Sayers G M, Bethell H W L
Department of Geriatric and General Medicine, Northwick Park Hospital, Harrow, UK.
Heart. 2004 Feb;90(2):134-5. doi: 10.1136/hrt.2003.022731.
Decision making competence is not necessarily present or absent. In many cases it is partial or compromised. This applies especially to those over 80 years old, in whom the prevalence of dementia is high. Three patients who presented with indications for permanent pacemaker insertion are considered. One was apparently competent, one had partial competence, and one was clearly incompetent. In all three cases the closest relatives were opposed to decisions made by either the patient or the doctors. The three cases reflect the tension between doctors, patients, and relatives in situations where medical interests, individual interests, and familial interests conflict. The cases illustrate the type of problems encountered in clinical practice. The current legal position is reviewed.
决策能力并非必然存在或缺失。在许多情况下，它是部分存在或受损的。这尤其适用于80岁以上的人群，他们中痴呆症的患病率很高。本文考虑了三名有永久性起搏器植入指征的患者。一名患者显然有决策能力，一名患者有部分决策能力，一名患者明显无决策能力。在所有这三个案例中，最亲近的亲属都反对患者或医生做出的决定。这三个案例反映了在医疗利益、个人利益和家庭利益发生冲突的情况下，医生、患者和亲属之间的紧张关系。这些案例说明了临床实践中遇到的问题类型。本文对当前的法律状况进行了审视。
