Theoretical Demonstration And Practical Path On Living Will For Patients With Advanced Cancer From The Perspective Of "Patient-Family"

Living will or advance directive(AD),refers to the signing of people with clear consciousness and free will,indicating the agreement or refusal of medical treatment and care at the end of the incurable injury or at the end of life.In China,there has not been a legislative act against this indicative document,and its promotion and popularization remain at the civilian level.Even so,the form of living will especially the content,is of great significance to the public,especially to advanced cancer patients and their families.Whether it is at the legal level or at the ethical level,the nature and content of living will can be defended and supported.However,the direct transition from the theoretical level to the practical level is not realistic in China's current social and cultural environment and medical practice.Therefore,whether it is possible to find a path and to properly realize the patient's relevant will on the premise of avoiding the dilemma of the standard document is to be concerned and studied.The study found that in medical practice,when patients with advanced cancer lose their corresponding behavioral ability,they are replaced by patients' families to make relevant choices and decisions.Even in patients with advanced cancer who still have the corresponding behavioral ability,medical staff tend to inform the patient's family of the condition and seek consent,in order to avoid adverse effects on the patient.Under such circumstances,family members directly and indirectly become the ultimate decision makers of the patient's interests.However,if the patient and the family are in different moral communities and hold different value judgments and value choices for the relevant matters,then the family members who do not fully communicate with the patient will extremely easy to infringe on the patient's autonomy and the best interests of the patient.From a theoretical perspective,there are many differences between the Chinese localized Confucian thinking mode and the Western liberal individualistic thinking mode.This further confirms that in the practice of our country,the establishment of the patient-family communication model cannot copy the Western model.As far as Confucian thinking mode is concerned,there are two mainstream theories at the level of bioethics,which are Professor Fan Ruiping's Confucian familism structure model and Professor Li Ruiquan's Confucian principled structure model.Both belong to the theoretical branch under the Confucian framework.They all set the tone of the overall thought with " benevolence" as the center and basic points.They can also finally achieve unity in the relationship between individuals and families and the same approach is taken in resolving conflicts.However,there is indeed a big difference between the two in terms of specific points of view.The same or similar theoretical basis and different external expressions provide an opportunity for the mutual integration and reference of the two structural models.The patient-family communication model with Chinese characteristics is nurtured in such a cultural and ideological context.However,although the general value of the relative value judgment and value choice of family members and patients who are influenced by Confucianism on the macro level is consistent,the family members and patients in the same group relationship are still two different individuals.Different views on a particular issue are most likely to attribute the two to different moral communities.In response to such disagreements,HT Engelhardt's concept of "moral aliens" proposed in his book The Foundations of Bioethics and its corresponding "principle of permission" can give some enlightenment to the model construction.From a practical perspective,the patient-family communication model can be divided into two phases:disease notification phase;medical decision-making phase.The roles and responsibilities of patients,families,and medical staff vary from stage to stage.As far as medical staff is concerned,their assessment and supervision responsibilities need to be taken seriously during the informed phase,and the medical staff as an intermediary and connection between the patient and the family also plays an important role in two stages.As far as the patient's family is concerned,in the notification stage,in the case that the patient's condition is not suitable to be informed of the condition,the family member must partially bear the obligation of the medical staff to inform,and in the medical decision-making stage,the family member serves as the patient's emotional support and the patient-related matter.The decider must be a listener and companion under the premise of fully understanding the patient's psychology,needs and mastering the corresponding skills.As far as patients are concerned,they should actively communicate with their family members and medical staff on their own needs.They do not deliberately hide their negative emotions and form a community of patients with their own illnesses and decision-making.