Overriding psychiatric advance directives: factors associated with psychiatrists' decisions to preempt patients' advance refusal of hospitalization and medication.
Overriding psychiatric advance directives: factors associated with psychiatrists' decisions to preempt patients' advance refusal of hospitalization and medication.
复制标题
压倒性的精神病学预先指示：与精神科医生决定预先阻止患者拒绝住院和药物治疗相关的因素。
DOI：
10.1007/s10979-006-9032-1
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发表时间：
2007
影响因子：
2.5
通讯作者：
Elbogen,EricB
中科院分区：
文献类型：
--
作者：
Swanson,JeffreyW;VanMcCrary,S;Swartz,MarvinS;VanDorn,RichardA;Elbogen,EricB
精神病学预先指示（PAD）旨在支持患者在危机期间的治疗决定。然而，PAD法规给予临床医生广泛的自由裁量权，决定是否执行患者的预先指示。本研究使用了一项对精神科医生（N=164）的调查数据，以检查覆盖PAD的原因。在回答一个假设的小插曲，47%的精神科医生表示，他们会推翻一个有效的，称职的执行PAD拒绝住院和药物治疗。在医院急诊科工作的精神科医生、那些担心病人暴力风险和缺乏洞察力的人以及那些合法自卫的人更有可能推翻PAD。在那些认为在高质量的精神卫生系统中非自愿治疗在很大程度上是不必要的参与者中，PAD覆盖的可能性较小。
Psychiatric advance directives (PADs) are intended to support patients' treatment decisions during a crisis. However, PAD statutes give clinicians broad discretion over whether to carry out patients' advance instructions. This study uses data from a survey of psychiatrists (N=164) to examine reasons for overriding PADs. In response to a hypothetical vignette, 47% of psychiatrists indicated that they would override a valid, competently-executed PAD that refused hospitalization and medication. PAD override was more likely among psychiatrists who worked in hospital emergency departments; those who were concerned about patients' violence risk and lack of insight; and those who were legally defensive. PAD override waslesslikely among participants who believed that involuntary treatment is largely unnecessary in a high-quality mental health system.