The use of advance care planning to guide decisions about artificial nutrition and hydration.
The use of advance care planning to guide decisions about artificial nutrition and hydration.
复制标题
DOI：
10.1177/0115426506021002126
复制
发表时间：
2006-04-01
期刊：
影响因子：
--
通讯作者：
Gillick, Muriel R
中科院分区：
文献类型：
--
作者：
Gillick, Muriel R
预先护理规划对于确保患者在有能力的情况下能够影响他们在失去决策能力的情况下接受的医疗护理的种类非常重要。由于代理人放弃营养支持的决定仍然存在争议，因此将人工营养和水合作用作为预先护理计划的一部分的具体内容变得越来越重要。本文回顾了有关人工营养和水化的选择，可能使用传统的预指令，如生前遗嘱，指导指令，价值观的历史，和组合指令。它概述了这些文件的法律的依据。它还描述了医生限制治疗的命令可以帮助执行关于使用人工营养和水合作用的决定的方式。最后，它强调了与患者和家属澄清营养支持在各种常见情况下的风险和益处的重要性，如晚期痴呆和转移性癌症，这是有意义的提前护理计划的必要先决条件。
Advance care planning is important to ensure that patients, when competent, can influence the kind of medical care they receive if they lose decision-making capacity. Because decisions by surrogates to for-go nutrition support remain controversial, specific inclusion of artificial nutrition and hydration as a part of advance care planning has taken on growing importance. This article reviews the choices about artificial nutrition and hydration that are possible using conventional advance directives such as the living will, the instructional directive, values histories, and combination directives. It summarizes the legal basis for such documents. It also describes the ways that physicians' orders to limit treatment can help implement decisions about the use of artificial nutrition and hydration. Finally, it stresses the importance of clarifying with patients and families the risks and benefits of nutrition support in a variety of common situations such as advanced dementia and metastatic cancer as an essential prerequisite to meaningful advance care planning.