家属代理同意与病人自主权

家属代理同意与病人自主权浙江医科大学（杭州３１０００６）施卫星一家属代理同意是指当病人由于缺乏作医疗决定的自主能力而又涉及病人医疗判断、医疗方案的选择或决定时,在医生向病人和病人家属说明有关医疗的好处、危险性和可能发生的其他情况等信息之后由病人家属为...     

患者的自主权及困境

在生命伦理学中,尊重自主性原则是指尊重病人或受试者的自主性,可理解为病人自主原则。自主性的实现涉及到自主性的人与自主性的选择,面对复杂的医疗情境,患者自主权的实施面临着重重困境。从自主、病人自主原则、病人自主的实践三个层面讨论了该原则,并尝试用境遇伦理学原理来解决病人自主原则的实践困境。     

病人自主权及其保障条件

病人自主权是病人的基本人权之一,是保障其生存权与健康权的基本条件,也是医学人道主义的重要内容。同时,在医疗活动的权力制衡中,代表病人权利的权力是必不可少的要素之一。因此,病人自主权必须受到充分的尊重。病人自主权要想得到充分的保障,必须以全民的权利意识觉醒为条件,以完善的法制与法治为保障,并要符合健康目的,遵从科学规律。     

对台湾地区“病人自主权利法”的评述及启示

台湾地区"病人自主权利法"不仅保障临终病人的善终权,同时也对病人的其他权利进行完整规制,以确保病人在诊疗过程中的尊严与地位。以其立法背景为切入点,从规制病人权利、完善权利保障措施、节约医疗资源三个角度揭示其立法必要性,探讨病人自主权与医生决定权的共融、自主善终与安乐死的差异等相关问题。提出大陆地区应在法律引导下明确病人权益,多部门协作推动建立生前预嘱制度与临终关怀体系,以达到缓解医患矛盾与保障病人权利的目的。     

论生命伦理学的自主性原则

自主性原则是生命伦理学的首要原则,其本质在于个人自主地选择自己的思想和行为.自主分为思想自主、意愿自主和行动自主.自主性原则的思想前提是道义论与后果论.在生命伦理学中,尊重、知情同意、保密和隐私权是自主性原则的具体表现形式.在医疗实践中,自主权的行使必须与具体的情境相结合,其价值才能充分实现.     

西方国家病人自主权概况及浅析

以美国、英国、荷兰、芬兰等西方国家有关病人自主权的法律法规为基础,综述当前西方国家针对病人知情同意权、知情拒绝权、未成年人医疗决定权利的实施现状及人们对病人自主权的认识现状,并从西方的传统文化、宗教、经济及政治制度四个方面对导致该现状的原因进行简要分析.     

面对临床无效治疗:思考与抉择

对于没有临床救治意义的病人 ,要不要继续治疗 ?这既是临床医疗问题 ,又是一个涉及社会、伦理、法规的问题。在社会多元化发展的今天 ,对于临床无效治疗无论放弃与否 ,都应当把维护病人的利益作为医疗活动的出发点。在此基础上 ,知情同意和尊重病人自主权是医务人员必须遵循的基本道德原则 ,同时也应当考虑卫生资源的有效分配和社会公众的健康利益     

论病人的医疗保障权

在关于病人权利的研究与讨论中,人们一直比较关心病人的自主权、保密权等。当然这样的讨论是必要的。然而还有一个很重要的问题也应当给予重视,即病人的医疗保障权及实现和维护这一权利的现实基础。笔者认为,享有卫生保健服务和医疗照顾是最基本的病人权利,没有这一条,就?..     

医生是否应该让患者参与医疗决策

美国法院要求医生在确定治疗方案时必须得到患者的知情同意。而近来伦理学家提出,尊重患者的自主权不仅要使其知情,还应让病人在医疗决策中发挥作用。然而有调查结果显示,事实上病人在参与医疗决策时起到的作用微乎其微。尽管医生也在为患者罗列出各种医疗方案,但多数医生并不希望由病人参与决策。而这些调查对为什么有时候病人不能充分参与医疗决策并未作出深入探讨,并忽视了对医生就病人参与医疗决策的认知分析。因此,笔者希望通过本次调查,在医生对患者参与医疗决策的态度、医生的态度如何影响病人以及临床医疗决策的构建等方面,做一次试…     

医生是否应该让患者参与医疗决策

美国法院要求医生在确定治疗方案时必须得到患者的知情同意.而近来伦理学家提出,尊重患者的自主权不仅要使其知情,还应让病人在医疗决策中发挥作用.然而有调查结果显示,事实上病人在参与医疗决策时起到的作用微乎其微.尽管医生也在为患者罗列出各种医疗方案,但多数医生并不希望由病人参与决策.而这些调查对为什么有时候病人不能充分参与医疗决策并未作出深入探讨,并忽视了对医生就病人参与医疗决策的认知分析.因此,笔者希望通过本次调查,在医生对患者参与医疗决策的态度、医生的态度如何影响病人以及临床医疗决策的构建等方面,做一次试探性、描述性的研究.     

