Culver C M, Gert B
Department of Psychiatry, Dartmouth Medical School, Hanover, NH 03756.
Milbank Q. 1990;68(4):619-43.
Patients' competence to make medical decisions, analysts frequently hold, is the key concept for determining whether those decisions may be overruled. Competence, however, is neither a necessary nor a sufficient condition for concluding when it is morally admissible to supersede refusals of treatment. People may be able to reach kinds of decisions involving immediate medical consequences, but not ones entailing long-term outcomes. Open recognition of the limited but important exceptions to the principle of never overruling competent patients' refusal of care would better preserve their autonomy than unduly accepting the absoluteness of the principle.
分析人士常常认为，患者做出医疗决策的能力是判定这些决策是否可被否决的关键概念。然而，能力既不是判定在道德上何时可以推翻拒绝治疗的决定的必要条件，也不是充分条件。人们可能有能力做出涉及直接医疗后果的各种决定，但无法做出涉及长期结果的决定。公开承认在绝不推翻有行为能力患者拒绝治疗这一原则上存在有限但重要的例外情况，比起过度接受该原则的绝对性，能更好地维护患者的自主权。
