Vollmann J
Institut für Medizinische Ethik und Geschichte der Medizin, Ruhr-Universität Bochum.
Nervenarzt. 2012 Jan;83(1):25-30. doi: 10.1007/s00115-011-3407-3.
Since 1 September 2009, advance directives are regulated by law in Germany. This article discusses ethical challenges of advance directives in patients with mental disorders. Besides concrete information on the preferred medical treatment in concrete clinical situations, the mental capacity of the patient at the time of issuing the directive is essential. The "Decisional Competence Assessment Tool for Psychiatric Advance Directives" and empirical studies from the USA on advance directives in patients with mental disorders and the assessment by the treating psychiatrists of these patient directives are discussed. Ethical conclusions are drawn for handling advance directives in psychiatric practice.
自2009年9月1日起，德国法律对预立医疗指示进行规范。本文探讨了精神障碍患者预立医疗指示的伦理挑战。除了关于具体临床情况下首选医疗治疗的具体信息外，患者在发出指示时的精神能力至关重要。本文还讨论了“精神科预立医疗指示决策能力评估工具”以及美国关于精神障碍患者预立医疗指示的实证研究，以及治疗精神科医生对这些患者指示的评估。得出了在精神科实践中处理预立医疗指示的伦理结论。
