医疗知情同意权概述

介绍了医疗知情同意权的渊源和定义,从法学角度论述了医疗知情同意权的知情权和同意权的统一、同意权的内涵界定、和知情同意权的性质。同时,把知情同意权的分成常规管理类、医疗诊疗类和医疗纠纷处理类。     

信息不对称状态下的知情同意权

医疗卫生服务属于特殊商品,兼具私人物品和公共物品双重属性,在一定程度上存在非竞争性和排他性。市场很难通过自身调节缓解信息不对称。知情同意权从道德、法律、现实层面赋予患者获取足够有效医疗服务信息的权利,能较好地缓解医疗服务市场的信息不对称。在我国现阶段,由于医疗卫生服务体制改革仍处在攻坚阶段,医疗服务市场竞争仍显混乱。知情同意权存在诸多问题。唯有从道德伦理层面,要求规范医生履行知情同意义务,从而更大限度地缓解医疗服务市场的信息不对称。     

谈患者知情同意权保障

近年来。医疗纠纷愈演愈烈,而在80％的医疗纠纷案中,患者都认为医方未尽到“告知并征得同意的义务”。显然,知情同意权已成为医患纠纷中最突出的问题。那么,患者应享有哪些知情同意权？患者知情同意权得不到保障的原因何在？又该如何保障患者知情同意权？谈谈我的看法。     

患者知情同意权法理之思

患者知情同意权的有效行使是医方合法开展重要医疗措施的前提,然而临床实践中,立法的局限、伦理的困境都限制了权利的发挥与发展。目前,中国几部重要的相关立法中均设置了有关患者知情同意权的规定。基于对患者知情同意权的内涵、发展历程、国外立法概况的梳理,从知情权的内容、涉及同意权行使问题的医疗行为之范围、不同情形下同意权行使的主体等几方面对上述立法的相关条款进行比对,发现在不同立法规定间,患者本人、家属、医疗机构三方在知情同意权事项中的权利分配格局有较大差异,究其变化孰优孰劣值得探讨。同时,患者知情同意权在临床实践中的充分落实有赖于医患沟通机制的重构及立法中权利设置的合理化。     

浅析医疗服务中知情同意权的实现

正1概念医疗服务中患者享有知情同意权。知情同意保证了患者在充分了解自己的病情、检查、诊断、治疗及预后等相关情况的基础上,决定是否同意采取特定的诊疗行为,体现了对患者人权的尊重,在一定程度上保护了患者的生命权、健康权。从其内容方面来说,只要和患者疾病相关,包括诊疗行为的利弊、实     

对患者知情同意权问题的探讨

在医疗实践中尊重患者知情同意权,是医务人员的义务。目前我国立法、司法和医疗实践中存在着依理性医生标准和按家长式医患模式行事的倾向,其结果为患者的知情同意权得不到充分尊重。文章从医患双方的共同参与、知情同意书的改进、风险的告知、患方对告知内容的正确理解、对患者弃权行为的尊重五个方面,提出了如何改进医务人员告知行为方式的建议,以期对解决和克服目前在医疗工作中存在的此类问题有所帮助。     

医疗保护制度与患者知情同意权中的伦理关系

知情同意权作为患者拥有的基本权利和医生应履行的起码的义务,在沟通医患关系中起着重要作用。由于认知程度的不同,患方主体对病情告知会产生不同的反应。而医生在履行这一义务时会面临法律、伦理和医疗保护制度之间的矛盾。正确认识和处理这些矛盾,对避免医疗纠纷有重要作用。     

内科老年病人对知情同意权需求的探讨

目的 探讨内科老年病人对知情同意权的需求.方法 质性描述.采用深度访谈法收集23名内科老年病人的资料,并进行分析总结.结果 内科老年病人认为知情同意权并非必要,但在用药和费用方面却是必需的.结论 满足内科老年病人对知情同意权的要求首先要和他们建立良好的关系,取得他们的信任,同时要保证病人的明白消费.     

