Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, Republic of Korea.
Bioethics. 2010 Mar;24(3):113-7. doi: 10.1111/j.1467-8519.2009.01787.x.
Despite the wide and daunting array of cross-cultural obstacles that the formulation of a global policy on advance directives will clearly pose, the need is equally evident. Specifically, the expansion of medical services driven by medical tourism, just to name one important example, makes this issue urgently relevant. While ensuring consistency across national borders, a global policy will have the additional and perhaps even more important effect of increasing the use of advance directives in clinical settings and enhancing their effectiveness within each country, regardless of where that country's state of the law currently stands. One cross-cultural issue that may represent a major obstacle in formulating, let alone applying, a global policy is whether patient autonomy as the underlying principle for the use of advance directives is a universal norm or a construct of western traditions that must be reconciled with alternative value systems that may place lesser significance on individual choice. A global policy, at a minimum, must emphasize respect for patient autonomy, provision of medical information, limits to the obligations for physicians, and portability. And though the development of a global policy will be no easy task, active engagement in close collaboration with the World Health Organization can make it possible.
尽管制定全球预嘱政策显然会面临广泛而艰巨的跨文化障碍，但这一需求同样明显。具体来说，医疗旅游推动的医疗服务的扩张，仅举一个重要的例子，就使这个问题变得非常紧迫。在确保跨国界一致性的同时，全球政策还将产生额外的、甚至可能更重要的影响，即增加在临床环境中使用预嘱的数量，并提高其在每个国家的有效性，无论该国的法律现状如何。在制定全球政策时，一个可能构成重大障碍的跨文化问题是，将患者自主权作为使用预嘱的基本原则，究竟是一种普遍规范，还是西方传统的一种构建，必须与可能对个人选择赋予较低重要性的替代价值体系相协调。全球政策至少必须强调尊重患者自主权、提供医疗信息、限制医生的义务以及可携带性。虽然制定全球政策并非易事，但在世卫组织的积极参与下进行密切合作，可以使其成为可能。
