Gamble E R, McDonald P J, Lichstein P R
Department of Medicine, East Carolina University School of Medicine, Greenville, NC 27858-2354.
Arch Intern Med. 1991 Feb;151(2):277-80.
The knowledge, attitudes, and behavior of elderly persons regarding living wills were explored in a rural county in eastern North Carolina. A questionnaire was administered to 75 ambulatory elderly persons by personal interview at community dining sites. Fifty-two percent (39) of these subjects said they were familiar with living wills and 64% (48 persons) correctly summarized what the North Carolina living will says. When asked about preferences for medical care in the setting of a terminal illness, 86% (65 persons) stated a desire to receive basic medical care or comfort care only. Although their preferences were consistent with the provisions of a living will, none had signed the living will document provided by the state of North Carolina, and only two (3%) had discussed a living will with their physician. Seventy (93%) wanted their family or spouse to make decisions about terminal care if they themselves were unable to participate, and discussions between these persons and their chosen proxies actually occurred 45% (34/75) of the time. Eighty-one percent (61 persons) stated a desire to discuss end-of-life care with their physicians, but a minority (eight [11%]) had actually talked with their physicians, and these discussions were usually initiated by the patient (five of eight). We conclude that living will legislation is congruent with the desire of many elderly persons to limit medical care in terminal illness. However, this elderly population did not make use of living wills as a means of indicating their wishes. Recommendations are made to improve physician-patient and patient-proxy communication regarding preferences for medical care at the end of life and living wills. Alternatives to the living will should also be explored.
在北卡罗来纳州东部的一个乡村县，对老年人关于生前遗嘱的知识、态度和行为进行了调查。通过在社区就餐场所进行个人访谈，对75名能走动的老年人进行了问卷调查。这些受试者中有52%（39人）表示熟悉生前遗嘱，64%（48人）正确总结了北卡罗来纳州生前遗嘱的内容。当被问及在绝症情况下对医疗护理的偏好时，86%（65人）表示只希望接受基本医疗护理或舒适护理。尽管他们的偏好与生前遗嘱的规定一致，但没有人签署北卡罗来纳州提供的生前遗嘱文件，只有两人（3%）与他们的医生讨论过生前遗嘱。70人（93%）希望如果他们自己无法参与，由他们的家人或配偶就临终护理做出决定，而这些人与他们选定的代理人之间实际进行讨论的时间为45%（34/75）。81%（61人）表示希望与他们的医生讨论临终护理，但只有少数人（8人[11%]）实际与他们的医生进行过交谈，而且这些讨论通常是由患者发起的（8人中有5人）。我们得出结论，生前遗嘱立法与许多老年人在绝症中限制医疗护理的愿望是一致的。然而，这一老年人群体并没有将生前遗嘱作为表明他们意愿的一种方式。建议改善医患之间以及患者与代理人之间关于临终医疗护理偏好和生前遗嘱的沟通。还应探索生前遗嘱的替代方案。
