Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Am J Respir Crit Care Med. 2012 Sep 15;186(6):480-6. doi: 10.1164/rccm.201204-0710CP. Epub 2012 Jul 19.
Many patients who develop incapacitating illness have not expressed clear treatment preferences. Therefore, surrogate decision makers are asked to make judgments about what treatment pathway is most consistent with the patient's values. Surrogates often struggle with such decisions. The difficulty arises because answering the seemingly straightforward question, "What do you think the patient would choose?" is emotionally, cognitively, and morally complex. There is little guidance for clinicians to assist families in constructing an authentic picture of the patient's values and applying them to medical decisions, in part because current models of medical decision making treat the surrogate as the expert on the patient's values and the physician as the expert on technical medical considerations. However, many surrogates need assistance in identifying and working through the sometimes conflicting values relevant to medical decisions near the end of life. We present a framework for clinicians to help surrogates overcome the emotional, cognitive, and moral barriers to high-quality surrogate decision making for incapacitated patients.
许多出现丧失能力的疾病的患者并未明确表达其治疗偏好。因此，需要由代理人来判断哪种治疗途径最符合患者的价值观。代理人在做出此类判断时往往存在困难。这是因为回答看似简单的问题“您认为患者会选择什么？”在情感、认知和道德方面都很复杂。临床医生几乎没有任何指导来帮助家属构建患者价值观的真实画面，并将其应用于医疗决策，部分原因是当前的医疗决策模型将代理人视为患者价值观方面的专家，而将医生视为技术医疗考虑方面的专家。然而，许多代理人在确定和处理与生命末期医疗决策相关的有时相互冲突的价值观方面需要帮助。我们提出了一个框架，帮助临床医生帮助代理人克服在为丧失能力的患者做出高质量代理决策时面临的情感、认知和道德障碍。
