Srebnik Debra, Brodoff Lisa
Department of Psychiatry and Behavioral Sciences, University of Washington, Box 359911, 325-9th Ave, Seattle, WA 98104, USA.
J Behav Health Serv Res. 2003 Jul-Sep;30(3):253-68. doi: 10.1007/BF02287316.
Psychiatric advance directives (PADs) are an emerging method for adults with serious and persistent mental illness to document treatment preferences in advance of periods of incapacity. This article presents and responds to issues most frequently raised by service providers when planning for implementation of PADs. Issues discussed include access to PADs; competency to execute PADs; the relationship of PADs to standards of care, resource availability, and involuntary treatment; roles of service providers and others in execution of PADs; timeliness and redundancy of PAD information; consumer expectations of PADs; complexity of PADs; revocation and "activation"; legal enforceability of PADs; the role and powers of agents; liability for honoring and not honoring PADs; and use of PADs to consent for release of health care information. Recommendations are made for training staff and consumers, consideration of statute development, and methods to reduce logistical, attitudinal, and system barriers to effective use of PADs.
精神科预先指示（PADs）是一种新出现的方法，供患有严重且持续性精神疾病的成年人在丧失行为能力之前记录其治疗偏好。本文提出并回应了服务提供者在规划实施PADs时最常提出的问题。讨论的问题包括获取PADs的途径；执行PADs的能力；PADs与护理标准、资源可用性及非自愿治疗的关系；服务提供者及其他人员在执行PADs中的作用；PADs信息的及时性和冗余性；消费者对PADs的期望；PADs的复杂性；撤销和“激活”；PADs的法律可执行性；代理人的角色和权力；遵守和不遵守PADs的责任；以及使用PADs同意披露医疗保健信息。文中针对培训工作人员和消费者、考虑法规制定以及减少有效使用PADs的后勤、态度和系统障碍的方法提出了建议。
