Appel Jacob M
Psychiatry and Medical Education, Academy for Medicine & the Humanities, Icahn School of Medicine at Mount Sinai, Attending Physician, Mount Sinai Health System, New York, NY, 10027, USA.
CNS Spectr. 2024 Nov 27;30(1):e3. doi: 10.1017/S1092852924002207.
Balancing autonomy and beneficence remains an ongoing challenge in the ethical treatment of patients with schizophrenia and other psychiatric disorders of thought. Psychiatric advance directives (PADs) offer one mechanism through which individuals can guide their own care, but unlike medical advance directives, they are not widely utilized in the United States. They are also highly limited by state law in the scope of their legal authority. This article explores the evidentiary basis for PADs as well as the legal and ethical issues that arise in the use of PADs in individuals with schizophrenia, arguing that providers' fears of complete opt-out from care by patients are likely unfounded and that PADs offer a powerful tool through which individuals with schizophrenia can ensure meaningful consideration of their own values and goals.
在精神分裂症和其他思维性精神障碍患者的伦理治疗中，平衡自主性与行善原则仍是一项持续存在的挑战。精神科预嘱（PADs）提供了一种个人能够指导自身治疗的机制，但与医疗预嘱不同的是，它们在美国并未得到广泛应用。其法律效力范围也受到州法律的极大限制。本文探讨了精神科预嘱的证据基础，以及在精神分裂症患者中使用精神科预嘱时出现的法律和伦理问题，认为医疗服务提供者担心患者完全拒绝接受治疗很可能是没有根据的，并且精神科预嘱提供了一个有力工具，通过它精神分裂症患者能够确保自身价值观和目标得到切实考量。
