How Would Terminally Ill Patients Have Others Make Decisions for Them in the Event of Decisional Incapacity? A Longitudinal Study

摘要: Many patients, as they approach death, are unable to speak for themselves. Healthcare professionals usually turn loved ones on behalf of such generally without any notion the manner in which these patients would have healthcare or decisions. The two major standards suggested ethical and legal literatures best interests standard (deciding what think be patient) substituted judgment (attempting discern patient wanted deciding accordingly, whether through a living will other knowledge patient’s values).1,2 The literature medical ethics many legislative judicial opinions privileged preferred others, yet one study has that receiving dialysis give surrogates wide latitude making decisions.3 Another shown slight majority terminally ill prefer decision made by even if it contradicted hypothetically “perfect” will.4 Moreover, multiple studies demonstrated judgments far from perfectly accurate.5,6 It is known who intact decisionmaking capacity vary considerably their control preferences.7-10 Some make decisions independently, some defer decision-making authority physicians, most opt shared decisionmaking. It recently been shown, similarly, with terminal diagnoses role assign physicians should no longer able themselves.11 judgments, others decide believe best, but combination approaches. stability choice style not studied. Advance directives have, opinion many, failed deliver promise improve at end life.12,13 problems encountered simplistic reliance advance led calls broader dubbed “advance care planning.”14 One hypothesis explain failure may change views just interventions want, also how ought become sicker closer death. This article reports long-term series measurements patients’ preferences regarding behalf. It was hypothesized that, came more likely physicians. Factors associated event decisional incapacity were examined.