, người nhà cứ bắt phải cấp cứu cho kỳ được và để vào máy thở. Nhiều người không còn tri giác gì cả, phải sống từ tháng này sang tháng khác, chỉ khổ cho bản thân và cho cả gia đình. Những cảnh này có thể tránh được nếu người bệnh có chúc thơ về sức khoẻ từ trước.
Vậy Chúc Thư Trong Y Khoa là gì?
Trong y khoa, chúc thư xác định cho bác sĩ biết người bệnh muốn chọn lựa phương pháp chữa bệnh trị liệu nào khi mình bị bệnh nặng không còn đủ sáng suốt để quyết định nữa. Nội dung bản chúc thư bao gồm nhiều mục:
- Chỉ định một người làm đại diện cho mình để quyết định sự điều trị thay cho mình khi không còn đủ sức quyết định lấy. Cho biết ý muốn của mình để giới hạn sự điều trị nếu hoặc mình bị bệnh không chữa được và có thể sẽ chết trong thời gian ngắn, hoặc mình bị hôn mê và có thể không tỉnh lại nữa, hoặc có chữa cũng không ích lợi gì cả.
- Cho phép dùng thuốc chống đau tối đa dù nó có thể làm người bệnh mau chết hơn.
- Cho biết một số nguyện vọng khác như vấn đề cho một hay nhiều cơ quan của mình sau khi chết cho người khác để thay (transplantation).
Về nguyên tắc chúng ta nên tìm hiểu những điều cần biết chung quanh chúc thư:
- Ðây là vấn đề tự nguyện, nhưng nên là, khi bệnh nhân lớn tuổi và bị bệnh nặng.
- Chúc thư không thay đổi cách trị và bác sĩ sẽ tiếp tục chữa bệnh như thường cho bệnh nhân.
- Có thể thay đổi ý kiến bất cứ lúc nào, không có ràng buộc gì cả.
- Bác sĩ phải tuân theo nguyện vọng của người bệnh như bản chúc thư đã ghi rõ, người nhà của bệnh nhân không được làm khác những ý muốn của bệnh nhân. Ðể tránh mâu thuẫn trong gia đình, khi làm chúc thư nên thảo luận với toàn thể gia đình trước.
Như đã ở trên đề cập, trong chúc thư, người ta có thể xác định chi tiết những phương tiện dùng trong điều trị. Ngoài xoa bóp tim và cho thở máy, người ta có thể xác định những phương tiện trị liệu khác như:
- Dịch truyền tĩnh mạch bao gồm nước biển (normal saline) để giữ cho không bị mất nước khi không uống được, dịch dinh dưỡng chứa chất protein, đường, chất béo, thiếu chất kim loại và sinh tố.
- Ðặt ống mũi bao tử để truyền đồ ăn lỏng khi người ta không nuốt được nhưng vẫn còn tiêu hoá được và cũng dùng để cho thuốc uống vào cơ thể. Trong trường hợp dùng ống lâu dài người ta có thể thay bằng ống bụng bao tử xuyên qua vách bụng.
- Các phương pháp thay thận nhân tạo khi thận bị suy hoàn toàn.
DNR: Có nhiều trường hợp khác, bệnh nhân có chúc thư dài dòng, nhưng họ lại có một nguyện vọng là không cấp cứu nếu tim và phổi không làm việc nữa, đó là lệnh “Ðừng cấp cứu”, gọi tắt là DNR hay là “Do Not Resuscitate”. Lệnh này có thể do bệnh nhân nói ra khi vào bệnh viện, dĩ nhiên phải có người chứng kiến sự phát biểu này để tránh tranh cãi về sau hay có thể điền vào một mẫu DNR in sẵn. Khi có lệnh này, nếu bệnh nhân ngưng tim và phổi không thở, người ta không xoa bóp tim, không đặt ống thở trong họng để nối với máy thở. Có một số vấn đề liên quan đến bệnh đừng cấp cứu:
- Lệnh này chỉ liên quan đến việc không xoa bóp tim và cho bệnh nhân thở máy. DNR không bao gồm những trị liệu khác.
- Bệnh nhân có thể huỷ bỏ lệnh DNR bất cứ lúc nào khi còn tỉnh không cần bằng văn bản, chỉ cần ra lệnh miệng là đủ giá trị.
- Khi người bệnh không còn tự quyết định, người đại diện không thể thay đổi DNR được.
- DNR cũng như chúc thư không có giới hạn thời gian, cho đến lúc nào người ta tự thay đổi lệnh.
Kết luận:
Chúc thư trong y khoa là điều nên nghĩ đến khi bệnh nhân lớn tuổi và bị bệnh nặng như bị bại liệt nặng do tai biến mạch máu não, ung thư ở giai đoạn cuối cùng v..v. Có chúc thư sẵn, người ta có thể tránh nhiều tranh cãi mâu thuẫn trong gia đình để có thể quyết định là có nên kéo dài đời sống của người thân khi không còn hy vọng sống sót. Nhiều người quan niệm phải làm bất cứ giá nào để cho người thân tiếp tục “sống” trong khi người đó chỉ là một cái xác không còn tri giác. Như thế mới là “có hiếu” hay chỉ là một sự hành hạ người thân của mình vào những giây phút cuối cùng của cuộc đời? Ðiều này có thể tránh được nếu bệnh nhân có chúc thư từ trước. Mọi phòng mạch đều có những chúc thư in sẵn chỉ cần điền tên tuổi và một số chi tiết cần thiết như ở trên đã bàn đến. Chúng ta cứ cho bác sĩ của mình biết ý định viết chúc thư, bác sĩ sẽ cung cấp các mẫu in sẵn và giải thích tường tận chi tiết của bản chúc thư. Nên thảo luận kỹ lưỡng với bác sĩ trước khi đi đến quyết định, và nhắc lại mọi quyết định đều có thể huỷ bỏ bất cứ lúc nào khi mình còn tỉnh trí và tự quyết định được.
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