Soriano Maria Aileen, Lagman Ruth
Section of Palliative Medicine and Supportive Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH 44195, USA.
Am J Hosp Palliat Care. 2012 Aug;29(5):401-4. doi: 10.1177/1049909111421163. Epub 2011 Oct 13.
The need to ascertain appropriate decision-making capacity is greatest when dealing with refusals of lifesaving or life-prolonging treatment. This may be complicated by delirium, concurrent depression, metabolic disturbances or significant symptom burden, family conflicts, and social issues. This is a case of a 48-year-old patient with a long-standing history of a symptomatic pan-invasive pituitary adenoma who refused life-prolonging treatment. Ultimately, a patient must be able to understand the information given to him, evaluate the consequences of the options presented, deliberate on these options based on his values, communicate this choice, and maintain consistency overtime. These refusals of treatment may fluctuate with time and intensity of the illness. Denial of this right of autonomy and self-determination may worsen the individual's physical and existential suffering.
在处理拒绝挽救生命或延长生命的治疗时，确定适当决策能力的需求最为迫切。这可能因谵妄、并发抑郁症、代谢紊乱或严重症状负担、家庭冲突和社会问题而变得复杂。这是一名48岁的患者，有症状性全侵袭性垂体腺瘤的长期病史，他拒绝了延长生命的治疗。最终，患者必须能够理解提供给他的信息，评估所呈现选项的后果，根据自己的价值观思考这些选项，传达这一选择，并随时间保持一致。这些拒绝治疗的情况可能会随疾病的时间和严重程度而波动。否认这种自主权和自决权可能会加重个人的身体和生存痛苦。
