知情同意权在手术同意书中的法律探讨——李丽云死亡案引发的思考

李丽云因为丈夫拒签手术同意书而造成“一尸两命”的事件,“拒签”事件击中了医疗法规知情同意权在医疗实施过程中的软肋。如何保护病人的生命权、被救助权和手术权,如何让医院救死扶伤而没有后顾之忧,建议政府部门应该建立相应的“国家担保”制度,使病人得到最为及时有效的抢救和治疗。以免类似的悲剧再次发生。     

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。     

知情同意权中的哥德巴赫猜想--知情权与患者认知能力之间的冲突

知情同意权作为医患关系中患者一方最基本的权利正受到患者认知能力的严重影响。这一方面是原本专业化医学正在逐步走向专门化原因造成的,但与医患关系,文化传统,知识水平等因素也有千丝万缕的联系,正确处理知情权与患者认知能力之间的关系对于衡平医患关系,维护医患双方权益有着重大的现实意义。问题既有赖于医患双方的协力;更要依靠社会各方面合作,形成合力加以解决。     

知情同意的临床实践存在的问题及对策

临床医疗实践中贯彻实施知情同意原则旨在保护病人的权益不受侵犯,然而知情同意原则实施起来并不简单,它常常会受到主客体两方面种种因素的制约,陷入意想不到的困境。分析了知情同意原则在实施过程中可能出现的一些难以回避的问题,并针对这些问题探讨了若干对策。     

Informed Consent Revisited: Japan and the U.S.

Informed consent, decision-making styles and the role of patient–physician relationships are imperative aspects of clinical medicine worldwide. We present the case of a 74-year-old woman afflicted with advanced liver cancer whose attending physician, per request of the family, did not inform her of her true diagnosis. In our analysis, we explore the differences in informed-consent styles between patients who hold an “independent” and “interdependent” construal of the self and then highlight the possible implications maintained by this position in the context of international clinical ethics. Finally, we discuss the need to reassess informed-consent styles suitable to the needs of each patient regardless of whether he or she resides in the United States or in Japan.     

浅论医患关系中的权利冲突——以医师的诊疗权与患者的知情同意权为例

现实中医患关系呈现给人们的似乎是永远纠缠不清的利益,掩盖了医惠之间模糊的、缺失的权利。实质上引发医患矛盾的主要原因不是利益而是权利的冲突,从医师的诊疗权与患者的知情同意权的角度出发,分析了医患关系中权利冲突的成因及其表现,提出了相关解决的方法。     

Psychophysiologic correlates of Type A behavior: Comments on Houston (1983) and Holmes (1983)

On the basis of a literature review, B. K. Houston (1983, Journal of Research in Personality, 17, 22–39) concluded that there is a reliable but relatively weak association between Type A (coronary-prone) behavior and heightened physiologic reactivity. D. S. Holmes (1983, Journal of Research in Personality, 17, 40–47) contends that by failing to take into account dependent measures yielding null results, Houston overestimated the consistency with which A/B differences have been obtained. In the present article, we show that it is critical to take into account the method used to assess Type A behavior. Structured Interview assessments show a more consistent association with reactivity than those based on the Jenkins Activity Survey. We then point out that, for certain physiologic measures, null effects do not necessarily reflect an absence of A/B differences in sympathetic-adrenomedullary activity. Other issues that are discussed include the role of situational parameters in eliciting hyperresponsiveness in Type A's, the problem of evaluating the magnitude and importance of A/B effects, and the need for a more theoretical approach to the study of Type A behavior.     

The study of religion(s) in Western Europe III: Further developments after World War II

This essay discusses main features and developments of the study of religion(s) in Western Europe. It attempts a historical, geographical, and thematic synthesis. Part III outlines post-World War II developments with regard to journals, textbooks, and survey works. It looks at national figureheads, disciplinary boundaries and the changing fortunes of the phenomenology of religion. The series concludes by addressing selected key areas of scholarly work and current issues and concerns.     

Protecting God from Science and Technology: How Religious Criticisms of Biotechnologies Backfire

Many religious critics argue that biotechnology (such as cloning and genetic engineering) intrudes on God's domain, or plays God, or revolts against God. While some of these criticisms are standard complaints about human hubris, I argue that some of the recent criticism represents a "Promethean" concern, in which believers unreflectively seem to fear that science and technology are actually replicating or stealing God's special deity–defining powers. These criticisms backfire theologically, because they diminish God, portraying God as an anthropomorphic superbeing whose relevance and special nature are increasingly rivaled by human power.     

