Stock Elisabeth, Nickel Christian H, Elger Bernice S, Martani Andrea
Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
Emergency Center, University Hospital Basel, Basel, Switzerland.
Res Health Serv Reg. 2025 Feb 5;4(1):1. doi: 10.1007/s43999-025-00060-6.
Open conversations between patients and healthcare professionals (HCP) are required to evaluate which treatments are reasonable for the individual case, especially towards the end of life. Advance Care Planning (ACP), which often results in drafting an Advance Directive (AD), is a useful tool to help with decisions in these circumstances, but the rate of AD completion remains low. During the COVID-19 pandemic, ACP and AD gained popularity due to the alleged advantage that they could facilitate resource allocation, to the benefit of public health. In this article, which presents a theoretical reflection grounded in scientific evidence, we underline an even stronger ethical argument to support the implementation of AD in end-of-life care (eol-C) i.e. the instrumental value at the individual level. We show, with particular reference to lessons learned from the COVID-19 pandemic, that AD are instrumentally valuable in that they: (1) allow to thematise death; (2) ensure that overtreatment is avoided; (3) enable to better respect the wish of people to die at their preferred place; (4) help revive the "lost skill" of prognostication. We thus conclude that these arguments speak for promoting the territorially uniform implementation and accessibility of high-quality AD in care.
患者与医护人员（HCP）之间需要进行开放的对话，以评估针对具体病例哪些治疗是合理的，尤其是在生命末期。预立医疗计划（ACP）通常会形成一份预立医嘱（AD），是帮助在这些情况下做出决策的有用工具，但AD的完成率仍然很低。在新冠疫情期间，ACP和AD因据称具有有助于资源分配、有益于公共卫生的优势而受到欢迎。在本文中，我们基于科学证据进行理论反思，强调了一个更强有力的伦理论据来支持在临终关怀（eol-C）中实施AD，即其在个体层面的工具性价值。我们特别参考从新冠疫情中吸取的教训表明，AD具有工具性价值，因为它们：（1）允许将死亡作为主题进行讨论；（2）确保避免过度治疗；（3）使人们更能尊重在其首选地点离世的愿望；（4）有助于恢复“失传的”预后判断技能。因此，我们得出结论，这些论据支持在医疗中促进高质量AD在地域上的统一实施和可及性。
