Lindemann Hilde, Nelson James Lindemann
*503 South Kedzie Hall, Michigan State University, East Lansing, MI 48824, USA.
J Med Philos. 2014 Apr;39(2):161-8. doi: 10.1093/jmp/jhu003. Epub 2014 Feb 19.
The authority of surrogates-often close family members-to make treatment decisions for previously capacitated patients is said to come from their knowledge of the patient, which they are to draw on as they exercise substituted judgment on the patient's behalf. However, proxy accuracy studies call this authority into question, hence the Patient Preference Predictor (PPP). We identify two problems with contemporary understandings of the surrogate's role. The first is with the assumption that knowledge of the patient entails knowledge of what the patient's choice of treatment would be. The second is with the assumption that a good decision reproduces the content of that choice. If we are right, then the PPP, helpful though it might be in guiding surrogates' decisions, nevertheless would hold them to the wrong standards and in that way could add to, rather than relieve, the stress they experience as they try to do their job.
代理人（通常是亲密家庭成员）为先前有行为能力的患者做出治疗决策的权力，据说是源于他们对患者的了解，在代表患者行使替代判断时，他们要依据这些了解。然而，代理人准确性研究对这种权力提出了质疑，因此出现了患者偏好预测器（PPP）。我们发现当代对代理人角色的理解存在两个问题。第一个问题是假设对患者的了解就意味着知道患者会选择何种治疗方式。第二个问题是假设一个好的决策会重现该选择的内容。如果我们是正确的，那么尽管患者偏好预测器在指导代理人决策方面可能会有所帮助，但它仍会让代理人遵循错误的标准，从而在他们试图履行职责时，增加而非减轻他们所经历的压力。
