Johnston S C
Department of Internal Medicine, University of Kansas School of Medicine-Wichita 67214-3199, USA.
J R Soc Med. 1996 Oct;89(10):568-70. doi: 10.1177/014107689608901008.
American physicians and patients share some common ground in their perspectives on advance directives. The majority in both groups strongly endorse the use of these documents. Both groups believe it is the physician's responsibility to initiate the discussion about advance directives. However, a gap between the two perspectives can be defined. In end-of-life decision making, physicians balance the ethical principle of patient autonomy with other principles such as appropriate withholding of care in the setting of futility. Patients' preferences for end-of-life care are most influenced by expected outcomes. Physicians tend to be selective in their indications for initiating a discussion about advance directives, according to clinical factors. In contrast, most patients want to discuss advance directives with their physician under all circumstances.
美国医生和患者在对预先指示的看法上有一些共同点。这两个群体中的大多数人都强烈支持使用这些文件。两个群体都认为医生有责任发起关于预先指示的讨论。然而，可以界定这两种观点之间的差距。在临终决策中，医生会在患者自主权的伦理原则与其他原则（如在治疗无效的情况下适当停止治疗）之间进行权衡。患者对临终护理的偏好受预期结果的影响最大。根据临床因素，医生在启动关于预先指示的讨论时往往有所选择。相比之下，大多数患者希望在任何情况下都与医生讨论预先指示。
