The Theory and Practice of Surrogate Decision-Making
The Theory and Practice of Surrogate Decision-Making
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DOI：
10.1002/hast.671
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发表时间：
2017-01-01
影响因子：
3.3
通讯作者：
Wendler, David
中科院分区：
文献类型：
--
作者：
Wendler, David
当患者缺乏决策能力并且没有留下明确的预先指示时，现在普遍认为患者指定的和近亲的代理人应该在共同决策的过程中执行替代判断。具体来说，在与患者的临床医生讨论了“现有的最佳科学证据，以及患者的价值观、目标和偏好”之后，患者指定的或近亲代理应该试图确定患者在这种情况下会做出什么决定。从某种程度上说，这种方法是有效的，它似乎为我们所要求的丧失行为能力的病人的自主权提供了尽可能多的尊重。但是，正如本期《报告》中Jeffrey Berger和Ellen Robinson及其同事的文章所强调的那样，现实带来了挑战。
When a patient lacks decision‐making capacity and has not left a clear advance directive, there is now widespread agreement that patient‐designated and next‐of‐kin surrogates should implement substituted judgment within a process of shared decision‐making. Specifically, after discussing the “best scientific evidence available, as well as the patient's values, goals, and preferences” with the patient's clinicians, the patient‐designated or next‐of‐kin surrogate should attempt to determine what decision the patient would have made in the circumstances. To the extent that this approach works, it seems to provide about as much respect for the autonomy of incapacitated patients as we could ask for. But, as articles in this issue of theReportby Jeffrey Berger and by Ellen Robinson and colleagues emphasize, reality presents challenges.