Báo cáo y học: Advanced directives and treatment decisions in the intensive care unit

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Advanced directives and treatment decisions in the intensive care unit...
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Báo cáo y học: "Advanced directives and treatment decisions in the intensive care unit" Available online http://ccforum.com/content/11/4/150CommentaryAdvanced directives and treatment decisions in the intensivecare unitLeslie M WhetstinePhilosophy and Bioethics, Walsh University, 2020 E. Maple Street, NW, North Canton, OH 44720, USACorresponding author: Leslie M Whetstine, Lwhetstine@walsh.eduPublished: 26 July 2007 Critical Care 2007, 11:150 (doi:10.1186/cc5971)This article is online at http://ccforum.com/content/11/4/150© 2007 BioMed Central LtdSee related review by Tillyard, http://ccforum.com/content/11/4/219Abstract them to predict what their future holds; that is, what kind of illness/injury they will suffer and what types of medicalProspective medical decision-making through the use of advanced interventions they must consider [5]. Because medicine is notdirectives is encouraged and frequently helpful in guiding treatment static, making a prospective determination regarding thefor the critically ill. It is important to recognize the attendantshortcomings when using such tools in clinical practice. types of treatment one would want in the future is difficult. The quality of life that patients may find intolerable whileIn this issue of Critical Care, Tillyard [1] explores whether healthy is apt to change when options are limited betweenadvanced directives are effective at guiding treatment choosing a compromised life or choosing death; thus, thedecisions for incapacitated patients. Tillyard concludes that psychological transition that an individual will undergo whenalthough advanced directives should ideally improve decision- faced with such choices is heavily nuanced and cannot bemaking, this frequently does not translate effectively at the accurately predicted in advance [6]. Further, living wills tendbedside. to be inflexible in that they express a preference but do not offer any supporting rationale, thus leaving little room forStudies have shown that, in themselves, advanced directives interpretation or authentic knowledge of the individual.are insufficient to withstand the complexities of end-of-lifecare [2,3]. To resolve this divide between theory and The bioethics literature suggests that it is best to combine apractice, however, it is helpful to refocus the issue. We ought living will with a durable power of attorney to ensure anot to be overly concerned with the execution and application comprehensive approach to future decision-making. In thisof advanced directives but with the motivation behind them regard an informed surrogate can adjust to changingand the dialogue they engender over time [4]. circumstances and maintain a collaborative relationship with the health care team while promoting the patient’s particularIn the United States, advanced directives are used as a value system and respecting the individual’s autonomy.blanket term that can refer either to a living will or a durablepower of attorney, two distinct methods designed to Despite the fact that the United States is known forsafeguard autonomous choice. A living will is a written supporting an assertive vision of autonomy and hasdocument that expresses a preference for or against specific witnessed the importance of advanced decision-makingtypes of treatment; it typically becomes effective only when played out in the media (for example the Schiavo case), athe patient is incompetent and either terminally ill or relatively small percentage of Americans complete advancedpermanently unconscious. A durable power of attorney is a directives, as Tillyard notes. The reasons for this may bedocument that empowers an individual surrogate (appointed multifactorial, ranging from the demands of managed care inby the patient) to assume decision-making authority as soon which the doctor–patient relationship has been undercut byas the patient loses decisional capacity. ...