Dixon Joseph D, Josyula Aruna V, Javier Noelle Marie, Zweig Yael, Singh Mriganka, Kim Luke, Thothala Niranjan, Farrell Timothy W
Division of Geriatric & Palliative Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Central Texas Veterans Health Care System, Temple, Texas, USA.
J Am Geriatr Soc. 2025 May;73(5):1353-1364. doi: 10.1111/jgs.19288. Epub 2024 Nov 30.
This paper is an official position statement of the American Geriatrics Society (AGS) and updates the 2017 AGS position statement, Making Medical Treatment Decisions for Unbefriended Older Adults. In this updated position statement, the term "unbefriended" is replaced by "unrepresented" as a term that is more value-neutral, more accurately describes the circumstance in which a person without medical decision-making capacity does not have recognized surrogate representation, and better aligns with increasingly preferred terminology as reflected in recent medical literature. We define unrepresented older adults as those who (1) lack decisional capacity to provide informed consent for a particular medical treatment, (2) have not executed an advance directive that addresses the medical treatment at hand and lack capacity to do so, and (3) lack representation from a surrogate decision-maker (i.e., family, friend, or legally authorized surrogate). Making medical decisions on behalf of unrepresented older adults is exceptionally challenging and, given demographic trends, is likely to become increasingly common in the years ahead. The process of arriving at treatment decisions for this population should follow standards of procedural fairness and include capacity assessment, search for potential surrogates, team-based efforts to determine the patient's values and preferences, and steps to guard against bias. Proactive measures are needed to identify older adults at risk for becoming unrepresented. This position statement also calls for national efforts to reduce state-to-state variability in legal approaches for unrepresented patients.
本文是美国老年医学会（AGS）的官方立场声明，对2017年AGS立场声明《为无亲友的老年人做出医疗决策》进行了更新。在这份更新后的立场声明中，“无亲友”一词被“无代理人”所取代，该词更具价值中立性，更准确地描述了无医疗决策能力的人没有得到认可的替代代表的情况，并且更符合近期医学文献中越来越常用的术语。我们将无代理人的老年人定义为那些：（1）缺乏对特定医疗治疗提供知情同意的决策能力；（2）未签署针对手头医疗治疗的预先指示且缺乏签署能力；（3）缺乏替代决策者（即家人、朋友或合法授权的代理人）代表的人。代表无代理人的老年人做出医疗决策极具挑战性，而且鉴于人口趋势，在未来几年可能会变得越来越普遍。为这一人群做出治疗决策的过程应遵循程序公平标准，包括能力评估、寻找潜在代理人、基于团队的努力以确定患者的价值观和偏好，以及防范偏见的措施。需要采取积极措施来识别有成为无代理人风险的老年人。本立场声明还呼吁全国努力减少各州在针对无代理人患者的法律方法上的差异。
