Rie M A
Department of Anesthesiology, University of Kentucky Chandler Medical Center, Lexington 40536-0084.
J Med Philos. 1992 Dec;17(6):647-64. doi: 10.1093/jmp/17.6.647.
The Supreme Court decision in Cruzan reaffirmed the power of the states to set procedural standards for due process regarding the individual's exercise of his liberty interest. As a result, to effect an autonomous decision to refuse treatment when one becomes incompetent requires an affirmative articulation by means of an advance directive. This article argues against simplified advance directives in that they fail to enhance individual liberty and responsibility and fail to provide physicians with needed information. A model protective advance directive is advocated with direction to terminate personal and health insurance payments for health care that is not desired by the patient.
最高法院在“克鲁赞案”中的裁决重申了各州有权为正当程序设定程序标准,以规范个人行使其自由权益的行为。因此,当一个人失去行为能力时,要做出自主拒绝治疗的决定,就需要通过预先指示进行明确表述。本文反对简化的预先指示,因为它们未能增强个人自由和责任,也未能为医生提供所需信息。本文提倡一种示范性的保护性预先指示,该指示要求停止为患者不希望接受的医疗保健支付个人和医疗保险费用。