Singer P A, Martin D K, Lavery J V, Thiel E C, Kelner M, Mendelssohn D C
University of Toronto Joint Centre for Bioethics, Department of Medicine, University of Toronto and Toronto Hospital, Ontario, Canada.
Arch Intern Med. 1998 Apr 27;158(8):879-84. doi: 10.1001/archinte.158.8.879.
Traditional academic assumptions about advance care planning (ACP) include the following: (1) the purpose of ACP is preparing for incapacity; (2) ACP is based on the ethical principle of autonomy and the exercise of control; (3) the focus of ACP is completing written advance directive forms; and (4) ACP occurs within the context of the physician-patient relationship. These assumptions about ACP have never been empirically validated.
To examine the traditional academic assumptions by exploring ACP from the perspective of patients actively participating in the planning process.
Forty-eight patients (30 men and 18 women with a mean age of 48.3 years) who were undergoing hemodialysis were interviewed 6 months after receiving an advance directive form. Their experience of ACP was noted in interviews that were audiotaped, transcribed, and analyzed.
The participants said that their purpose in ACP was to prepare for death and dying, and their underlying goals included the exercise of control and an attempt to relieve burdens placed on loved ones. Advance care planning was viewed as a social process, and completing a written advance directive form was often regarded as unnecessary. Participants often involved close loved ones, but physicians infrequently.
The traditional academic assumptions are not fully supported from the perspective of patients involved in ACP. The patients we interviewed stated that (1) the purpose of ACP is not only preparing for incapacity but also preparing for death; (2) ACP is not based solely on autonomy and the exercise of control, but also on personal relationships and relieving burdens placed on others; (3) the focus of ACP is not only on completing written advance directive forms but also on the social process; and (4) ACP does not occur solely within the context of the physician-patient relationship but also within relationships with close loved ones.
关于预先医疗计划（ACP）的传统学术假设包括以下几点：（1）ACP的目的是为无行为能力做准备；（2）ACP基于自主和控制权行使的伦理原则；（3）ACP的重点是填写预先医疗指示书面表格；（4）ACP发生在医患关系背景下。这些关于ACP的假设从未得到实证验证。
通过从积极参与计划过程的患者角度探索ACP来检验传统学术假设。
对48名正在接受血液透析的患者（30名男性和18名女性，平均年龄48.3岁）在收到预先医疗指示表格6个月后进行访谈。他们的ACP经历在录音、转录和分析的访谈中被记录下来。
参与者表示他们进行ACP的目的是为死亡和临终做准备，其潜在目标包括行使控制权以及试图减轻所爱之人的负担。预先医疗计划被视为一个社会过程，填写预先医疗指示书面表格通常被认为没有必要。参与者经常让亲密的爱人参与，但很少让医生参与。
从参与ACP的患者角度来看，传统学术假设并未得到充分支持。我们访谈的患者表示：（1）ACP的目的不仅是为无行为能力做准备，也是为死亡做准备；（2）ACP不仅基于自主和控制权行使，还基于人际关系以及减轻他人负担；（3）ACP的重点不仅在于填写预先医疗指示书面表格，还在于社会过程；（4）ACP不仅发生在医患关系背景下，也发生在与亲密爱人的关系中。
