Miller D L, Bolla L R
Geriatrics Institute, St. Luke's Hospital, Bethlehem, Pennsylvania 18017, USA.
Clin Geriatr Med. 1998 Nov;14(4):813-29.
Physicians are increasingly challenged by issues surrounding medical decision-making for hospitalized patients. Advance directives express a patient's preferences regarding end-of-life care; when available, they should be used to guide medical treatment. Patients who lack decision-making capacity require special consideration to ensure maximal patient participation with appropriate surrogate involvement. An ethics committee consultation may be especially helpful to resolve conflicts that may arise regarding medical treatments. Physicians play a vital role in promoting earlier patient-physician discussions about end-of-life care preferences, increased completion of advance directives, and ongoing education for physicians to improve communication skills.
围绕住院患者医疗决策的诸多问题给医生带来了越来越大的挑战。预先指示表达了患者对临终护理的偏好；如有预先指示，应将其用于指导医疗治疗。缺乏决策能力的患者需要特殊考虑，以确保患者在适当的替代者参与下最大限度地参与其中。伦理委员会的咨询对于解决医疗治疗中可能出现的冲突可能特别有帮助。医生在促进医患更早地讨论临终护理偏好、提高预先指示的完成率以及持续开展医生教育以提高沟通技巧方面发挥着至关重要的作用。
