美国倡导清醒有自决能力的成年人用预先指示的方式表明自己在丧失自决能力时的医疗选择。预先指示主要分为生前遗嘱和持续性医疗授权书两种形式。美国联邦和各州有相对完善的法律制度,规定预先指示的形式内容及预先指示不存在时能为病人作出决定的人群和权限。医院也会有程序指南为医务工作者提供指导原则。中国可借鉴美国经验在转变大众对于死亡的观念、尊重病人自主权、出台相应法律法规、行业指南、增强医务工作者的沟通技巧和人文关怀等方面作出积极改变,完善放弃治疗的程序,满足病人要求,解决医务工作者的两难困境。 The United States advocates that conscious, self-reliant adults use a pre-instructional modality to demonstrate their medical choices in the event of loss of self-determination. Pre-instruction is divided into two major forms of living wills and continuing medical authorization. The United States and the states have relatively well-established legal systems that provide for the formalization of advance directives and the pre-directive instructions to those who do not have the ability to make decisions for patients when they do not exist. Hospitals also have procedural guidelines that provide guidelines for healthcare workers. China can learn from the experience of the United States to make positive changes in the aspects of changing the public’s concept of death, respecting patients’ autonomy, introducing relevant laws and regulations, industry guidelines, enhancing the communication skills and humanistic care of medical workers, and improving procedures for giving up treatment to meet the needs of patients Requirements, solve the dilemma of medical workers.