New York University.
Nurs Ethics. 2024 Nov;31(7):1247-1257. doi: 10.1177/09697330241247320. Epub 2024 May 6.
Currently, in the United States, there is no legal obligation for medical professionals or civil courts to uphold patients' Advance Directives (ADs) regarding end-of-life care. The applicability and standing of ADs prepared by Alzheimer's patients is a persistent issue in bioethics. Those who argue against giving ADs full status take two main approaches: (1) appealing to beneficence on behalf of the Alzheimer's patient and (2) claiming that there is no longer any personal equivalence between the AD's creator and the subject of the AD. In this paper, I present profound arguments against both approaches. Firstly, I argue that the principle of beneficence cannot apply in the case of Alzheimer's patients, and, secondly, that the moral and legal authority of the AD need not depend on strict equivalence of personal identity. I conclude by arguing that valid ADs protect the dignity and autonomy of Alzheimer's patients and that, therefore, there are moral obligations to uphold ADs which should be reflected in public policy and legislation.
目前，在美国，医学专业人员或民事法庭没有法律义务遵守患者关于临终关怀的预先指示 (AD)。阿尔茨海默病患者制定的 AD 的适用性和地位是生物伦理学中的一个持续存在的问题。那些反对给予 AD 完全地位的人采取了两种主要方法：(1) 代表阿尔茨海默病患者呼吁善行，(2) 声称 AD 的制定者和 AD 的主体之间不再存在任何个人等同性。在本文中，我提出了反对这两种方法的深刻论据。首先，我认为，在阿尔茨海默病患者的情况下，不能适用善行原则，其次，AD 的道德和法律权威不必依赖于严格的个人身份等同性。我最后认为，有效的 AD 保护了阿尔茨海默病患者的尊严和自主权，因此，存在维护 AD 的道德义务，这应反映在公共政策和立法中。
