Olsen Douglas P
Douglas P. Olsen, PhD, RN, Michigan State University College of Nursing, East Lansing, MI, USA
J Am Psychiatr Nurses Assoc. 2016 Jan-Feb;22(1):52-9. doi: 10.1177/1078390316629958.
Psychiatric advance directives (PADs) represent a shift from more coercive to more recovery-oriented care and hold the promise of empowering patients while helping fill the gap in treatment of non-dangerous patients lacking decision-making capacity. Advance directives for end-of-life and psychiatric care share an underlying rationale of extending respect for patient autonomy and preventing the harm of unwanted treatment for patients lacking the decision-making capacity to participate meaningfully in planning their care.
Ethically relevant differences in applying advance directives to end-of-life and psychiatric care are discussed.
These differences fall into three categories: (1) patient factors, including decision-making capacity, ability to communicate, and prior experience; (2) decisional factors, including expected outcome and the nature of the decisions; and (3) historical-legal precedent.
Specific recommendations are offered.
Clinicians need to appreciate the ethical implications of these differences to effectively invoke PADs or assist patients in creating PADs.
精神科预先指示（PADs）代表了从更具强制性的护理向更注重康复的护理的转变，并有望增强患者的权能，同时帮助填补对缺乏决策能力的非危险患者治疗方面的空白。临终护理和精神科护理的预先指示有着共同的基本原理，即扩展对患者自主权的尊重，并防止对缺乏决策能力以有意义地参与护理计划的患者进行不必要治疗所带来的伤害。
讨论在将预先指示应用于临终护理和精神科护理时在伦理上相关的差异。
这些差异分为三类：（1）患者因素，包括决策能力、沟通能力和既往经历；（2）决策因素，包括预期结果和决策的性质；（3）历史法律先例。
提供了具体建议。
临床医生需要认识到这些差异的伦理含义，以便有效地援引精神科预先指示或协助患者制定精神科预先指示。
