Ersek M, Kagawa-Singer M, Barnes D, Blackhall L, Koenig B A
Pain Research Department, Swedish Medical Center, Seattle, WA, USA.
Oncol Nurs Forum. 1998 Nov-Dec;25(10):1683-90.
PURPOSE/OBJECTIVES: To describe advance directives and the Patient Self-Determination Act (PSDA), to explore the European American sociocultural values underlying advance directives, and to describe the ethical and cultural issues that arise when attempting to encourage and use advance directives in culturally diverse populations.
Research articles, case studies, and theoretical articles from clinical and bioethical literature.
An overview of advance directives and the PSDA is provided. The European American cultural values underlying advance directives are reviewed and contrasted with sociocultural values of culturally diverse groups to raise the question of cross-cultural applicability of advance directives and European-based bioethics.
The sociocultural values of many culturally diverse groups conflict with the values on which the use of advance directives is based. Thus, working with end-of-life decisions and advance directives for people from culturally diverse groups may be problematic.
Nurses should be sensitive to sociocultural beliefs that influence decisions affecting end-of-life care, especially the use of advance directives. Practitioners must incorporate this knowledge to increase flexibility of institutional practices and standards of care in the application of advance directives.
目的/目标：描述预先指示和《患者自我决定法案》（PSDA），探讨预先指示背后的欧美社会文化价值观，并描述在不同文化背景人群中鼓励和使用预先指示时出现的伦理和文化问题。
临床和生物伦理文献中的研究文章、案例研究及理论文章。
提供了预先指示和PSDA的概述。回顾了预先指示背后的欧美文化价值观，并将其与不同文化群体的社会文化价值观进行对比，以提出预先指示和基于欧洲的生物伦理的跨文化适用性问题。
许多不同文化群体的社会文化价值观与使用预先指示所基于的价值观相冲突。因此，处理来自不同文化群体的人的临终决定和预先指示可能会有问题。
护士应敏感于影响临终护理决策的社会文化信念，尤其是预先指示的使用。从业者必须纳入这些知识，以提高机构实践和护理标准在应用预先指示方面的灵活性。
