精神科患者的预先指示？平衡家长主义与自主权。

Advance directives for psychiatric patients? Balancing paternalism and autonomy.

作者信息

Sass Hans-Martin

机构信息

Centre of Medical Ethics, Ruhr University, Universitätsstrasse 150, 44780 Bochum, Germany.

出版信息

Wien Med Wochenschr. 2003;153(17-18):380-4. doi: 10.1007/s10354-003-0018-z.

DOI:10.1007/s10354-003-0018-z

PMID:14571662

Abstract

Advance directives contain wishes and values, fears and refusals of competent lay people regarding medical interventions in future situations when they might lack communicative and decision-making capacities. However, these advance directives for medical, psychiatric and care interventions can very well be used to improve the care for patients in psychiatry and gerontopsychiatry and to provide individualized care and treatment. The development and use of advance-care documents in psychiatry, and the clinical and ethical appreciation and recognition of the wishes and values of those patients, represent a particularly difficult challenge to medical paternalism.

摘要

预先指示包含有行为能力的普通人对于未来可能缺乏沟通和决策能力时医疗干预的愿望、价值观、恐惧和拒绝。然而，这些针对医疗、精神科和护理干预的预先指示完全可以用来改善精神病学和老年精神病学中对患者的护理，并提供个性化的护理和治疗。精神病学中预先护理文件的制定和使用，以及对这些患者的愿望和价值观的临床和伦理理解与认可，对医疗家长主义来说是一个特别艰巨的挑战。