Moon J B, Graber G C
J Med Humanit Bioeth. 1985 Spring-Summer;6(1):12-27. doi: 10.1007/BF01149835.
The patient we call Danny was a mildly mentally retarded male in his mid-thirties who adamantly refused kidney dialysis when it was offered as the only therapeutic option for his progressive kidney failure. It was uncertain how fully Danny understood the implications of his refusal. To complicate the case still further, several "advocates" emerged to speak on Danny's behalf--each with a somewhat different interpretation of the situation and different sets of value presuppositions and ethical principles to apply to the choice. We chronicle the development of this situation through a series of scenes; and in each scene we also attempt to clarify the ethical and medico-legal issues involved at that point. Danny was finally permitted to make this decision for himself--though more by default than by an agreement by all parties to honor his autonomy. Our hope is that this presentation will lead to further discussion and clarification of these important issues.
我们称作丹尼的患者是一名35岁左右的轻度智障男性，当肾脏透析作为其进行性肾衰竭的唯一治疗选择提供给他时，他坚决拒绝。尚不确定丹尼对自己拒绝的后果理解到何种程度。更复杂的是，出现了几位“倡导者”代表丹尼发言——每个人对情况的解读略有不同，适用于该选择的价值预设和伦理原则也各不相同。我们通过一系列场景记录了这种情况的发展；在每个场景中，我们还试图阐明当时所涉及的伦理和医疗法律问题。最终允许丹尼自己做出这个决定——尽管更多是由于默认，而非各方都同意尊重他的自主权。我们希望这个陈述能引发对这些重要问题的进一步讨论和澄清。