临床麻醉中知情同意的思考

临床麻醉工作中,尊重患者自主权是知情同意的基础,知情同意反映了患者自主权与医学干涉主义之间的相互妥协。在信任基础上的知情同意,是患者自主权的最佳体现,也是对医学干涉主义的尊重,从而为患者的利益提供服务。     

Autonomy,constraining options,and organ sales

Although there continues to be a chronic shortage of transplant organs the suggestion that we should try to alleviate it through allowing a current market in them continues to be morally condemned, usually on the grounds that such a market would undermine the autonomy of those who would participate in it as vendors. Against this objection Gerald Dworkin has argued that such markets would enhance the autonomy of the vendors through providing them with more options, thus enabling them to exercise a greater degree of control over their bodies. Paul Hughes and T. L. Zutlevics have recently criticized Dworkin's argument, arguing that the option to sell an organ is unusual in that it is an autonomy–undermining "constraining option" whose presence in a person's choice set is likely to undermine her autonomy rather than enhance it. I argue that although Hughes' and Zutlevics' arguments are both innovative and persuasive they are seriously flawed — and that allowing a market in human organs is more likely to enhance vendor autonomy than diminish it. Thus, given that autonomy is the preeminent value in contemporary medical ethics this provides a strong prima facie case for recognizing the moral legitimacy of such markets.     

卫生保健政策与医学伦理学

卫生保健政策是卫生资源、价值目标和伦理原则三者的结合。医学伦理学是卫生政策的重要基础。当代卫生事业的特点,卫生保健服务面临的挑战以及医学伦理主体与客体的变化,决定了医学伦理学在当代卫生保健政策中的特殊意义。在医学面临全民保健的阶段,一个科学的符合人民健康利益的卫生保健政策是不言而喻的。摆脱当前卫生政策面临的困难,要求必须在医学伦理学方面作出正确的选择。     

试论病人的自主性与医主之间的关系

病人具有自主性,应该受到医生的尊重。由于病人的自主性受到一些条件的限制,因而医主仍具有继续存在的价值。但是,除在一些特定情况下外,病人的自主性应优先于医主,然而医生又不能放弃自己的责任。     

Including a Spiritual Dimension in Family Therapy: Ethical Considerations

The inclusion of a spiritual dimension in family therapy theory and clinical practice may well be viewed as an important professional challenge of the nineties. Following a working definition of terms, this paper explores the ethical complexities inherent in operationalizing a spiritual orientation in therapy in light of the following principles adopted from medical ethics: Respect for clients' autonomy, safeguarding clients' welfare, protecting them from harm, and treating them justly and honestly.     

风死不救与医疗欠费——临床医德悖论及其化解

本文分析了一民工重伤求治,被六家医院拒收的事件,指出在实行临床医德准则过程中存在着悖论现象,并阐述临床医德悖论产生的原因,提出化解临床医德悖论具体的途径。     

医疗事故处理法律亟待统一规范

目前在我国医疗工作的实践中,医疗纠纷呈上升趋势。然而,解决和处理医疗纠纷与医疗事故的法律、法规尚不移规范统一。随着我国法制的逐步健全,法律,法规的不断完善,医疗事故处理的法律亟待统一规范,以利于全社会遵法,守法,执法的实现。     

新型农村合作医疗的受益公平性研究

2003年,我国开展了新型农村合作医疗制度(以下简称“新农合”)试点工作。利用新农合试点县卫生服务调查资料,从卫生服务需要量、利用率、医疗费用以及从新农合得到的费用补偿等方面分析不同收入水平的参合农民的受益情况。结果显示,贫困农民卫生服务需要量大,卫生服务需求的未满足程度较高,从合作医疗中受益相对较少。认为不同经济状况的参合农民在卫生服务利用中存在不公平现象。     

Professional Autonomy and the Normative Structure of Medical Practice

Professional autonomy is often described as a claim of professionalsthat has to serve primarily their own interests. However, it can also beseen as an element of a professional ideal that can function as astandard for professional, i.e. medical practice. This normativeunderstanding of the medical profession and professional autonomy facesthree threats today. 1) Internal erosion of professional autonomy due toa lack of internal quality control by the medical profession; 2)the increasing upward pressure on health care expenses that calls for ahealth care policy that could imply limitations for the professionalautonomy of physicians; 3) a distorted understanding of theprofession as being based on a formal type of knowledge and relatedtechnology, in which other normative dimensions of medical practice areneglected and which frustrates meaningful communication betweenphysicians and patients. To answer these threats a normative structureanalysis of medical practice is presented, that indicates whichprinciples and norms are constitutive for medical practice. It isconcluded that professional autonomy, normatively understood, should bemaintained to avoid the lure of the technological imperative and toprotect patients against third parties' pressure to undertreatment.However, this professional autonomy can only be maintained if members ofthe profession subject their activities and decisions to a criticalevaluation by other members of the profession and by patients and ifthey continue to critically reflect on the values that regulate today'smedicine.     

Autonomy and coercion in disease prevention and health promotion

Most of the attention regarding the balance between autonomy and paternalism has been focused on the therapeutic relation. Much less attention has been devoted to the problem of autonomy in the application of medical knowledge for preventive purposes. Here, because the good to be achieved is social as well as individual, an unavoidable dilemma ensues. Effective preventive measures of benefit to all must necessarily limit autonomy and involve some coercion. I argue that there are principles which can be established to guide society in a moral use of coercion. The question of employing medical knowledge is not, as it is in therapeutic medicine, to preserve or enhance autonomy. Rather its aim is to enhance voluntary co-operation. Principles for moral use of coercion must thereby be derived from health as a moral value.