Ritzenthaler-Spielmann Daniela
Dialog Ethik, Interdisziplinäres Institut für Ethik im Gesundheitswesen, Zürich.
Ther Umsch. 2009 Aug;66(8):585-9. doi: 10.1024/0040-5930.66.8.585.
The concept of 'living will', also known as 'advanced directive', emerged in response to modern medical technologies and aggressive medical treatments being implemented in ambiguous situations such as a poor prognostic state. A living will aims at protecting the patient's right to autonomy in such a situation. Ideally, it is a substitute for the actual informed consent or refusal in situations where the individual is unable to express his or her will due to incapacity. At least, a living will can usefully inform medical-ethical decision-making on behalf of an incompetent patient. A living will can either be very general or very specific. It may hold specific directives about the use or foregoing of potentially burdensome medical treatments including food and water to be supplied by feeding tubes or other medical devices. In addition of being a helpful tool for respecting a patient's autonomy, a living will may be regarded as an opportunity for improving communication about death and dying with patients and healthy people alike.
“生前预嘱”的概念，也被称为“预先医疗指示”，是为应对现代医疗技术以及在诸如预后不佳等模糊情况下所实施的激进医疗手段而出现的。生前预嘱旨在保护患者在这种情况下的自主权利。理想情况下，它是在个人因无行为能力而无法表达自己意愿的情况下，替代实际的知情同意或拒绝的一种方式。至少，生前预嘱可以有效地为无行为能力患者的医疗伦理决策提供信息。生前预嘱可以非常笼统，也可以非常具体。它可能包含关于使用或放弃潜在负担沉重的医疗治疗的具体指示，包括通过喂食管或其他医疗设备提供的食物和水。除了是尊重患者自主权的有用工具外，生前预嘱还可被视为改善与患者及健康人群关于死亡和临终问题沟通的契机。
