LIVING WILLS: FOR PRIMARY CARE, AIDS AND CANCER PATIENTS

据推测，道德决策是关于 对绝症患者的医疗干预将得到改善 广泛使用综合性生前遗嘱。使用DO NOT 复苏秩序虽然有帮助，但已被证明是 没有得到充分利用，这只是众多决策中的一个 这是必须要做的。因此，有人建议， 对患者选择有限或有限的权利的最佳保护 广泛的医疗干预将为制定 所有患者的综合生活意愿，类似于 常规遗嘱的常规准备。 我们会研究这项建议的特点，包括 内科医生在初级保健中开展讨论的可行性 以及非卧床病人的特殊护理实践。这项研究 将使用专门设计的生前遗嘱格式 在几种情况下选择各种医疗干预措施 损害的类型。这份生前遗嘱是作为 调查旨在评估讨论临终关怀的倾向和 在特定情况下给予治疗优惠，以及 对谁应该做出哪些决定的偏好。耐用性 患者的体位将通过重新给予 在初次调查后6至12个月以及在 任何间歇性住院治疗。 队列包括：a)388名初诊患者 护理医生执业。B)291名获得性疾病患者 免疫缺陷综合症。这两个队列中的这些患者 将由医生或研究助理进行调查。 C)电话登记处的410名患者。这些人将 通过电话接受调查。 这项研究预计将评估全面的生前遗嘱 对医生和患者来说都是实用的，无论他们是 患者想要的。这项研究有望提供一些模型 医生和病人如何处理 表明在发生灾难性疾病时对护理的偏好， 一个模范生活将会形成。

It has been postulated that ethical decision making regarding medical interventions for the terminally ill would be improved by widespread use of comprehensive living wills. Use of the Do Not Resuscitate order, although helpful, has been shown to be inadequately used, and is only one of a large spectrum of decisions that need to be made. It has therefore been suggested that the best available protection of patients' rights to choose limited or extensive medical intervention would be provision for making a comprehensive living will for all patients, analogous to the routine preparation of regular wills. We will study features of this suggestion, including the practicability of physicians opening the discussion in primary care and specialty care practices for ambulatory patients. The study will make use of a specifically designed living will format with options for a variety of medical interventions in case of several types of impairment. This living will is included as part of a survey designed to assess inclination to discuss terminal care and to give preferences for treatment in specific circumstances, and preferences for who should make which decisions. The durability of patients positions will be assessed by re-administering the survey 6 to 12 months after the initial survey and at the time of any interium hospitalization. Cohorts include the following: a) 388 patients seen in primary care physicians practices. b) 291 patients with acquired immunodeficiency syndrome. These patients in these two cohorts will be surveyed either by the physician or a research assistant. c) 410 patients from a telephone registry. These individuals will be surveyed by telephone. The study is expected to assess whether comprehensive living wills are practical for physicians and patients, and whether they are desired by patients. The study is expected to provide some models for how physicians and patients can handle the process of indicating preferences for care in case of catastrophic illness, and a model living will format.