Department of Medicine, University of California, San Francisco, CA, USA.
Am J Respir Crit Care Med. 2011 Apr 1;183(7):915-21. doi: 10.1164/rccm.201008-1214OC. Epub 2010 Oct 29.
Despite ongoing ethical debate concerning who should control decisions to discontinue life support for incapacitated, critically ill patients, the perspectives of surrogate decision makers are poorly understood.
To determine (1) what degree of decisional authority surrogates prefer for value-sensitive life support decisions compared with more technical biomedical decisions, and (2) what predicts surrogates' preferences for more control over life support decisions.
This was a prospective study of 230 surrogate decision makers for incapacitated, mechanically ventilated patients at high risk of death. Surrogates reported their preferred degree of decisional authority using the Degner Control Preferences Scale for two types of decisions: a value-sensitive decision about whether to discontinue life support and a decision regarding which antibiotic to prescribe for an infection.
The majority of surrogates (55%, 127/230; 95% confidence interval, 49-62%) preferred to have final control over the value-sensitive life support decision; 40% (91/230) wished to share control equally with the physician; 5% (12/230) of surrogates wanted the physician to make the decision. Surrogates preferred significantly more control over the value-sensitive life support decision compared with the technical decision about choice of antibiotics (P < 0.0001). Factors independently associated with surrogates' preference for more control over the life support decision were: less trust in the intensive care unit physician, male sex, and non-Catholic religious affiliation.
Surrogates vary in their desire for decisional authority for value-sensitive life support decisions, but prefer substantially more authority for this type of decision compared with technical, medical judgments. Low trust in physicians is associated with surrogates preferring more control of life support decisions.
尽管在停止对无行为能力、病危患者进行生命支持的决策方面存在持续的伦理争议，但对于代理人的观点却知之甚少。
确定（1）与更具技术性的生物医学决策相比，代理人在价值敏感的生命支持决策中希望拥有多大程度的决策权；（2）预测代理人对更多控制生命支持决策的偏好的因素。
这是一项针对 230 名无行为能力、机械通气、高死亡风险患者的代理人的前瞻性研究。代理人使用 Degner 控制偏好量表报告了他们对两种决策的偏好程度：是否停止生命支持的价值敏感决策和为感染开哪种抗生素的决策。
大多数代理人（55%，127/230；95%置信区间，49-62%）希望对价值敏感的生命支持决策拥有最终控制权；40%（91/230）希望与医生平等分享控制权；5%（12/230）的代理人希望由医生做出决定。与关于抗生素选择的技术性决策相比，代理人对价值敏感的生命支持决策的控制意愿明显更强（P<0.0001）。与代理人对生命支持决策偏好更多控制的因素独立相关的是：对重症监护病房医生的信任度较低、男性和非天主教宗教信仰。
代理人在价值敏感的生命支持决策中对决策权的渴望存在差异，但与技术性、医学判断相比，他们更希望对这种类型的决策拥有更多的控制权。对医生的信任度低与代理人更希望控制生命支持决策有关。
