Sommerville A
Ethics, Audit, and Career Department, British Medical Association, London.
BMJ. 1995 Jun 24;310(6995):1663-5. doi: 10.1136/bmj.310.6995.1663a.
Polls show increasing public interest in advance statements or directives about medical treatment ("living wills") but that few people, apart from Jehovah's Witnesses, carry such documents. Patients' firm, witnessed oral decisions are often sufficient to aid clinical decision making but should still be recorded in medical notes. Without documentation, dilemmas arise when others claim to know patients' views on the basis of past unrecorded conversations and demand withdrawal of treatment when patients are not terminally ill and cannot speak for themselves. Legal and ethical considerations oblige doctors to act in the best interests of an incapacitated patient; these considerations are now formally defined in draft legislation as including consideration of the patient's past wishes. The practicalities of ascertaining the strength and validity of such wishes from conversations reported second hand are complex. The paucity of legal and ethical guidance on reported oral advance statements makes debate imperative and renders the alternative of having designated surrogate decision makers increasingly attractive.
民意调查显示，公众对关于医疗治疗的预先声明或指令（“生前遗嘱”）的兴趣日益增加，但除了耶和华见证人之外，很少有人持有此类文件。患者坚定的、有证人在场的口头决定通常足以辅助临床决策，但仍应记录在病历中。如果没有文件记录，当其他人声称根据过去未记录的谈话了解患者的观点，并在患者并非处于绝症末期且无法自行表达时要求停止治疗，就会产生困境。法律和伦理考量要求医生为无行为能力的患者的最大利益行事；这些考量现在在立法草案中被正式定义为包括考虑患者过去的意愿。从二手报告的谈话中确定此类意愿的力度和有效性的实际操作很复杂。关于报告的口头预先声明的法律和伦理指导很少，这使得进行辩论势在必行，也使得指定替代决策者的选择越来越有吸引力。
