对痴呆症安乐死能力的评估:对60个荷兰病例的定性研究
Arne van den Bosch1, Radboud M Marijnissen1, Denise J C Hanssen1
1Department of Psychiatry (CC74), University Medical Center Groningen, Groningen, The Netherlands.
Journal of the American Geriatrics Society
|October 21, 2024
概括
评估痴呆症患者安乐死决策能力是复杂的. 诸如沟通和患者与医生的关系等因素会影响判断,强调需要改进评估过程.
科学领域:
- 医学伦理 医学伦理
- 神经学 神经学
- 精神病学是一个精神病学.
背景情况:
- 在荷兰,痴呆症患者的安乐死和协助自杀 (EAS) 正在增加.
- 由于认知能力下降,评估痴呆症患者的决策能力具有挑战性.
- 对于EAS的法律要求包括决策能力或预先指令.
研究的目的:
- 在接受EAS的痴呆症患者中对决策能力的判断产生影响的因素进行定性评估.
- 了解这些因素如何影响评估过程.
主要方法:
- 对60个荷兰痴呆症EAS病例摘要 (2012-2021) 的定性研究.
- 基于理论的方法用于分析决策能力相关的报价.
- 具有预先指示和不同能力判断的案件的有目的抽样.
主要成果:
- 在所有审查的案件中都确认了决策能力.
- 医生隐含地使用了既定的认知标准 (Appelbaum和Grisso).
- 六个因素 (沟通,共同疾病,个性,预先指示,请求一致性,患者与医生的关系) 影响了能力判断.
结论:
- 关于安乐死的决策能力是多维的,通常是隐式评估.
- 支持因素和背景因素对能力判断有很大的影响.
- 评估中的主观性引发了伦理/法律方面的担忧,需要提高质量.
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