谈医师的独立诊疗权和患者知情同意权对医患纠纷的影响

沉寂了一段时间的医患纠纷。再次成为社会关注的焦点。各界呼吁医院尽快落实患者的“知情同意权”,以解医患纠纷的燃眉之急。知情同意是医学伦理学的一条基本原则,2002年9月1日开始实施的《医疗事故处理条例》明确规定：医疗机构及其医务人员应当将患者的病情、医疗措施、医疗风险等如实告知患者,即“知情同意”。临床医疗中落实好患者的知情同意权,不仅有助于达到医疗目标,     

论患者知情同意权与医方的告知义务

患者知情同意权包括患者知情权与患者同意权。知情是同意的前提和基础,而同意与否是知情的结果。患者知情同意权实现的过程就是医方充分说明、患者对信息理解、在说明和自己理解基础上的同意。笔者着重探讨了知情同意权构成要素“知情”、“自由意识”和“有能力”以及医方履行告知义务的范围和程度,有效保障患者知情同意权,实现患者在诊疗过程中享有的基本权利。     

维护癌症患者知情同意权中伦理问题的质性研究

目的探讨在治疗和康复过程中维护癌症患者知情同意权中存在的伦理问题,旨在维护癌症患者的知情同意权,提供更合理的人性化的治疗和护理。方法采用质性研究中的现象学研究方法,用立意取样法选取13位癌症患者。采用深入访谈法收集资料,用Clolaizzi法分析资料并形成主题。结果影响癌症患者知情同意权中存在的伦理问题有八大类主题：求医选择知情权、病情知情权、医疗保险知情权、医疗风险知情权、治疗方案知情权、医疗文件知情权、医疗检查知情权和家属同意知情权等。结论在治疗和康复过程中为了提供更合理的人性化治疗和护理,必须减少癌症患者知情同意权中存在的伦理问题．维护癌症患者的知情同意权。     

知情同意的中国式困境分析

在我国,患者的知情同意权表现出明显的＂中国特色＂,如：＂家文化＂中的、医患不信任的、简单功利化的知情同意,使知情同意陷入在医学目的混乱,职业精神弱化;商业化管理和运营模式下的中国式困境中。为了充分保护患者的权利,履行医方的责任,必须对知情同意进行全方位的本土构建,从国情出发,肯定和保障患者的知情同意权,明确规定知情同意权行使的条件和程序。重视医患信任系统的构建,真正地将病人利益放在首位,明确知情同意的实质,让医院回归公益属性。保障患者知情同意权的顺利实现。     

患者知情同意原则的法律应用分析

患者知情同意原则是现代医疗法律的基本原则之一。《侵权责任法》首次在基本民事法律层面规定了患者知情同意原则,弥补了以往的法律缺失,具有极为重要的意义。针对《侵权责任法》第55条在适用中存在的问题,本文提出,在实践中应将患者知情同意原则区分为患者知情权和患者同意权两个权利,同时应给予患者的知情范围一个大致明确的界定和确定医疗机构履行告知义务的标准,最终还应明确医疗机构的免责条件。     

知情同意告知应尽快纳入规范化管理轨道

针对我国目前医疗知情同意权的现状,分别就医疗知情同意告知主体的资质、医疗知情同意权除患者本人外的主体、书面告知义务履行、知情同意书文本制订的规范、医生履行知情同意告知的职责和义务、知情同意应纳入医学教育及医院管理中、知情同意的医疗行为立法等问题,提出了建议。     

知情同意在临床药学中的应用

知情同意有丰富的内涵,知情同意权是患者的一项基本权利。知情同意权是临床上处理医患关系的基本伦理准则和法律原则之一,包括知情权、选择权、拒绝权和同意权等四项内容。在签署医疗知情同意书时,适时给予患者情感上的关爱,重视患者心理需求,采取医学技术与人文关怀相结合的医疗活动,有助于在现代医学模式基础上构建和谐的医患关系。     

知情同意权的发展渊源与常见问题探讨

本文对知情同意权的定义、构成及内容、知情权与同意权的辩证关系、临床实践中知情和同意的具体内容、西方和国内知情同意权的发展渊源进行了概况,并探讨了知情同意权在医疗实践中常出现的知情同意书书写不规范、告知主体和客体错误,忽视患者本身的知情同意权、代为行使知情同意权时无授权委托书、过多采取口头告知的方式,导致告知证据未固定等问题,为医务人员更好落实知情同意权提供思路.     

论知情同意对医患和谐的作用

目的探讨医务人员认真落实知情同意权对构建和谐医患关系的重要作用。方法我国已确立患者知情同意的法律制度,明确患者知情同意权的内涵和意义,分析患者享有知情同意权的现实状况,提出落实患者知情同意权的途径和方法。结果随着医患沟通的不断加强,患者的知情同意权得到落实,医患间的矛盾和问题得到化解,融洽和谐的医患关系正在逐步形成。结论加强医患沟通,落实知情同意,对构建和谐医患关系,促进社会稳定,推动社会进步与发展具有十分重要的意义。     

尊重病人的知情同意权,履行医师的权利和义务

近年来，医患纠纷日益增多，究其原因，不外乎社会的、医院与医务人员的、患者和家属的等多种因素所致。其表现形式，让医院扮演了纠纷的主体。就纠纷的主客观原因分析，其中医务人员不重视患者的知情同意权是重要的原因之一。因此正确理解知情同意权，并在医疗实践中贯彻实施，对预防和减少医疗纠纷极为有利。在新的《医疗事故处理条例》、《执业医师法》中也充分体现了尊重患者的知情同意权的重要性。     

完善知情同意书填写 防范医疗风险

目的 探讨患者知情同意书的完善与医疗风险的防范.方法 抽查我院四年23份医疗投诉案例,结合相关出院病案,参照国务院新颁<医疗事故处理条例>,分析探讨医疗纠纷的成因.结果 我院近年来医患纠纷的发生率无明显增高知情同意书缺页或缺项有所减少对患者病情、治疗、危险性和预后等据实通报是对患者权力的维护而知情同意书的完善,本质上有益于医院管理的规范、医患纠纷的防范,其实质也是对医务人员利益的保护.结论 完善知情同意的病案内容,严格知情同意书的书写质量,加大知情同意书缺页缺项的处理力度,是维护医患双方权益,减少医患纠纷发生的新举措.     

