Advance Decisions: Informing implementation strategies through interdisciplinary and cross-national dialogue

事先决定是一份文件，允许人们在以后无法表达这些愿望（例如，因为他们处于昏迷状态或患有痴呆症）的情况下，事先列出他们对医疗的愿望和偏好。最近，在2007年生效的《2005年精神能力法》中，他们被赋予了法定的法律效力。提前拒绝治疗（例如拒绝呼吸机，或人工营养和水合作用）对英格兰和威尔士的医生具有法律约束力，并受到许多主要慈善机构的积极推动，包括Age UK，麦克米伦癌症支持，运动神经元疾病协会，玛丽居里癌症护理和大多数临终关怀。这项新立法在一定程度上是对人们没有得到他们想要的死亡方式（例如，在家里而不是在医院）这一广泛认识的问题的回应，也是对人们公认的生命结束时过度治疗的问题的回应（Leadbeater & Garber, 2010）。有证据表明，越来越多的人接受ad可能会导致人们在生命结束时选择他们愿意接受或不愿意接受的治疗方式得到更好的尊重（Satherley & Hehir, 2010）。然而，ad的使用率一直很低：调查显示，一般人群的使用率约为3%至8%。在英国几乎没有针对这个问题的研究。这是一个及时的系列研讨会，将讨论2005年《精神能力法》（2007年）实施五年后出现的一些问题。本系列研讨会的目的是从跨国和跨学科的角度来解决英国对ad的吸收问题，利用从美国ad更悠久的历史中吸取的经验教训，并汇集了从事促进ad的慈善机构的人员，具有法律，医学，社会学/心理学和生物伦理学等一系列学科专业知识的学者（包括来自美国的领先生物伦理学家），以及执业医生。主要目标是：(i)发展我们对英国人在危机发生前提前计划医疗保健的原因的理解（ii）制定鼓励采用ADs的最佳方法（iii）确定将ADs引入英国法定法律所产生的新研究议程（iv）合作编写一本针对这些问题的编辑书籍。我们还将创建一个在线论坛，记录研讨会的结果（例如张贴演讲者的幻灯片，以及带有评论的完整广告集），并与当地社区艺术中心合作，放映电影，然后围绕这个问题进行讨论，从而为更广泛的公众讨论提供信息。该系列研讨会将使与会者受益，对他们来说，这将是一个密集的跨学科和学术实践者学习经验；她们中的许多人也在其中工作的实践环境（例如在法律、医学和姑息治疗领域），并在制定实践准则的有影响力的委员会和工作组中任职；慈善机构和临终关怀院旨在增加使用ad -（这些机构的代表也将参加研讨会）；以及其他在临终决策和医疗护理知情选择领域的学术研究人员。

An Advance Decision is a document that allows people to set out their wishes and preferences for medical treatment in advance, in the event that they later become unable to express those wishes (e.g. because they are in a coma, or have dementia). They were recently given statutory legal force in the Mental Capacity Act 2005, which came into force in 2007. Advance refusals of treatment (e.g. refusing a ventilator, or artificial nutrition and hydration) are legally binding on doctors in England and Wales and are actively promoted by many key charities, including Age UK, Macmillan Cancer Support, the Motor Neurone Disease Association, Marie Curie Cancer Care and most hospices. This new legislation is in part a response to the widely recognised problem that people are not getting the kind of death they want (e.g. home rather than hospital) and to the acknowledged problem of over-treatment at the end of life (Leadbeater & Garber, 2010). There is evidence that increased uptake of ADs is likely to result in people's choices about the kind of treatments they do and do not want to receive at the end of life being better respected (Satherley & Hehir, 2010). However, uptake of ADs has been low: survey polls show that uptake ranges from about 3% to 8% in the general population. There is virtually no research in the UK addressing this issue. This is a timely seminar series that will address some of the issues arising five years after the (2007) implementation of the Mental Capacity Act 2005.The aim of this seminar series is to address the problem with uptake of ADs in the UK from a trans-national and interdisciplinary perspective that uses lessons learnt from the much longer history of ADs in the USA and brings together people working in charities concerned with promoting ADs, academics with expertise across a range of disciplines including law, medical, sociology/psychology and bioethics (including a leading bioethicist from the USA), and practising doctors.The main objectives are:(i) to develop our understandings of what inhibits people in the UK from planning ahead for their medical care in advance of a crisis(ii) to work out the best ways of encouraging uptake of ADs(iii) to identify new research agendas arising out of the introduction of ADs into statutory law in the UK(iv) to collaborate on the production of an edited book addressing these issues.We will also inform a wider public discussion of ADs by creating an online forum recording the findings of the symposium (e.g. posting speaker slides, and a collection of completed ADs with commentary) and by working with a local community arts center to show films followed by discussion sessions around this issue. The seminar series will benefit the participants for whom it will be an intensive interdisciplinary and academic-practitioner learning experience; the practice-settings in which many of them also work (e.g. in law, medicine and palliative care) and in relation to which they sit on influential committees and working parties drawing up guidelines for practice; the charities and hospices aiming to increase the use of ADs - (representatives from these will also be seminar participants); and other academic researchers in the field of end-of-life decision making and informed choice in medical care.