Obstetric Autonomy and Informed Consent

I argue that public officials and health workers ought to respect and protect women’s rights to make risky choices during childbirth. Women’s rights to make treatment decisions ought to be respected even if their decisions expose their unborn children to unnecessary risks, and even if it is wrong to put unborn children at risk. I first defend a presumption of medical autonomy in the context of childbirth. I then draw on women’s birth stories to show that women’s medical autonomy is often ignored during labor. Medical interventions are performed during childbirth without women’s consent. Childbirth is risky and some coercive medical interventions may be understood as attempts to protect children and to prevent mothers from acting impermissibly. However, even if it is wrong to make risky choices during childbirth, women have rights to do wrong in these cases. Therefore, coercive medical interventions are impermissible during childbirth and institutions should adopt specific protections for obstetric autonomy.     

Self-Ownership, Freedom, and Autonomy

The libertarian view of freedom has attracted considerable attention in the past three decades. It has also been subjected to numerous criticisms regarding its nature and effects on society. G. A. Cohen's recent book, Self-Ownership, Freedom and Equality, continues this attack by linking libertarian views on freedom to their view of self-ownership. This paper formulates and evaluates Cohen's major arguments against libertarian freedom and self-ownership. It contends that his arguments against the libertarian rights definition of freedom are inadequate and need modification. Similarly, Cohen's defense of restrictions on self-ownership on behalf of autonomy are also found wanting. Finally, I argue that the thesis of self-ownership (whether in its full or partial version) ought to be rejected.     

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.     

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.     

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。     

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。     

知情同意:从纽伦堡到赫尔辛基

知情同意被视为临床伦理学与研究伦理学的基本原则.大量的文献倡导提高同意的必要条件.据说,同意应当更加明确、具体.经验主义的证据显示,满足任何一方标准是极其困难的,有时是不可能的,因此,这些目标很难行得通.倡导知情同意不实际与不可能的要求,有极小的价值.讨论告知不能作为临床伦理学与研究伦理学的基本标准,知情同意可以最好视为病人与受试者以及其他人所能选择性放弃其他的义务,而不采取侵害性行为的一种方法.它提供了一种调节根本的义务的重要方式,这一义务是由尊重真正执行同意所需要的伦理标准与认识力的双方提供.     

知情同意：从纽伦堡到赫尔辛基

知情同意被视为临床伦理学与研究伦理学的基本原则。大量的文献倡导提高同意的必要条件。据说,同意应当更加明确、具体。经验主义的证据显示,满足任何一方标准是极其困难的,有时是不可能的,因此,这些目标很难行得通。倡导知情同意不实际与不可能的要求,有极小的价值。讨论告知不能作为临床伦理学与研究伦理学的基本标准,知情同意可以最好视为病人与受试者以及其他人所能选择性放弃其他的义务,而不采取侵害性行为的一种方法。它提供了一种调节根本的义务的重要方式,这一义务是由尊重真正执行同意所需要的伦理标准与认识力的双方提供。     

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.     

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.

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.     

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。     

Research without Consent: Exception from and Waiver of Informed Consent in Resuscitation Research

The ethical concept of Informed Consent provides individuals with the right and the opportunity to approve of events that will occur regarding his or her own person. In medicine, informed consent is obtained for treatment and for research participation. However, under some circumstances, prospective informed consent cannot be obtained because of the devastating clinical condition of the patient. In emergency circumstances, treatment is never withheld if obtaining informed consent from a critically ill person is not possible or if a delay while seeking surrogates would further endanger life. In emergency research circumstances, waiving informed consent for study participation is fraught with additional ethical considerations. This article will review a presentation given at the June 2, 2006 conference entitled “The Ethics of Research in Emergency Medicine”. An earlier version of this paper was presented at: The 7th International Conference on Bioethics on “The Ethics of Research in Emergency Medicine”, held on June 2, 2006, Warsaw, Poland.