Bernat E
Department of Civil Law, University of Graz, Austria.
Med Law Int. 1999;4(1):1-21. doi: 10.1177/096853329900400101.
There is a widespread consensus in law and medical ethics that living wills have to be obeyed by the physician if the patient was competent when the medical directive was signed and if, after the patient becomes incompetent, additional conditions occur which were considered by him. According to this viewpoint, the effectiveness of living wills is a direct consequence of the patient's right of self-determination. As the British Law Commission has recently put it: "An advance refusal made with capacity simply survives any supervening incapacity." However, this opinion does not take into account the empirical fact that the formerly competent person's critical interests (at t1) do not necessarily correspond wit his experiential interests after incompetency is established irreversibly (at t2). The author's goal is to answer the question of whether there can be cases which do not allow the formerly competent person's critical interests to prevail over the incompetent patient's experiential interests.
法律和医学伦理学界普遍认为,如果患者在签署医疗指令时具备行为能力,并且在患者丧失行为能力后出现了其曾考虑过的其他情况,那么医生就必须遵守生前遗嘱。根据这一观点,生前遗嘱的有效性是患者自决权的直接结果。正如英国法律委员会最近所说:“有行为能力时做出的预先拒绝在随后出现的任何无行为能力状态下仍然有效。”然而,这种观点没有考虑到这样一个经验事实,即先前有行为能力的人的关键利益(在t1时)不一定与他在不可逆转地丧失行为能力后(在t2时)的体验利益相一致。作者的目标是回答是否存在这样的情况,即先前有行为能力的人的关键利益不能优先于无行为能力患者的体验利益。