试论医院维权与自律的关系

从维权与自律的概念入手,分析了伦理学界定的自律与医院自律公约的区别,认为维权只有当侵权发生后才被重视,维权应以法律为依据。从三个方面阐述了维权与自律的关系:从工作上看,自律是维权的基础;从典型案例看,二者虽有一定关系但无必然联系;从理论上看,二者分属法学与伦理学范畴,法与道德在卫生领域有着诸多特殊性;鉴于目前医院作为法人的权利尚不明晰,建议尽快制定医院权益的有关规定,以指导医院的维权工作。     

From the Office of the General Counsel. Cruzan v Director of Missouri Department of Health: an ethical and legal perspective

In December 1989, the U.S. Supreme Court heard arguments in a Missouri right-to-die case, Cruzan v. Director of Missouri Department of Public Health. The family of Ms. Cruzan, a young woman who has been in a persistent vegetative state for nearly seven years, was seeking to have her gastrostomy feedings discontinued. In an amicus curiae brief, the American Medical Association urged the Supreme Court to recognize Cruzan's constitutional right to have life-prolonging medical treatment withdrawn. Orentlicher, writing under the auspices of the AMA's Office of the General Counsel, summarizes the AMA's brief and discusses the ethical and legal considerations in the Cruzan case. He differentiates among the vegetative state, coma, and brain death, and discusses the issues of the relevance of a patient's mental incompetence, surrogate decision making, protecting the disabled patient, and artificial feeding as medical treatment.     

The Perruche judgment and the "right not to be born"

The French government has given in to public pressure and overturned a controversial legal ruling which recognised the right of a disabled child to seek damages. Most notably, the ruling, widely described as establishing a child's right "not to be born", had provoked "outrage" amongst groups defending the rights of the disabled and led to a ban on prenatal scans by French gynaecologists. Once again, only parents will be able to seek damages but some people think the ruling has been misinterpreted.     

知情同意的作用和意义

着重讨论知情同意制度作用和意义,旨在为充分保证患者知情权和医务人员的合法权益,预防医疗纠纷,提高医疗服务水平提供一些参考。更希望能为推进医疗体制改革和完善医疗法规制度进行有益的探索。     

When consent is unbearable--a case report.

Informed consent has become one of the central problems in medical ehtics. At first sight, it would seem that no argument can be made against a person's right to be fully aware of the extent, course, and implications of his medical condition. It seems equally obvious that it is the patient's right to participate in, influence, or fully and solely assume the decisions of medical actions that should be undertaken or withheld with regard to his disease. Nevertheless, there are circumstances in which these commonly held assumptions about a patient's rights may not apply. It is the purpose of this report to describe a case where informed consent was deliverately not sought, and to discuss the ethical issues involved.     

The medical student and the suicidal patient.

Today''s medical students are being confronted with ethical situations of far greater complexity than were their predecessors and yet the medical education system does little to prepare students for the ethical dilemmas which they inevitably face when entering the hospital environment. The following article addresses the issues surrounding a case where a patient has told a student in confidence of his plans to commit suicide. What should the student do? The only way for the student to prevent death is by breaking confidentiality because the student has insufficient clinical experience to provide adequate guidance. However, this requires ignoring the patient''s right to autonomy, a right enshrined in both case law and medical ethics. Clearly the student''s ethical, moral and legal position must be carefully evaluated.     

住院肿瘤患者知情需求调查研究

目的:了解住院肿瘤患者对医疗护理信息的需求愿望高低(求知率)和探讨知情权内容的程度(知情率)及影响知情欲望的因素,以便更好地落实患者的知情同意权。方法:采用自制问卷调查法。结果:住院肿瘤患者对医疗护理信息的求知率为78.82%,对知情权内容范围的知情率为70.12%;患者的性别、年龄、职业和文化程度对知情需求没有显著影响。结论:20%的住院肿瘤患者缺乏知情的欲望;有知情欲望的患者对医疗护理信息的知情率也较低,对30%的内容不了解。应提高医患双方对知情权的认识和相互沟通。     

The right not to know: an autonomy based approach

The emerging international biomedical law tends to recognise the right not to know one's genetic status. However, the basis and conditions for the exercise of this right remain unclear in domestic laws. In addition to this, such a right has been criticised at the theoretical level as being in contradiction with patient's autonomy, with doctors' duty to inform patients, and with solidarity with family members. This happens especially when non-disclosure poses a risk of serious harm to the patient's relatives who, without that vital information, could be deprived of preventive or therapeutic measures. This paper argues, firstly, that individuals may have a legitimate interest in not knowing their genetic make up to avoid serious psychological consequences; secondly, that this interest, far from being contrary to autonomy, may constitute an enhancement of autonomy; thirdly, that the right not to know cannot be presumed, but must be "activated" by the individual's explicit choice, and fourthly, that this is not an absolute right, in the sense that it may be restricted when disclosure to the patient is necessary in order to avoid a risk of serious harm to third persons.