London Health Sciences Centre, PO Box 5375, London ON, Canada N6A 4G5.
J Crit Care. 2010 Mar;25(1):171.e1-7. doi: 10.1016/j.jcrc.2009.07.008. Epub 2009 Sep 24.
When patients are unable to communicate their own wishes, surrogates are commonly used to aid in decision making. Although each jurisdiction has its own rules or legislation governing how surrogates are to make health care decisions, many rely on the notion of "best interests" when no prior expressed wishes are known.
We purposively sampled written decisions of the Ontario Consent and Capacity Board that focused on the best interests of patients at the end of life. Interpretive content analysis was performed independently by 2 reviewers, and themes that were identified by consensus as describing best interests were construed, as well as the characteristics of an end-of-life dispute that may be most appropriately handled by an application to the Consent and Capacity Board.
We found that many substitute decision makers rely on an appeal to religion or God in their interpretation of best interests, whereas physicians focused narrowly on the clinical condition of the patient in their interpretations.
Several lessons are drawn for the benefit of health care teams engaged in end-of-life conflicts with substitute decision makers over the best interests of patients.
当患者无法表达自己的意愿时，通常会使用代理人来协助决策。尽管每个司法管辖区都有自己的规定或立法来规范代理人应如何做出医疗保健决策，但在不知道事先表达的意愿的情况下，许多司法管辖区都依赖于“最佳利益”的概念。
我们有意抽样了安大略省同意和能力委员会的书面决定，这些决定集中在生命末期患者的最佳利益上。两名评审员独立进行解释性内容分析，并通过共识确定描述最佳利益的主题，并确定最适合通过同意和能力委员会申请来处理的临终争议的特征。
我们发现，许多代理人在解释最佳利益时依赖于对宗教或上帝的诉求，而医生在解释时则将注意力集中在患者的临床状况上。
为了使参与与代理人就患者最佳利益发生冲突的临终关怀的医疗团队受益，我们得出了一些教训。
