Vollmann J, Pfaff M
Institut für Geschichte und Ethik der Medizin, Friedrich-Alexander-Universität Erlangen-Nuremberg, Erlangen.
Dtsch Med Wochenschr. 2003 Jul 4;128(27):1494-7. doi: 10.1055/s-2003-40280.
The article examines on the basic of empirical data the discrepancy between the theoretical demand and the practical role of advance directives. Often advance directives have no influence on medical decision-making in clinical care of critically ill patients. The vague language of the widely used standard living wills and the lack of physician-patient communication in the process of delivering an advance directives are contributing factors. However, many physicians even disregard patients' preferences in concrete and meaningful living wills at the end of life. Besides the lack of information many even seriously ill patients do not deliver an advance because they misjudge their medical prognosis and life expectancy. Often the communication between patients and doctors are blocked because they expect from the each other the first step to talk about end of life decisions and advance directives. In this context physicians claim lack of time, training in communication skills and their discomfort in talking about death and dying with their patients.
本文基于实证数据研究了预先指示的理论需求与实际作用之间的差异。在重症患者的临床护理中，预先指示往往对医疗决策没有影响。广泛使用的标准生前遗嘱语言模糊，以及在传达预先指示过程中缺乏医患沟通，都是促成因素。然而，许多医生甚至在患者临终时无视其在具体且有意义的生前遗嘱中表达的偏好。除了信息匮乏之外，许多重病患者甚至也不签署预先指示，因为他们误判了自己的医疗预后和预期寿命。医患之间的沟通常常受阻，因为他们都期望对方迈出第一步来谈论临终决策和预先指示。在这种情况下，医生们声称缺乏时间、沟通技巧培训，并且在与患者谈论死亡和临终问题时感到不适。
