Biller-Andorno Nikola, Biller Armin
Faculty of Medicine, Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zürich, Switzerland.
Multi-Dimensional Medical Information Lab, Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany.
Front Digit Health. 2021 Oct 15;3:753747. doi: 10.3389/fdgth.2021.753747. eCollection 2021.
Advance directives allow people to declare their treatment preferences for a potential future state of incompetency. Covid-19, with its high numbers of quickly deteriorating patients requiring intensive care, has acutely demonstrated how helpful it would be for clinicians to have reliable, readily available, up-to-date information at hand to be able to act in accordance with what the individual patient would have wanted. Yet for the past few decades advance directives have fallen short of their potential, for various reasons. At worst, advance directives are perceived as unwieldy legal documents that put excessive demands on patients without providing useful guidance for better care. Recent efforts such as advance care planning have tried to remedy some of these shortcomings but have so far met with limited success. We suggest a new concept-the Advance Care Compass-that harnesses the potential of digitalization in healthcare to overcome many of difficulties encountered so far.
预先医疗指示允许人们声明他们对于未来可能出现的无行为能力状态下的治疗偏好。新冠疫情中，大量患者病情迅速恶化需要重症监护，这深刻表明，对于临床医生而言，若能随时获取可靠、最新的信息，以便根据患者个人意愿采取行动，将会非常有帮助。然而，在过去几十年里，由于各种原因，预先医疗指示并未充分发挥其潜力。最糟糕的是，预先医疗指示被视为繁琐的法律文件，对患者要求过高，却没有为改善护理提供有用的指导。诸如预先护理计划等近期努力试图弥补其中一些不足，但迄今为止成效有限。我们提出一个新概念——“预先护理指南针”，它利用医疗保健数字化的潜力，克服迄今为止遇到的许多困难。
