Rich B A
University of Colorado Health Sciences Center, Box B137, 4200 East Ninth Street, Denver, Colorado 80262, USA.
Psychol Public Policy Law. 1998 Sep;4(3):610-28.
This article considers 2 major critiques of advance directives and offers a defense to each of them. The 1st critique is philosophical in nature and maintains that the moral authority of an advance directive is undercut by a failure of personal identity to survive the loss of decisional capacity. The response in this article is that this critique relies on a flawed and disfavored concept of persons and their persistence over time. The 2nd critique, pragmatic in nature, argues that advance directives cannot be authoritative because the requisite elements of an informed consent to or refusal of treatment are rarely present, and many such instruments are ambiguous. The author argues that if the creation of advance directives, as a form of advance care planning, is made an integral aspect of clinical practice, many more patients will elect to execute directives, and those directives will not be ambiguous.
本文探讨了对预立医疗指示的两大主要批评，并对每一项批评进行了辩护。第一项批评本质上是哲学性的，认为个人身份在决策能力丧失后无法存续，这削弱了预立医疗指示的道德权威。本文的回应是，这一批评依赖于一个有缺陷且不受青睐的关于人及其随时间延续的概念。第二项批评本质上是务实性的，认为预立医疗指示不可能具有权威性，因为对治疗的知情同意或拒绝所需的要素很少存在，而且许多此类文书含糊不清。作者认为，如果将预立医疗指示的制定作为预先护理计划的一种形式，纳入临床实践的一个组成部分，更多患者将选择签署指示，而且这些指示也不会含糊不清。
