Ang Aaron, Loke Peter C W, Campbell Alastair V, Chong Siow Ann
Department of Geriatric Psychiatry, Institute of Mental Health, Singapore.
Ann Acad Med Singap. 2009 Apr;38(4):370-4.
Medical co-morbidities are very common in patients with psychiatric conditions. Although respecting one's autonomy to make treatment decisions is the ethical default position, the capacity to make such decisions may need to be assessed, especially when patients are in relapse of their psychiatric condition, and/or when the decisions made are high-risk and possibly fatal. This case report highlights the ethical issues of refusing potential life-saving treatment in a patient who is in relapse of her schizoaffective disorder. In particular, the assessment of decisional capacity and the role of the doctors (if the patient lacks capacity) are discussed. Recommendations are also made on how to better manage such situations.
躯体共病在精神疾病患者中非常常见。尽管尊重患者自主做出治疗决策是伦理上的默认立场，但做出此类决策的能力可能需要评估，尤其是当患者精神疾病复发时，和/或当所做决策具有高风险且可能致命时。本病例报告强调了一名精神分裂症情感障碍复发患者拒绝潜在救命治疗的伦理问题。特别讨论了决策能力的评估以及医生的角色（如果患者缺乏决策能力）。还就如何更好地处理此类情况提出了建议。