国外和中国香港、台湾地区医疗知情同意权的相关规定

对美国、英国、荷兰、芬兰、韩国以及中国台湾和香港地区的医疗知情同意权相关法律、法规进行了研究,分别介绍了上述国家和地区的有关规定。     

论医疗干涉权与知情同意权的冲突

在医疗实践中,患者的知情同意权和医生的医疗干涉权往往会发生冲突。医学伦理学论证了医疗干涉权存在的正当性;《侵权责任法》从立法层面规定了医疗干涉权。通过对两个权利在不同情况下的冲突的分析,来界定医疗干涉权的行使范围。提出通过建立“非本人意见审查机制”以弥补知情同意制度所存在的不足,进而完善医疗干涉权制度。     

Informed Consent

There have been significant changes in the doctor patient relationship with the impact of technology in day-to-day practice. More and more patients are aware of their rights and are keen to make free choice and decision on their treatment. This helps them to choose the treatment of their choice from the options available and to select a physician of their choice. Doctor''s decisions are being questioned regarding their correctness and there is a need to educate the patient, on what one offers by way of treatment. In some procedures and types of treatment, patient needs to be educated and informed of the merits and demerits of the treatment available. This will help the patient to make appropriate choice and also to accept some adverse outcome of treatment. Towards this end, all countries are looking afresh at the necessity of Informed Consent. Methods adopted by some countries are highlighted to help our physicians practice them in an appropriate way. A lot of remedial work needs to be done to minimize future litigation, as many doctors misunderstand their legal obligations and haven''t caught up with the change in judge''s thinking.Key Words: Doctor-patient relationship, Consumer ethics, Medical negligenceClinical ethics teaches physicians, a wide range of specific ethical issues e.g informed consent, truth telling, end-of-life decisions, advance directives (substitute decision making for incompetent patients) and increasing third-party constraints on the autonomy of both patients and physicians [1].There have been many changes, between 1965 and 1970 on the subject of medical ethics and physician-patient relationship. The traditional medical ethical principle required that the physician do what he thought would benefit the patient. The principle of mutual trust protected these decisions. The medical profession even refused to recognize the wishes of the patient and felt that he knows what is best for the patient – a paternalistic attitude. The physicians failed to accept that the patient is entitled to make his own free choice and decision-the principle of autonomy [2].Patients had earlier placed their faith in the physician''s higher education and the authority of his medical role. But of late doubts have been raised about the quality of doctor''s decision, as their decisions vary depending upon the facts that :

• a.He is a long trusted physician or an emergency room doctor seeing the patient for the first time,
• b.The patient is acutely ill or is suffering from a chronic illness,
• c.The procedure / treatment is a one time or it involves prolonged or repeated treatment,
• d.There are multiple / alternative choices or only one choice,
• e.Patient''s economic and social status, source of fund for treatment, and
• f.Doctor-patient relationship [3].

The rights (autonomy) of the patient have deeply eroded the old model of doctor-patient relationship. The emerging model prefers to treat a doctor as a service provider (medical) for hire, governed by negotiation and a commercial relationship. The consumer ethics has displaced the physician from their previous prominent status and allow patients to say, “Doctors are not Gods“. The patient has now the ability to select and dismiss their doctors. They have the resources and can express their preferences about making decisions on general or even specific treatments. They can ask questions, reject proposals, and often find allies in dealing not only with doctors but also hospitals from legal literature, support group, counsellors, and social workers [3].The clinical-ethical process of shared decision-making is mirrored by the legal doctrine of Informed Consent (IC). Informed consent is defined as voluntary acceptance by a competent patient of a plan for medical care after physician adequately discloses the proposed plan, its risks and benefits, and alternative approaches. This requires a process of effective communication and education between the physician and patient [1]. Informed consent is a process with the elements of autonomous authorization, free from coercion or manipulation, decision-making capacity, disclosures to the patients, and comprehension [4].In academic medicine, as teaching of medical ethics became formalized in the 1970s, moral principles of respect for autonomy, non-malfeasance (the obligation to avoid causing harm), beneficence (obligation to provide benefits and to balance benefits against risks), and justice, assumed a central role. Thirty years later, IC is still written with the intent to protect the medical profession from lawsuits. Indeed, court views of IC also include a therapeutic privilege for physicians not to inform a patient who may be harmed by the disclosed information [5].Over the past two decades a considerable volume of litigation in many countries have focused on the consent issue and the doctrine of informed consent has assumed a significant role in the medical negligence debate.     

