Gillick Muriel R
Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim, 133 Brookline Avenue, Boston, MA 02215, USA.
Nutr Clin Pract. 2006 Apr;21(2):126-33. doi: 10.1177/0115426506021002126.
Advance care planning is important to ensure that patients, when competent, can influence the kind of medical care they receive if they lose decision-making capacity. Because decisions by surrogates to for-go nutrition support remain controversial, specific inclusion of artificial nutrition and hydration as a part of advance care planning has taken on growing importance. This article reviews the choices about artificial nutrition and hydration that are possible using conventional advance directives such as the living will, the instructional directive, values histories, and combination directives. It summarizes the legal basis for such documents. It also describes the ways that physicians' orders to limit treatment can help implement decisions about the use of artificial nutrition and hydration. Finally, it stresses the importance of clarifying with patients and families the risks and benefits of nutrition support in a variety of common situations such as advanced dementia and metastatic cancer as an essential prerequisite to meaningful advance care planning.
预先护理计划很重要，以确保患者在有行为能力时，如果失去决策能力，能够影响他们接受的医疗护理类型。由于代理人决定放弃营养支持仍存在争议，将人工营养和水合作用具体纳入预先护理计划变得越来越重要。本文回顾了使用传统预先指令（如生前遗嘱、指示性指令、价值观记录和组合指令）时关于人工营养和水合作用的选择。它总结了此类文件的法律依据。它还描述了医生限制治疗的医嘱有助于实施关于使用人工营养和水合作用的决策的方式。最后，它强调在诸如晚期痴呆和转移性癌症等各种常见情况下，向患者和家属阐明营养支持的风险和益处作为有意义的预先护理计划的基本前提的重要性。
