Department of Surgery, Facultyof Medicine, Tehran Universityof Medical Sciences, Tehran, Iran.
J Med Ethics. 2011 Sep;37(9):523-5. doi: 10.1136/jme.2010.040691. Epub 2011 Apr 8.
Substitute decision making on behalf of incapable patients is based on the ethical principle of 'respect for autonomy'. This study was conducted to assess patients' wishes and preferences in terms of a substitute decision maker and determinants of such preferences.
The authors conducted a cross-sectional study and selected samples randomly from patients presenting at Farabi Eye Hospital clinics who were 18 years of age or older. Questionnaires were completed through interviews.
200 patients between the ages of 18 and 83 years were interviewed. About 52% (N=105) were men and 73% (N=77) were married. Among married patients, the spouse was chosen as the substitute decision maker in only 51% of cases. Single men preferred their father first in 36% (N=9) of cases, while single girls chose their father in 5.6% (N=1) of cases and their most prevalent choice was other unmentioned people (33.3%, N=6). Most patients (93.5%) wished to be asked about their substitute decision maker when hospitalised.
The results of this study show that the people we usually consult for decisions concerning patient treatment are significantly different from the patients' preferred substitute decision makers. The authors suggest patients be allowed to choose their substitute decision maker while conscious.
代表无行为能力的患者做出替代决策是基于“尊重自主权”的伦理原则。本研究旨在评估患者对替代决策者的意愿和偏好以及影响这些偏好的因素。
作者进行了一项横断面研究，从 Farabi 眼科医院诊所就诊的年龄在 18 岁及以上的患者中随机选择样本。通过访谈完成问卷。
共对 200 名年龄在 18 至 83 岁之间的患者进行了访谈。其中 52%（N=105）为男性，73%（N=77）已婚。在已婚患者中，仅有 51%（N=105）的患者选择配偶作为替代决策者。单身男性首选父亲作为替代决策者的比例为 36%（N=9），而单身女性选择父亲作为替代决策者的比例为 5.6%（N=1），她们最常选择的是其他未提及的人（33.3%，N=6）。大多数患者（93.5%）希望在住院时被问及替代决策者的选择。
本研究结果表明，我们通常咨询的有关患者治疗决策的人，与患者首选的替代决策者显著不同。作者建议在患者有意识的情况下，允许其选择替代决策者。
