规范医疗知情同意书的探讨

《侵权责任法》为医疗机构实施医疗知情同意提供了法律依据,但缺少如何落实知情同意的具体操作方法和要求。文章分析了在知情同意管理中的问题,如特殊情况下医疗知情同意主体不明确、个别医务人员向患者或家属交待病情不仔细,只是完成将知情同意书交给患者签字的手续,没有认真履行知情告知义务以及知情同意书的内容及项目有遗漏等问题。探讨规范医疗知情同意书和知情同意管理的具体做法,如制定《医疗知情同意管理办法》,制作统一的医疗知情同意书项目和模板,规范医疗知情同意的履行手续,明确特殊情况下医疗知情同意的主体,划分医疗知情同意的形式,开展培训与考核,确保医疗知情同意落实到实处。     

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。     

《民法典》背景下我国医疗知情同意履行方式探究

知情同意贯穿于整个医疗行为过程中，是医疗行为合法性的基础。现阶段医方在医疗活动中告知义务履行不充分是医疗纠纷发生的主要原因。《民法典》的颁布和实施对医疗知情同意的履行提出了更高的要求。现阶段《民法典》背景下，作者对医疗知情同意履行方式进行了分析探究，对于缓解医患矛盾、重建医患信任和解决医疗纠纷等具有重要的意义。     

落实知情同意权的法律思考

作者分析患者知情同意的法律基础及其法律责任,认为知情同意达到违法阻却必须满足以医疗为目的、充分履行告知义务和被告知者须有知情同意的能力等为条件。并就知情同意书免责条款的法律效力、医疗活动中的强制行为进行法律解析,认为提高医疗主体履行法定责任的自觉性才能自觉地实践告知义务,达到医院患者和谐。     

医疗知情同意的历史和现状

对国内外知情同意书渊源、立法与现状进行综述,对我国医疗知情同意文书的制定和履行现状作深入的追踪和分析,进而总结我国现阶段医疗知情同意文书的不足之处,并对签署知情同意文书的必要性进行探讨,为进一步完善和规范我国医疗知情同意文书提供依据.     

患者获得有效知情同意探讨

知情同意是指医生在诊断和治疗疾病的过程中,应该将患者的病情、医学诊断、医疗措施、医疗风险、备用治疗措施及预后等情况如实地告知患者,以使患者及家属对医生提出的诊疗方案作出理性的、自愿的选择[1]。这是患者在疾病诊疗过程中的一项基本权利,也是中华人民共和国《执业医师法》赋予每个执业医师的义务。在知情同意中,同意是建立在知情的基础之上的。由于医学是一个专业性很强的学科,面对缺乏医学知识的患者,千方百计地让患者获得真正有效的知情同意是医生履行知情同意过程中义不容辞的责任。何谓有效知情同意呢?即是指:①病人能获得有…     

医学科学数据共享与使用的伦理要求和管理规范（三）

医学科学数据共享应该履行知情同意手续。数据共享和再利用中因数据储存、传送过程引起新的风险。数据共享中隐私保护与知情同意既相互影响又相互矛盾。去隐私化的共享数据再利用的知情同意履行困难或无法履行，且个体参与者随时退出将无法实现。无论内容还是程序，传统的知情同意都无法完全适用于数据共享。泛知情同意作为一种新的机制，为参与者签署个体数据共享和未来再利用的同意提供了一种潜在方案，但是也引起相应的伦理问题。数据共享中知情同意的应对策略实质是如何兼顾和平衡个体参与者的权益和促进数据共享，个体权益保障仍是首要原则。     

忽视手术告知的案例分析

患者知情同意权利越来越受到社会各界的重视,这其实也是对医生说明告知义务的履行提出了更高的要求.合格、有效的履行说明告知义务应是一个动态延续的过程,贯穿于医疗行为始终,特别是术中发生意外需要另行告知患者或患者家属的情况,容易被忽视、遗忘.本文通过分析一则与此方面有关的典型医疗纠纷案例,探讨医生术中说明告知义务履行的相关问题并对侵犯患者知情同意权的医疗侵权类型进行反思.     

知情同意权引发医患纠纷的成因与对策

目的实施知情同意能够有效地保护患者的合法权利,同时也是调节医患关系、减少医患纠纷的重要措施。方法总结医疗实践中由于医务人员对知情同意告知程序履行不完善或医患之间沟通理解存在的问题。结果知情同意权履行不力易导致医患纠纷使医患关系陷入困境而达不到预期效果。结论医务人员转变观念,正确认识知情同意权的涵义,加强医患沟通和进行舆论的正确引导,从根本上增进信任和理解,有效减少医患纠纷。     

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。     

谈患者的知情同意权

患者的知情同意权是医患沟通的重要组成部分,是人权在医疗系统的重要体现。本文概括了知情同意权的由来,从权利、义务的主体及内容明确了知情同意权的法律概念,探讨了知情同意权在医学实践中的表现形式和实现程序,提出了医务人员的告知是基础、患方知情是核心、患者签字是最终体现的理念,为医务人员准确理解并落实患者知情同意权提供了新思路。     

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。     

知情同意书质量分析与改进对策

目的 检查了解手术与有创操作知情同意书签署缺陷,分析原因,寻找对策.方法 随机抽取某院2013年1月-2014年3月手术及有创检查6369份归档病案,根据卫生部颁布的《病历书写基本规范》与总部病案检查评分标准,就知情同意书填写格式、项目、内容签署缺陷进行质控检查并做统计.结果 在手术与有创检查的6369份病案中检出各类知情同意书缺陷病案631份（达9.91％）.631份病案中各类知情同意书均有一项至多项缺陷,其中手术知情同意书缺陷580频次;麻醉知情同意书缺陷236频次;输血知情同意书缺陷173频次;有创治疗检查操作同意书缺陷213频次;其它缺陷167频次.结论 病案中知情同意书规范性、完整性尚存在不足,须采取有效措施加以提高.保障知情同意书作为法律依据的完整性、有效性,是有效规避医疗纠纷的有力措施.     

