Informed Consent: Autonomy and Self-Ownership

abstract    Using the example of an unconsented mouth swab I criticise the view that an action of this kind taken in itself is wrongful in respect of its being a violation of autonomy. This is so much inasmuch as autonomy merits respect only with regard to 'critical life choices'. I consider the view that such an action is nevertheless harmful or risks serious harm. I also respond to two possible suggestions: that the action is of a kind that violates autonomy; and, that the class of such actions violates autonomy. I suggest that the action is wrongful in as much as it is a bodily trespass. I consider, and criticise, two ways of understanding how morally I stand to my own body: as owner and as sovereign. In respect of the latter I consider Arthur Ripstein's recent defence of a sovereignty principle. Finally I criticise an attempt by Joel Feinberg to explain bodily trespass in terms of personal autonomy.     

对知情同意书和知情同意过程的探讨

在<医疗事故处理条例>实施中,存在着一种现象:重视一张由患者签字的知情同意书,轻待知情同意过程.签字的知情同意书不等于知情同意,知情同意书不等于"生死契约".知情同意的本义:对患者权利、尊严、人格和自由的尊重,只有在知情同意过程中获得.因此知情同意过程应该重要于知情同意书.医生严格履行好法定的告知和说明义务,尊重患者的知情同意权,就是尊重法律,也是医生保护自己的最好方式.     

知情同意—患者的权利与困境

知情同意是目前被广为认可的一项病人权利。从历史渊源看,它可以分为出于医生权威的知情同意与出于尊重患者人格、尊严、个性化权利的知情同意。尽管东西方对权利主体的强调不一致,但都是出于医疗行善的目的。这并不一定能保证病人的真正利益。现实中,有必要对这一权利做一定的限制。     

Informed Consent

Summary

This article focuses on informed consent and the components to be reviewed with clients in the first session or as early as possible thereafter. Recent changes that give patients greater autonomy in the treatment process are also presented. The process of obtaining informed consent or informed refusal places a new responsibility on the practitioner. Informed consent as it pertains to clinical practice, supervision and training, and psychological research is also discussed.     

Steven Wear,Informed Consent: Patient Autonomy and Clinician Beneficence Within Health Care

Theoretical Medicine and Bioethics -     

正确理解知情同意

知情同意最初由美国于18世纪末19世纪初提出,随着社会不断进步,医学科学的不断发展,人们权力意识的不断增强,知情同意作为患者享有的一项权力,医务人员在医疗过程中应遵循的一条原则已日益到人们的关注。然而在现实的医疗实践中人们对这一的理解和认识还存在一定的偏差。正确理解,践行知情同意既是尊重患者的权利,贯彻“以病人为中心”的原则的保证,也能有效地保护医务人员的合法权益。     

Collective Informed Consent and Decision Power

It has been suggested that, in addition to individual level decision-making, informed consent procedures could be used in collective decision-making too. One of the main criticisms directed at this suggestion concerns decision-making power. It is maintained that consent is a veto power concept and that, as such, it is not appropriate for collective decision-making. This paper examines this objection to collective informed consent. It argues that veto power informed consent can have some uses in the collective level and that when it is not appropriate the decision power a concerned party ought to have in connection with an arrangement should be made relative to the interest she has at stake in it. It concludes that the objection examined does not undermine collective informed consent.

Precedent Autonomy and Subsequent Consent

Honoring a living will typically involves treating an incompetent patient in accord with preferences she once had, but whose objects she can no longer understand. How do we respect her “precedent autonomy” by giving her what she used to want? There is a similar problem with “subsequent consent”: How can we justify interfering with someone's autonomy on the grounds that she will later consent to the interference, if she refuses now? Both problems arise on the assumption that, to respect someone's autonomy, any preferences we respect must be among that person's current preferences. I argue that this is not always true. Just as we can celebrate an event long after it happens, so can we respect someone's wishes long before or after she has that wish. In the contexts of precedent autonomy and subsequent consent, the wishes are often preferences about which of two other, conflicting preferences to satisfy. When someone has two conflicting preferences, and a third preference on how to resolve that conflict, to respect his autonomy we must respect that third preference. People with declining competence may have a resolution preference earlier, favoring the earlier conflicting preference (precedent autonomy), whereas those with rising competence may have it later, favoring the later conflicting preference (subsequent consent). To respect autonomy in such cases we must respect not a current, but a former or later preference.     

急诊医疗中的知情同意问题

急诊医疗中的知情同意似乎与通常的临床情形不同,它不需要完全的知情同意,甚至可以被免除。这一特点可能给人以一种印象,即在急诊情况下对知情同意的考量,或可与其他情形有所不同。其实急诊情形下之所以出现知情同意的例外或免除,并非知情同意原则在急诊情况下不适用,或者是知情同意原则做出了让步。真正的原因是,知情同意在急诊治疗中往往以特殊或不同的形式表现出来。     

病人、医生与知情同意

医务人员应当视病人为治疗疾病过程中的参与者.知情同意的目的是,使病人充分理解他的困境后做出理性的决定.医生与病人分享信息、分担责任与做出决定,以保持良好的医患关系.     

论医师的告知说明义务

患者知情同意权的真正实现有赖于医师告知说明义务的履行,医师此义务要在诊疗中又因所处不同阶段在法律中有不同的性质。在具体治疗前为取得患者有效承诺的告知说明义务在医疗契约中为从给付义务,而实施完具体诊疗后,就有关康复、服药等注意事项所作的告知说明属于附随义务。实践中医师对此两阶段的义务都应当给与同样的重视,以利于维护患者的利益。     

签字与知情同意

从“丈夫不签字妻子难产死亡”案例入手,对我国临床医疗中普遍存在的签字等同于知情同意现象进行剖析,从知情同意的伦理视角对我国现行术前签字制度、代理行使签字权等现实问题进行思考。提出应正确理解知情同意,健全法律见证程序,完善医疗法规,大力开展医疗风险教育,营造医患诚信文化氛围。     

Nanotoxicology and Ethical Conditions for Informed Consent

While their strength, electrical, optical, or magnetic properties are expected to contribute a trillion dollars in global commerce before 2015, nanomaterials also appear to pose threats to human health and safety. Nanotoxicology is the study of these threats. Do nanomaterial benefits exceed their risks? Should all nanomaterials be regulated? Currently nanotoxicologists cannot help answer these questions because too little is known about nanomaterials, because their properties differ from those of bulk materials having the same chemical composition, and because they differ so widely in their applications. Instead, this paper answers a preliminary ethical question: What nanotech policies are likely to contribute to society’s ability to give or withhold free informed consent to the potential risks associated with production and use of nanomaterials? This paper argues that at least four current policies appear to jeopardize the risk-disclosure condition that is required for informed consent. These are the funding problem, the conflict-of-interest problem, the labeling problem, and the extrapolation problem. Apart from future decisions on how to ethically make, use, and regulate nanomaterials, this paper argues that, at a minimum, these four policies must be modified. Government must spend greater monies on nanotoxicology; ensure independent nanotoxicology research; label consumer products containing nanomaterials; and avoid assuming that nanotoxicological properties are based merely on mass and chemical composition. Otherwise free informed consent to these new technologies and materials may be jeopardized.     

知情同意的道德基础

知情同意的道德基础可以从义务论和目的论两个方面得到辩护.从义务论上看,对病人或受试者实施知情同意是尊重其自主性、尊重人的表现,是医生或生物医学研究者应该履行的道德义务;从目的论上看,实施知情同意的目的是保护和促进病人或受试者的健康,健康作为善是他们的幸福所在.