Carr Deborah, Khodyakov Dmitry
Rutgers University, USA.
J Health Soc Behav. 2007 Jun;48(2):180-94. doi: 10.1177/002214650704800206.
Dying persons are encouraged to name as durable power of attorney for health care (DPAHC) someone who will thus be empowered to make end-of-life treatment decisions for them in the event that they become incapacitated. We use data from the Wisconsin Longitudinal Study to investigate whether and whom older adults designate as their DPAHC. DPAHC appointments are affected by recent hospitalizations, personal beliefs (including religion, fear of death, and the belief that doctors rather than patients should control health care decisions), and personal experience with the recent painful death of a loved one. The selections of DPAHC designees are generally consistent with the hierarchical compensatory model: Married persons overwhelmingly name their spouses, while unmarried parents appoint their children. Women are more likely than men to rely on children. Parents of one or two children tend to bypass their children for another relative. Unmarried, childless persons show considerable heterogeneity in their choices. We discuss implications of these findings for health care policy and practice.
鼓励垂危者指定某人作为医疗保健的持久授权书（DPAHC）代理人，这样在他们丧失行为能力时，该代理人将有权为他们做出临终治疗决定。我们利用威斯康星纵向研究的数据来调查老年人是否指定以及指定谁为他们的DPAHC代理人。DPAHC的指定受到近期住院情况、个人信仰（包括宗教、对死亡的恐惧以及认为应由医生而非患者控制医疗保健决策的信念）以及近期亲人痛苦死亡的个人经历的影响。DPAHC被指定人的选择通常与分层补偿模型一致：已婚者绝大多数指定其配偶，而未婚父母则指定其子女。女性比男性更有可能依赖子女。有一两个孩子的父母往往会越过自己的孩子而指定其他亲属。未婚且无子女的人在选择上表现出相当大的异质性。我们讨论了这些发现对医疗保健政策和实践的影响。
