Lost in translation: the unintended consequences of advance directive law on clinical care.
Lost in translation: the unintended consequences of advance directive law on clinical care.
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DOI：
10.7326/0003-4819-154-2-201101180-00012
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发表时间：
2011-01-18
影响因子：
39.2
通讯作者：
Sudore RL
中科院分区：
文献类型：
--
作者：
Castillo LS;Williams BA;Hooper SM;Sabatino CP;Weithorn LA;Sudore RL
先行指令法可能会损害先行指令的临床有效性。识别可能阻止患者传达临终偏好的提前指令法的意外法律后果。从1966年到2010年8月，美国所有50个州和哥伦比亚特区的高级指令法律法规以及LexisNexis、Westlaw和MEDLINE的英语搜索。两名独立审查员选择了51项先行指令法规和20条条款。三名独立的法律审查员选择了105项法律程序。两名审查员独立评估了数据来源，并使用关键内容分析来确定先行指令临床有效性的法律障碍。分歧通过协商一致得到解决。法律和与内容相关的障碍包括可读性差(即所有州的法律都写在12年级阅读水平以上)、医疗保健代理或代孕限制(例如，40个州不包括同性或家庭伴侣作为默认代孕)，以及使表格合法有效所需的执行要求(例如，35个州不允许口头提前指令，48个州要求证人签名、公证人签名或两者兼而有之)。最有可能受到这些障碍影响的弱势群体包括识字能力有限、英语水平有限或两者兼而有之的患者，他们不能阅读或执行预先指令；同性或家庭伴侣可能没有合法有效和值得信任的代理人；以及没有朋友、住院或无家可归的患者，他们可能没有证人和合适的代理人。只有上诉级别的法律案件可用，这可能排除了相关案件。提前指令法律限制的意外负面后果可能会阻止所有患者，特别是脆弱的患者，制定和传达他们的临终愿望，并让他们得到尊重。这些限制使预先指令在临床上的用处变得更小。建议包括提高可读性，允许口头提前指令，以及取消证人或公证要求。美国退伍军人事务部和辉瑞基金会。
Advance directive law may compromise the clinical effectiveness of advance directives. To identify unintended legal consequences of advance directive law that may prevent patients from communicating end-of-life preferences. Advance directive legal statutes for all 50 U.S. states and the District of Columbia and English-language searches of LexisNexis, Westlaw, and MEDLINE from 1966 to August 2010. Two independent reviewers selected 51 advance directive statutes and 20 articles. Three independent legal reviewers selected 105 legal proceedings. Two reviewers independently assessed data sources and used critical content analysis to determine legal barriers to the clinical effectiveness of advance directives. Disagreements were resolved by consensus. Legal and content-related barriers included poor readability (that is, laws in all states were written above a 12th-grade reading level), health care agent or surrogate restrictions (for example, 40 states did not include same-sex or domestic partners as default surrogates), and execution requirements needed to make forms legally valid (for example, 35 states did not allow oral advance directives, and 48 states required witness signatures, a notary public, or both). Vulnerable populations most likely to be affected by these barriers included patients with limited literacy, limited English proficiency, or both who cannot read or execute advance directives; same-sex or domestic partners who may be without legally valid and trusted surrogates; and unbefriended, institutionalized, or homeless patients who may be without witnesses and suitable surrogates. Only appellate-level legal cases were available, which may have excluded relevant cases. Unintended negative consequences of advance directive legal restrictions may prevent all patients, and particularly vulnerable patients, from making and communicating their end-of-life wishes and having them honored. These restrictions have rendered advance directives less clinically useful. Recommendations include improving readability, allowing oral advance directives, and eliminating witness or notary requirements. U.S. Department of Veterans Affairs and the Pfizer Foundation.
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影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
影响因子：
254.7
作者：
Davis, TC;Williams, MV;Glass, J
通讯作者：
Glass, J
DOI：
10.1177/0115426506021002126
发表时间：
2006-04-01
期刊：
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
影响因子：
--
作者：
Gillick, Muriel R
通讯作者：
Gillick, Muriel R
影响因子：
4.4
作者：
Ache, K. A.;Wallace, L. S.
通讯作者：
Wallace, L. S.
影响因子：
5.7
作者：
Hawkins, NA;Ditto, PH;Smucker, WD
通讯作者：
Smucker, WD