Choice Blindness and Preference Change: You Will Like This Paper Better If You (Believe You) Chose to Read It!

Choice blindness is the finding that participants both often fail to notice mismatches between their decisions and the outcome of their choice and, in addition, endorse the opposite of their chosen alternative. But do these preference reversals also carry over to future choices and ratings? To investigate this question, we gave participants the task of choosing which of a pair of faces they found most attractive. Unknown to them, we sometimes used a card trick to exchange one face for the other. Both decision theory and common sense strongly suggest that most people would easily notice such a radical change in the outcome of a choice. But that was not the case: no more than a third of the exchanges were detected by the participants. We also included a second round of choices using the same face pairs, and two stages of post‐choice attractiveness ratings of the faces. This way we were able to measure preference strength both as choice consistency and by looking at measures of rating differences between chosen and rejected options. We found that the initially rejected faces were chosen more frequently in the second choice, and the perceived attractiveness of these faces was increased even in uncoupled individual ratings at the end of the experiment. This result is discussed in relation to Chen and Risen's recent criticism of the Free Choice Paradigm, as it shows that choices can affect future preferences. Copyright © 2013 John Wiley & Sons, Ltd.     

IMPLICATIONS OF BEHAVIORAL PHARMACOLOGY RESEARCH FOR APPLIED BEHAVIOR ANALYSES: JEAB'S SPECIAL ISSUE CELEBRATING THE CONTRIBUTIONS OF JOSEPH V. BRADY (MARCH 1994)

We review four articles from JEAB's March 1994 issue celebrating the contributions of Joseph V. Brady. These articles have implications for studying private events and for studying multiple operants. We suggest that regularly including self-reports about private events in behavioral pharmacological research has resulted in an accumulated knowledge that has facilitated examination of interesting relations among self-reports, environmental factors, and other observable behaviors. Methodological lessons that behavioral pharmacologists have learned regarding the study of multiple operants are also relayed. We provide examples of how these lessons could be useful to applied behavior analysts studying nonpharmacological issues.     

On this,that, and the other: Nonegocentrism in very young children

The development of comprehension and production of spatial deictic terms “this/that”, “here/there”, “my/your”, and “in front of/behind” was investigated in the context of a hide-and-seek game. The first three contrasts are produced according to the speaker's perspective, so comprehension requires a nonegocentric viewpoint. The contrast “in front of/behind” is produced relative to the hearer, i.e., production is nonegocentric. The subjects were 39 children, rangin in age from 2.5–4.5 years, and 18 college undergraduates. The 2.5-year-old children were best at those contrasts which do not require a shift in perspective. The 3- and 4-year-old children were adept at switching to the speaker's perspective for comprehension of the terms requiring this shift, i.e., were nonegocentric. Four-year-olds were also capable of nonegocentric production of “in front of/behind”.     

The Chronotype-Academic Performance Model (CAM): Daytime sleepiness and learning motivation link chronotype and school performance in adolescents

Many adolescents experience a discrepancy between their biological time, which is shifted toward eveningness, and early school starting times. Due to this social jetlag, eveningness is negatively correlated with school performance. On the basis of the here presented data, we derived a model for the association of chronotype and school performance, the Chronotype-Academic Performance Model (CAM), including daytime sleepiness and achievement motivation as mediating factors. The sample comprised N = 273 adolescents aged 14–16 years. Circadian preference, daytime sleepiness, learning and achievement motivation, and information about participants’ last school certificate were assessed online. Chronotype was not directly related to academic performance, but was mediated by daytime sleepiness and learning motivation. Morning-orientation was negatively associated with daytime sleepiness and positively with learning motivation, which, in turn, affected performance. In evening-types, we found the strongest association between sleepiness and refusal to work. The CAM suggests that chronotype may not directly influence academic performance, but be mediated by daytime sleepiness and learning motivation. Evening types seem to be at high risk to suffer from daytime sleepiness and to display dysfunctional attitudes toward work. Measures of reducing sleepiness and modifying attitudes toward academic achievement might attenuate the disadvantages of evening-types due to social jetlag.