Daverio Andrea, Piazzi Gioia, Saya Anna
Istituto Italiano di Igiene Mentale Transculturale, Roma.
UOC Psichiatria e Psicologia Clinica, Dipartimento di Neuroscienze, Università di Roma Tor Vergata.
Riv Psichiatr. 2017 Nov-Dec;52(6):220-225. doi: 10.1708/2846.28725.
Over the last twenty years we have witnessed a growing focus on the rights of the ill people. The debate on informed consent and a new redefinition of the therapeutic relationship is constantly evolving. With this article, we propose a critical literature review of the so-called "Ulysses contract" or "psychiatric advance directives". It refers to the will that a subject expresses in writing, or orally, about the treatments he or she wishes or does not wish to be subject to if the time comes when it may be impossible to express his/her consent. This can especially occur in those with psychiatric disorders with serious clinical involvement and remitting-relapse (typically bipolar disorder, but also chronic delusional disorders and schizophrenia). In this context, the question is whether during intercritical periods the patient may or may not leave instructions to their care-givers. This aspect opens up to a series of interdisciplinary problems. In this article, we want to show the complexity of this debate from a clinical, ethical, legal and psychodynamic point of view, emphasizing the strengths and the major criticisms of the psychiatric advance directives for each area.
在过去二十年里，我们目睹了对病人权利的日益关注。关于知情同意的辩论以及治疗关系的新定义在不断演变。通过本文，我们建议对所谓的“尤利西斯契约”或“精神科预先指示”进行批判性文献综述。它指的是一个人以书面或口头形式表达的意愿，即如果到了无法表达同意的时候，他或她希望或不希望接受哪些治疗。这尤其可能发生在患有严重临床症状且病情缓解-复发的精神疾病患者身上（典型的如双相情感障碍，但也包括慢性妄想性障碍和精神分裂症）。在这种情况下，问题在于在病情平稳期患者是否可以向其护理人员留下指示。这方面引发了一系列跨学科问题。在本文中，我们想从临床、伦理、法律和心理动力学角度展示这场辩论的复杂性，强调精神科预先指示在每个领域的优势和主要批评意见。