Informed Consent

There have been significant changes in the doctor patient relationship with the impact of technology in day-to-day practice. More and more patients are aware of their rights and are keen to make free choice and decision on their treatment. This helps them to choose the treatment of their choice from the options available and to select a physician of their choice. Doctor's decisions are being questioned regarding their correctness and there is a need to educate the patient, on what one offers by way of treatment. In some procedures and types of treatment, patient needs to be educated and informed of the merits and demerits of the treatment available. This will help the patient to make appropriate choice and also to accept some adverse outcome of treatment. Towards this end, all countries are looking afresh at the necessity of Informed Consent. Methods adopted by some countries are highlighted to help our physicians practice them in an appropriate way. A lot of remedial work needs to be done to minimize future litigation, as many doctors misunderstand their legal obligations and haven't caught up with the change in judge's thinking.     

试论知情同意与公共卫生实践

知情同意赋予患者、受试者自我选择和决定医疗或实验的权利,是生命伦理学和生命法学的重要论题,有着丰富的内涵。随着公共卫生事业的发展,知情同意在公共卫生领域应用受到广泛关注,讨论公共卫生实践中及流行病学科研中可能遇到的知情同意问题越来越有必要。在公共卫生实践中知情同意须根据不同的研究目的和研究方法采用不同知情同意方式,使之更好规范医学研究实施。     

论知情同意

在社会提倡知情同意的同时。部分患者却斥责知情同意权是残忍的权利，从而拒绝接受。究其原因，一是受中国传统文化心理影响，二是与医患双方（特别是医方）对知情同意的理解。操作失之片面有关，知情同意原则强调的是医疗活动过程中对患者的尊严。人格和自由的尊重，贯彻这一原则，不能照搬某种形式，重要的是对其内涵有深刻理解和情感认同，从而达到内心的自觉和自律，同时多从患者的角度考虑，立足本国国情去践履这一原则。     

签署麻醉同意书应注意的知情同意问题

知情同意是一项医学伦理学原则,知情同意权是患者的法定权利,告知说明是医师的法定义务。签署麻醉同意书是以法律的形式书面证明了麻醉医师已经履行了告知说明义务,患者行使了其知情同意权。麻醉医师应该按照医学伦理学的要求和卫生法的规定来签署麻醉同意书。要做到正确理解签署麻醉同意书的含义,选择正确的告知对象和签字人,告知的内容要充分且易懂,实行保护性医疗措施,并在变更麻醉时重新签字。     

知情同意再探

从知情和同意两个方面探讨了知情同意这一概念的历史、内涵与要素，以及在现实中遇到的问题。旨在通过这些理论上的探讨，为进一步解决实践中存在的问题提供帮助。     

知情同意的演变及发展

18世纪末19世纪初,美国认可患者有权在治疗中了解和选择有关措施,并提出医生在实行手术治疗前必须取得患者知情同意。1946年,在审判纳粹通过的《纽伦堡法典》中,知情同意被作为患者的权利确定下来。1957年美国加利福尼亚州上诉法院对Salgo事件的判决中,法官引入了“知情同意”这一词汇,将“知情同意”引入医疗诉讼领域,形成了“知情同意”理论。1964年6月,第18届世界医学协会联合大会在芬兰通过了《赫尔辛基宣言》,它对人体实验作了进一步要求。1975年,第29届世界医学会对其作了大幅改动,将informedconsent一词置于宣言中。1981年,世界医学会第34届全体大会提出了《里斯本病人权利宣言》,将知情同意扩展到了对所有病人的治疗中。20世纪80年代中后期,知情同意被引入中国,1999年,这一理念被纳入《中华人民共和国执业医师法》。自此,知情同意在中国逐渐得到应用和发展。