新修订的《深圳经济特区医疗条例》近日经深圳市人大常委会表决通过，并将于2023年1月1日起正式实施。生前预嘱是本次立法的一大亮点。《条例》规定，医疗机构收到患者或者其近亲属提供的符合法定条件的患者生前预嘱的，在患者不可治愈的伤病末期或者临终实施医疗措施，应当尊重患者的意思表示。生前预嘱内容包括采取或者不采取插管、心肺复苏等创伤性抢救措施，使用或者不使用生命支持系统，进行或者不进行原发疾病的延续性治疗等。如何确保生前预嘱是患者的真实意愿呢？《条例》规定：经公证或者有两名以上见证人在场见证，且见证人不得为参与救治患者的医疗卫生人员；采用书面或者录音录像的方式，除经公证的外，采用书面方式的，应当由立预嘱人和见证人签名并注明时间；采用录音录像方式的，应当记录立预嘱人和见证人的姓名或者肖像以及时间。

生前预嘱在我国属于一项全新的制度，具体实施细则需要不断完善以便更好地实施这项制度。其实，生前预嘱制度已在某些国家实施，下面以英国为例，来了解一下英国的生前预嘱制度。

“预立医疗决定的含义及意义

An advance decision (sometimes known as an advance decision to refuse treatment, an ADRT, or a living will) is a decision you can make now to refuse a specific type of treatment at some time in the future.

预立医疗决定（有时又称“预先拒绝治疗决定”或“生前遗嘱”）是当前做出的在未来某一时间拒绝接受某种特定治疗的决定。

It lets your family, carers and health professionals know your wishes about refusing treatment if you’re unable to make or communicate those decisions yourself.

通过预立医疗决定，预立医疗决定之人的家人、看护和医疗人员能够在其无法做出决定或无法交流的情况下了解其拒绝治疗的想法。

预立医疗决定的有效性

An advance decision may only be considered valid if:

you're aged 18 or over and had the capacity to make, understand and communicate your decision when you made it;

you specify clearly which treatments you wish to refuse;

you explain the circumstances in which you wish to refuse them;

it's signed by you (and by a witness if you want to refuse life-sustaining treatment);

you have made the advance decision of your own accord, without any harassment by anyone else;

you have not said or done anything that would contradict the advance decision since you made it (for example, saying that you've changed your mind).

预立医疗决定仅在以下情况下被视为有效：

预立医疗决定之人年满18岁，且有能力做出该等决定以及在做出该等决定时理解该等决定并进行传达；

预立医疗决定之人明确指出拒绝接受的治疗手段；

预立医疗决定之人说明拒绝接受治疗的情形；

由预立医疗决定之人签名（若拒绝接受生命支持治疗注1，还须有一名见证人签名）；

由预立医疗决定之人出于自愿做出，并非受到他人骚扰被迫做出；

自做出预立医疗决定起，预立医疗决定之人的言语或行为未与该等决定相抵触（比如，声称已改变主意）。

预立医疗决定的法律约束力

An advance decision is legally binding as long as it:

complies with the Mental Capacity Act;

is valid;

applies to the situation.

预立医疗决定满足以下条件才视为在法律上具有约束力：

符合Mental Capacity Act的规定；

具有有效性；

适用于当前情形。

If your advance decision is binding, it takes precedence over decisions made in your best interest by other people.

若预立医疗决定具有约束力，其效力优先于他人为维护预立医疗决定之人的最大利益做出的决定。

有权查看预立医疗决定之人

You have the final say on who sees it, but you should make sure that your family, carers or health and social care professionals know about the decision. You should also let them know where to find it.

预立医疗决定之人拥有最终决定权来决定谁有权查看，但是须确保其家人、看护或医疗和社会服务人士了解相关内容，还须告知上述人士预立医疗决定的放置之处。

You can keep a copy in your medical records.

预立医疗决定之人可以在其医疗记录中保存一份副本。

注1 You can refuse a treatment that could potentially keep you alive, known as life-sustaining treatment, such as:

ventilation – this may be used if you cannot breathe by yourself

cardiopulmonary resuscitation (CPR) – this may be used if your heart stops

antibiotics – this can help your body fight infection

预立医疗决定之人可以拒绝接受以下生命支持治疗，包括但不限于：

通气—无法自主呼吸时使用

心肺复苏（CPR）—心脏骤停时使用

抗生素—抗感染时使用”

来源：

深圳市人大常委会官网

英国NHS官网