Bayley C, Michel V
Health Prog. 1985 Dec;66(10):18-21, 58.
Medical technology has created dilemmas for those who make decisions regarding whether to prolong life in the face of severe, irreversible illness. Two questions usually arise: who should decide, and what standards should the decision makers use? These questions can be particularly difficult for members of religious institutes. The basic legal standard for such decisions is the patient's autonomy or self-determination; the patient's wishes are paramount. If the patient has been determined incompetent, a person who has the patient's best interests at heart should make the treatment decisions. Sometimes it may be necessary for the court to appoint a conservator. In California a recent law enables a person to create a Durable Power of Attorney--that is, to designate someone to make all health care decisions if the designator becomes incompetent. The surrogate can base decisions on either of two basic legal standards: substituted judgment or best interests. The substituted-judgment standard holds that the decision should be the one that the patient would have made if competent. The decision should be based on any available information about the patient's values and preferences. If these are not sufficiently known, the decision maker may have to resort to the best-interest standard, evaluating all options to determine what is "best" for the patient. In the case of a religious who becomes incompetent and has no family members, the physician probably will accept a member of the institute as a surrogate. If the incompetent religious has family, they and the institute should discuss who should be responsible for communicating with medical personnel. In California, a competent member of an institute should designate a surrogate in advance to avoid any confusion or conflict later.
面对严重的、不可逆转的疾病，医疗技术给那些决定是否延长生命的人带来了两难困境。通常会出现两个问题：谁应该做决定，以及决策者应该采用什么标准？对于宗教机构的成员来说，这些问题可能特别棘手。此类决定的基本法律标准是患者的自主权或自我决定权；患者的意愿至关重要。如果患者被判定无行为能力，那么一个真正关心患者最大利益的人应该做出治疗决定。有时可能需要法院指定一名监护人。在加利福尼亚州，最近通过的一项法律允许个人设立一份持久授权书——也就是说，指定某人在授权人丧失行为能力时做出所有医疗保健决定。代理人可以依据两个基本法律标准中的任何一个来做决定：替代判断标准或最佳利益标准。替代判断标准认为，该决定应该是患者在有行为能力时会做出的决定。该决定应该基于任何有关患者价值观和偏好的现有信息。如果这些信息了解得不够充分，决策者可能不得不诉诸最佳利益标准，评估所有选项以确定什么对患者“最有利”。对于一名丧失行为能力且没有家庭成员的宗教人士，医生可能会接受该机构的一名成员作为代理人。如果这位无行为能力的宗教人士有家人，他们和该机构应该讨论谁负责与医务人员沟通。在加利福尼亚州，机构中的一名有行为能力的成员应该提前指定一名代理人，以避免日后出现任何混乱或冲突。
