Neiswanger Institute for Bioethics, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois (Doyle); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota (DeMartino); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Sperry); School of Law, Loyola University Chicago, Chicago (Unno); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Roberts); Department of Cardiology, Massachusetts General Hospital, Boston (Dudzinski); Departments of Medicine and Philosophy, Georgetown University, Washington, D.C. (Sulmasy); Department of General Internal Medicine, Mayo Clinic Health System, La Crosse, Wisconsin (Mueller); Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston (Kramer); MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago (Siegler).
Psychiatr Serv. 2021 Jan 1;72(1):81-84. doi: 10.1176/appi.ps.201900320. Epub 2020 Oct 14.
The authors sought to describe state-to-state variations in the scope of statutory authority granted to default surrogates who decide on mental health treatment for incapacitated patients.
The authors investigated state statutes delineating the powers of default surrogates to make decisions about mental health treatment. Statutes in all 50 U.S. states and the District of Columbia were identified and analyzed independently by three reviewers. Research was conducted from August 2017 to November 2018 and updated in January 2020.
State statutes varied in approaches to default surrogate decision making for mental health treatment. Eight states' statutes delegate broad authority to surrogates, whereas 25 states prohibit surrogates from giving consent for specific therapies. Thirteen states are silent on whether surrogates may make decisions.
Heterogeneity among state statutory laws contributes to complexity of treating patients without decisional capacity. This variability encumbers efforts to support surrogates and clinicians and may contribute to health disparities.
作者旨在描述赋予各州默认代理人在决定丧失行为能力患者的精神卫生治疗方面的法定权限的范围。
作者研究了各州法规中关于默认代理人在精神卫生治疗方面做出决策的权力。从 2017 年 8 月至 2018 年 11 月，独立地由三位评审员对所有 50 个美国州和哥伦比亚特区的法规进行了调查和分析，并于 2020 年 1 月进行了更新。
州法规在默认代理人做出精神卫生治疗决策的方法上存在差异。8 个州的法规将广泛的权力授予代理人，而 25 个州则禁止代理人同意特定的治疗方法。13 个州则对代理人是否可以做出决策保持沉默。
州法定法规之间的差异导致了对无决策能力患者进行治疗的复杂性。这种变异性给支持代理人和临床医生带来了困难，可能导致健康差距。
