Brody Benjamin D, Meltzer Ellen C, Feldman Diana, Penzner Julie B, Gordon-Elliot Janna S
NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA.
HEC Forum. 2017 Dec;29(4):303-311. doi: 10.1007/s10730-017-9323-6.
The Patient Self Determination Act (PSDA) of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient's preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity (DMC). In general, patients are presumed to have DMC. A patient's DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected. Physicians and other healthcare professionals working in hospital settings where medical illness is frequently comorbid with depression, adjustment disorders, demoralization and suicidal ideation, can expect to encounter ethical tension when medically sick patients who are also depressed or suicidal request do not resuscitate orders.
1991年的《患者自主决定法案》（PSDA）使人们对预先护理计划和替代决策的重要性给予了迫切需要的关注。该法律的目的是确保患者对医疗护理的偏好得到认可和推进，即使患者丧失了决策能力（DMC）。一般来说，患者被推定具有决策能力。当因疾病、谵妄、抑郁或其他精神症状导致的思维和理解出现扭曲被识别或怀疑时，患者的决策能力可能会受到质疑。在医院环境中工作的医生和其他医疗保健专业人员，那里医疗疾病经常与抑郁症、适应障碍、士气低落和自杀意念共病，当患有抑郁症或有自杀倾向的患病患者请求不进行心肺复苏医嘱时，他们可能会遇到伦理困境。