手术科室知情同意书规范化的探索

知情同意书作为体现患者知情同意权的有效途径,亟需进行规范化、统一化,而手术科室风险更大,知情同意书的书写应做到告知内容的规范化、告知程序的规范化,并加强相应监管。这对提高医务人员认识、树立患者至上的观念,充分履行告知义务,保障患者知情同意权,探索知情告知途径,提升诊疗质量有积极意义。     

Enforcing patient preferences. Linking payment for medical care to informed consent

The legal and ethical doctrine of informed consent is well accepted in modern medicine. Nonetheless, medical interventions sometimes take place in the absence of informed consent, particularly in the case of life-sustaining medical procedures. These procedures ordinarily are reimbursed by third-party payers. This article proposes as a strategy to ensure greater attention to patient preferences in medical decision making that financial reimbursement for each medical service be linked to a requirement of valid patient (or surrogate) consent to the service involved. Utilization review bodies could monitor informed consent in the same way that other aspects of necessity, appropriateness, and quality are now monitored.     

To see for myself: informed consent and the culture of openness

Informed consent needs to be practised within a culture of openness if it is to enhance public trust in medical procedures around death. Openness should entail patients not just receiving information from doctors, but also having the right to see certain medical procedures. This article proposes in particular that it would be desirable for the public to be allowed to attend an autopsy of a person they do not know. Evidence from the UK, where members of the public may go backstage to witness the process of cremation, the other technical process in which dead bodies are violently but legitimately assaulted, suggests benefits from a policy of openness. When a family consents to cremation in Britain, their consent is only minimally informed, but the system has nothing to hide, and trust is high. This suggests that the opportunity for lay people also to witness certain medical procedures might do more to restore public trust in medical procedures around death than a narrow interpretation of informed consent in which information is controlled by the profession.     

Should informed consent be based on rational beliefs?

Our aim is to expand the regulative ideal governing consent. We argue that consent should not only be informed but also based on rational beliefs. We argue that holding true beliefs promotes autonomy. Information is important insofar as it helps a person to hold the relevant true beliefs. But in order to hold the relevant true beliefs, competent people must also think rationally. Insofar as information is important, rational deliberation is important. Just as physicians should aim to provide relevant information regarding the medical procedures prior to patients consenting to have those procedures, they should also assist patients to think more rationally. We distinguish between rational choice/action and rational belief. While autonomous choice need not necessarily be rational, it should be based on rational belief. The implication for the doctrine of informed consent and the practice of medicine is that, if physicians are to respect patient autonomy and help patients to choose and act more rationally, not only must they provide information, but they should care more about the theoretical rationality of their patients. They should not abandon their patients to irrationality. They should help their patients to deliberate more effectively and to care more about thinking rationally. We illustrate these arguments in the context of Jehovah's Witnesses refusing life-saving blood transfusions. Insofar as Jehovah's Witnesses should be informed of the consequences of their actions, they should also deliberate rationally about these consequences.     

充分履行知情同意权是构建和谐医患关系的基础

医患关系是医疗服务中最重要,最复杂的人际关系,建立良好的医患关系是保证医疗工作顺利进行的必备条件.病人的满意度在很大程度上取决于自己的权利被尊重的程度,在病人诊程过程所拥有诸多权利中,知情同意权是基础,也是关键.知情同意权得到应有的重视和落实,对进一步改善医患关系,提高医疗服务质量与水平,建立良好的医疗秩序,推动医疗卫生事业良性发展具有重要的意义.     

Is respect for autonomy defensible?

Three main claims are made in this paper. First, it is argued that Onora O'Neill has uncovered a serious problem in the way medical ethicists have thought about both respect for autonomy and informed consent. Medical ethicists have tended to think that autonomous choices are intrinsically worthy of respect, and that informed consent procedures are the best way to respect the autonomous choices of individuals. However, O'Neill convincingly argues that we should abandon both these thoughts. Second, it is argued that O'Neill's proposed solution to this problem is inadequate. O'Neill's approach requires that a more modest view of the purpose of informed consent procedures be adopted. In her view, the purpose of informed consent procedures is simply to avoid deception and coercion, and the ethical justification for informed consent derives from a different ethical principle, which she calls principled autonomy. It is argued that contrary to what O'Neill claims, the wrongness of coercion cannot be derived from principled autonomy, and so its credentials as a justification for informed consent procedures is weak. Third, it is argued that we do better to rethink autonomy and informed consent in terms of respecting persons as ends in themselves, and a characteristically liberal commitment to allowing individuals to make certain categories of decisions for themselves.     

知情同意的伦理思考

尊重患者的意愿是医学人道主义的体现,履行知情同意有助于制约医务人员权利的过度运用,有利于在意外情况发生时患者采取较为客观的态度,避免医患矛盾,但应防止医务人员将知情同意作为自我保护的手段。