Tunzi Marc, Spike Jeffrey P
Medicine Residency Program, Natividad Medical Center, Salinas, California; Department of Family and Community Medicine, University of California, San Francisco (Dr Tunzi); and McGovern Center for Humanities and Ethics, UTHealth, University of Texas-Houston (Dr Spike).
Prim Care Companion CNS Disord. 2014 Nov 27;16(6). doi: 10.4088/PCC.14br01666. eCollection 2014.
Three cases are presented that demonstrate the difficulty of assessing medical decision-making capacity in patients with psychiatric illness who are refusing care. Health professionals often assess capacity differently in practice. Provided their patients have some understanding of their illness and have some plans for meeting basic needs, psychiatrists are often inclined to give patients the freedom to refuse care even if they do not exhibit a full understanding of the medical facts of their case and why they are refusing it. Adult medicine physicians, in contrast, are inclined to require patients to state a more complete understanding of the benefits and burdens of evaluation and treatment before allowing them to refuse care when their refusals might result in adverse medical outcomes. The 3 cases exemplify the tension between these approaches and highlight the role of hospital ethics consultation in addressing this conflict.
本文介绍了三起案例，这些案例表明评估拒绝治疗的精神疾病患者的医疗决策能力存在困难。在实际操作中，医疗专业人员对能力的评估往往存在差异。只要患者对自己的病情有一定了解，并且有满足基本需求的一些计划，精神科医生通常倾向于给予患者拒绝治疗的自由，即使他们对自己病例的医学事实以及拒绝治疗的原因没有全面的理解。相比之下，成人内科医生倾向于要求患者在拒绝治疗可能导致不良医疗后果时，在允许他们拒绝之前，更全面地说明对评估和治疗的益处及负担的理解。这三起案例体现了这些方法之间的矛盾，并突出了医院伦理咨询在解决这一冲突中的作用。
