Fischhoff Baruch, Barnato Amber E
Department of Engineering and Public Policy, Institute for Politics and Strategy, Carnegie Mellon University, Pittsburgh, Pennsylvania.
The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
MDM Policy Pract. 2019 Feb 1;4(1):2381468318817523. doi: 10.1177/2381468318817523. eCollection 2019 Jan-Jun.
The principal policy tool for respecting the preferences of patients facing serious illnesses that can prompt decisions regarding end-of-life care is the advance directive (AD) for health care. AD policies, decision aids for facilitating ADs, and clinical processes for interpreting ADs all treat patients as rational actors who will make appropriate choices, if provided relevant information. We review barriers to following this model, leading us to propose replacing the goal of rational choice with that of , enabling patients (and, where appropriate, their surrogates) to be as rational as they when making these fateful choices. We propose approaches, and supporting research, suited to individuals' cognitive, affective, and social circumstances, resources, and desires.
尊重面临严重疾病患者的偏好（这些偏好可能促使做出临终关怀决策）的主要政策工具是医疗保健预先指示（AD）。AD政策、促进AD制定的决策辅助工具以及解读AD的临床流程，都将患者视为理性行为者，认为如果提供相关信息，他们会做出适当选择。我们审视了遵循该模式的障碍，从而促使我们提议用“使能”目标取代理性选择目标，使患者（以及在适当情况下他们的替代者）在做出这些重大选择时尽可能保持理性。我们提出了适合个人认知、情感、社会状况、资源和愿望的方法及相关支持性研究。
