Hastings Cent Rep. 2017 Jan;47(1):2. doi: 10.1002/hast.663.
This issue of the Hastings Center Report (January-February 2017) features three articles exploring aspects of decision-making for others. In the first two, the focus is on the limits of surrogate decision-makers' authority when the surrogates' judgments about a patient's treatment conflict with the physicians'. If a physician decides that a patient will not benefit from CPR, for example, but the patient's surrogate insists on it, is the physician obliged to proceed with the procedure? Or can the physician, pointing to a duty to provide good care to the patient and not to cause the patient to suffer, get a do-not-resuscitate order for the patient-even in the face of the surrogate's objections? These are the questions that animate the first article, in which a group of authors report on a policy implemented at Massachusetts General Hospital to help doctors who face this dilemma. The second article, by physician Jeffrey Berger, flips the questions. If a physician decides that a patient's intractable suffering requires palliative sedation, may the surrogate prevent it anyway? Or can the physician, pointing to a duty to alleviate the suffering, administer palliative sedation even in the face of the surrogate's objections? Such circumstances, says Berger, show the need for conceptual work delineating the limits of surrogates' authority and practical work on mechanisms for doing so-protecting patients and giving physicians a clear route to follow.
本期《 Hastings 中心报告》（2017 年 1-2 月）的三篇文章探讨了为他人做决策的各个方面。在前两篇文章中，重点讨论了在代理人对患者治疗的判断与医生的判断相冲突时，代理人的权威的局限性。例如，如果医生决定患者不会从心肺复苏术（CPR）中受益，但患者的代理人坚持要进行，医生是否有义务进行该程序？或者，医生是否可以指出有责任为患者提供良好的护理而不是让患者受苦，为患者开具不复苏医嘱——即使面对代理人的反对？这就是第一篇文章的核心问题，一组作者报告了马萨诸塞州综合医院实施的一项政策，以帮助医生应对这一困境。第二篇文章的作者杰弗里·伯格（Jeffrey Berger）则反过来提出了问题。如果医生决定患者无法忍受的痛苦需要进行缓和镇静治疗，代理人是否可以阻止？或者，医生是否可以指出减轻痛苦的责任，即使面对代理人的反对，也要进行缓和镇静治疗？伯格表示，这些情况表明需要进行概念性工作来划定代理人权威的界限，并需要进行实际工作来确定这样做的机制——保护患者并为医生提供明确的遵循路径。
