Digestive Health Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Department of Emergency Medicine, University of Pittsburgh Medical Center Hamot, Erie, Pennsylvania, USA.
J Healthc Risk Manag. 2021 Oct;41(2):31-39. doi: 10.1002/jhrm.21459. Epub 2021 Jan 25.
Living wills are designed to ensure that patients' preferences will be respected at the end of life should they lose capacity to make decisions. However, data on living will use suggest there are barriers to achieving this objective. Moreover, there is evidence that completion of a living will creates a risk of an unwanted outcome: the potential for premature withdrawal of interventions. We suggest a multifaceted approach to improve the ability of living wills to achieve their goals. However, acknowledgment of the current reality should oblige providers offering a living will to their patients to present a balanced view of living wills that includes enumeration of the risk, barriers to achieving the purported benefits, and alternatives to completing a living will, in addition to discussion of the potential benefits. This requires a change in current practice that would encourage shared decision making regarding whether completing a living will or other type of advance directive is desired by the patient and discourage the proliferation of living wills completed without providing these important advantages and disadvantages to the patient.
生前预嘱旨在确保患者在丧失决策能力时，其个人意愿在生命末期能够得到尊重。然而，有关生前预嘱使用的数据表明，在实现这一目标方面存在障碍。此外，有证据表明，完成生前预嘱可能会带来不良后果的风险：干预措施过早被撤销。我们建议采取多方面的方法来提高生前预嘱实现其目标的能力。然而，提供者在向患者提供生前预嘱时，应该承认当前的现实，以平衡地阐述生前预嘱的风险、实现所谓的益处的障碍以及完成生前预嘱的替代方案，除了讨论潜在的益处。这需要改变当前的做法，鼓励就患者是否希望完成生前预嘱或其他类型的预先指示进行共同决策，并劝阻在没有向患者提供这些重要的优缺点的情况下广泛传播完成的生前预嘱。
