Vollmann J
Institut für Geschichte der Medizin, Arbeitsgruppe Ethik in der Medizin, Freie Universität Berlin, Klingsorstr. 119, Berlin 12203, Germany.
Med Health Care Philos. 2001;4(2):161-7. doi: 10.1023/a:1011491100267.
Advance patient directives are various forms of anticipatory medical directives made by competent individuals for the eventuality of future incompetence. They are therefore appropriate instruments for competent patients in the early stage of Alzheimer's disease to document their self-determined will in the advanced stages of dementia. Theoretical objections have been expressed against the concept of advance patient directives (problems of authenticity and identity) which, however, cannot negate the fundamental moral authority of advance patient directives. Therefore, patients, family members, and physicians should make use of the appropriate form of advance directive as part of common treatment and care planning. Advance directives, when utilized intelligently, represent appropriate instruments for shared decision-making by patient, family members and physician. They should be utilized to a greater extent, particularly for the treatment planning of demented patients.
预先医疗指示是有行为能力的个人针对未来可能丧失行为能力的情况所制定的各种形式的预期医疗指令。因此，对于处于阿尔茨海默病早期阶段的有行为能力的患者而言，预先医疗指示是合适的工具，可用于记录他们在痴呆晚期的自主意愿。针对预先医疗指示的概念存在一些理论上的反对意见（真实性和身份问题），然而，这些反对意见并不能否定预先医疗指示的基本道德权威性。因此，患者、家属和医生应采用适当形式的预先医疗指示，作为共同治疗和护理计划的一部分。如果明智地使用，预先医疗指示是患者、家属和医生共同决策的合适工具。应更广泛地利用预先医疗指示，特别是用于痴呆患者的治疗计划。
