Golan Ofra G
Harefuah. 2009 Apr;148(4):248-9, 276.
The provision of care for the dying patient confronts the caring team with very complex ethical dilemmas that doctors have no "medical" means to manage. Such decisions should be made according to the patient's will and preferences reflecting the value of life and the quality of life. However, many patients are not competent at this stage to decide or to express their wishes. Therefore, the Dying Patient Law of 2005, recognized advance expression of will through advance directives and power of attorney. Yet, there are many difficulties in the actual application of this idea. Dr. Shalev's article in this issue, to which this editorial relates, discusses the problems of communication between doctor and patient at the stage of preparing advance directives, and suggests a way to handle these deliberations. The Israeli law of 2005 provides some original solutions to other obstacles presented in the Literature as causing "the failure of the Living will". One resolution is the requirement that an explanation of the relevant medical information be given by a doctor or a nurse to the person who wishes to prepare written advance directives. This article suggests that the required explanation should be given within the framework of a discussion that simulates a process of informed consent for an unknown scenario at the end-of-life. Such discussions should be conducted as a dialogue, in which the doctor, first and foremost, Listens to the patient in order to clarify his/her worries and wishes, according to which specific medical orders can then be formulated.
为临终患者提供护理使护理团队面临非常复杂的伦理困境，而医生没有“医学”手段来处理这些困境。此类决定应根据患者反映生命价值和生活质量的意愿及偏好来做出。然而，许多患者在这个阶段没有能力做出决定或表达自己的意愿。因此，2005年的《临终患者法》认可通过预先指示和授权书预先表达意愿。然而，这一理念在实际应用中存在许多困难。与本社论相关的沙莱夫博士在本期发表的文章讨论了在准备预先指示阶段医生与患者之间的沟通问题，并提出了处理这些商议的方法。2005年的以色列法律针对文献中提出的导致“生前遗嘱失败”的其他障碍提供了一些原创性解决方案。其中一项解决方案是要求医生或护士向希望准备书面预先指示的人解释相关医疗信息。本文建议，所需解释应在模拟临终时未知情况的知情同意过程的讨论框架内进行。此类讨论应作为对话进行，在对话中，医生首先要倾听患者的意见，以澄清其担忧和愿望，然后据此制定具体的医疗指令。
