Sellars Marcus, Fullam Rachael, O'Leary Catherine, Mountjoy Rachel, Mawren Daveena, Weller Penelope, Newton Richard, Brophy Lisa, McEwan Troy, Silvester William
Respecting Patient Choices, Austin Health, Melbourne, Australia.
Sydney Medical School, University of Sydney, Australia.
Psychiatr Psychol Law. 2016 Jul 20;24(1):61-73. doi: 10.1080/13218719.2016.1198224. eCollection 2017.
This study examines whether Australian psychiatrists would support requests in a psychiatric advance directive (PAD) and the reasons underlying their decisions in response to a hypothetical vignette. An online survey was completed by 143 psychiatrists. Fewer than 3 out of 10 psychiatrists supported the patient to create a PAD which requested cessation of pharmacotherapy (27%) or remaining out of hospital and not being subject to an involuntary treatment order (24%) should their depression condition deteriorate. A thematic analysis showed that patient autonomy was the strongest theme among those who supported the patient to create a PAD, whereas the clinical profile of and risk to the patient and the professional or ethical imperative of the psychiatrist were strongest among those who were unsure about supporting the patient or who did not support the patient. These findings provide a challenge about how to fulfil obligations under the United Nations Convention on the Rights of Persons with Disabilities (2006).
本研究探讨了澳大利亚精神科医生是否会支持精神科预先指示（PAD）中的请求，以及他们针对一个假设的案例做出决定的背后原因。143名精神科医生完成了一项在线调查。在抑郁症病情恶化时，每10名精神科医生中支持患者制定要求停止药物治疗的PAD的不到3人（27%），支持患者制定要求在不住院且不受非自愿治疗令约束的PAD的也不到3人（24%）。主题分析表明，在支持患者制定PAD的人中，患者自主权是最突出的主题，而在不确定是否支持患者或不支持患者的人中，患者的临床情况和风险以及精神科医生的专业或道德要求是最突出的。这些发现对如何履行《联合国残疾人权利公约》（2006年）规定的义务提出了挑战。
