人类辅助生殖技术研究与实施中知情同意的伦理思考

近20年来，随着我国经济市场化和社会法制化的转型，传统的医院和家属决定医疗措施的模式已经不能充分保护患者的权益，对病情的知情权和治疗措施的决定权已经被动地移到患者本人。然而在辅助生殖技术领域知情同意更为特殊。由于生殖涉及夫妻双方和家庭，知情权有时与隐私权形成尖锐地对立；患者是否能自愿选择，也仍然受到了女性的弱势社会地位、来自家庭和社会的各种压力的影响；辅助生殖技术是在其尚不成熟时开始临床应用的，其科研探索和医疗行为的性质同时并存。这些问题须引起伦理学界的高度关注。从伦理角度而言，对于辅助生殖技术，政府和行业协会应当通过制度和行业规范保障社会公益性不受到损害，病人的普遍利益得到保护，而知情同意则是针对特定的个人进行权益保护的防线。

An Ethical Reflection on Informed Consent in the Research and Application of Assisted Reproduction Technique

With the transformation of marketization of economy and legislation of society in recent 20 years in China,the traditional mechanism in which medical therapy is decided by patients' relatives and doctors has not been able to offer sufficient protection for the legal rights of patients.So the rights of informed consent and decision making have been transferred passively to the patients' side.But in the field of assisted reproduction technique(ART),informed consent has to face some specific and unique problems.Firstly,being fully informed is sharply against the privacy of his(her) spouse as reproduction involved both the couple and their families.Secondly,it is a question that whether a wife can make her freewill choice when she accepts an ART program,because of the pressures coming from her family,the society,and her low social status well.And thirdly,The ART has the characteristics of both clinical therapy and scientific research as it is imperfect and its protocols still need to be improved.Ethicists should focus on thiese challenges.In the aspect of ethics,the regulations established by government and occupational association are the safeguard of the commonweal of society and general rights and benefits,and the ethics review and informed consent offered the final protection for the patients.