摘要
生前预嘱是对临终或伤病末期医疗手段的预先指示.生前预嘱在其发源地美国已有近五十年的历史.有关其后效的评估表明,生前预嘱并未实现其预期承诺.它没有促进更早使用缓和医疗和更少使用延命医疗,没有降低临终医疗开销和促进医患沟通.其模式化的文本难以应对复杂紧急多变的临终医疗境况.从"关系性"和"不确定性"两个维度进行反思,生前预嘱的理念意义大于其实践意义,重要的是提供高质量的临终照护,而不是在模式化的文本中做出选择.
Abstract
An advance directive is a pre-instruction for end-of-life or terminal medical care.In June 2022,Shenzhen included advance directives in its local regulations.Compared to the widespread praise,the critical viewpoints are few.Since its origination in the United States nearly five decades ago,the assessments of its effectiveness have shown that advance directives have not fulfilled their intended promises.They neither advanced the earlier use of palliative care nor reduced the use of life-sustaining treatment,nor did they decrease end-of-life medical expenses or facilitate doctor-patient communication.The standardized text is challenging to apply in the intricacy,urgency of terminal medical care.This paper explores the research topic from two distinct dimensions,"relationality"and"uncertainty".The end of life is a relational event where others'assistance might not necessarily infringe on autonomy;instead,it might promote it.The paper also discusses the issues related to the uncertainties concerning medical situations,patient wishes and disease trajectories.In conclusion,the conceptual significance of advance directives outweighs their practical significance;what is important is to provide high-quality end-of-life care rather than to make choices within a standardized text.
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