Icahn School of Medicine at Mount Sinai, New York, New York11029, USA.
Camb Q Healthc Ethics. 2023 Jan;32(1):69-75. doi: 10.1017/S0963180122000512. Epub 2022 Dec 5.
Clinicians are often called upon to assess the capacity of a patient to appoint a healthcare agent. Although a consensus has emerged that the standard for such assessment should differ from that for capacity to render specific healthcare decisions, exactly what standard should be employed remains unsettled and differs by jurisdiction. The current models in use draw heavily upon analogous methods used in clinical assessment, such as the "four skills" approach. This essay proposes an alternative model that relies upon categorization and sliding scale risk assessment that can be used to determine to how much scrutiny the proxy appointment should be subjected and how much certainty of accuracy should be required in order to maximize the patient's autonomy and ensure that her underlying wishes are met.
临床医生经常被要求评估患者指定医疗代理人的能力。尽管已经达成共识，即这种评估的标准应该与做出特定医疗决策的能力的标准不同，但具体应该采用什么标准仍然没有定论，并且因司法管辖区而异。目前使用的模型主要借鉴了临床评估中使用的类似方法，例如“四项技能”方法。本文提出了一种替代模型，该模型依赖于分类和滑动比例风险评估，可以用来确定代理人的任命应该受到多大程度的审查，以及需要多大程度的准确性来最大化患者的自主权并确保满足她的潜在意愿。
