从权利意识的视角看实践患者知情同意的文化障碍

实现知情同意权是对患者自主权利的尊重,但患者知情同意权的实现遇到诸多的文化障碍,从权利意识的视角看,主要来自于中国的一元社会结构、儒家文化和法律文化传统对个人权利诉求的影响,只有培养和提高患者权利意识,增强主体性和自主性,消除文化障碍,才能真正落实知情同意权。     

Some ethical and legal issues in Germany involving informed consent and patenting

This paper elaborates on discussions in Germany regarding some of the ethical and legal issues in the area of the use and patenting of inventions involving human tissue. The issues discussed pertain to the benefits and problems regarding informed consent and the issue of property rights as they relate to the donation of cells and tissue. An earlier version of this paper was presented at an international conference, “The Ethics of Intellectual Property Rights and Patents,” held in Warsaw, Poland on 23–24 April, 2004.     

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。     

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。     

Authorization and The Morality of War

Why does it matter that those who fight wars be authorized by the communities on whose behalf they claim to fight? I argue that lacking authorization generates a moral cost, which counts against a war's proportionality, and that having authorization allows the transfer of reasons from the members of the community to those who fight, which makes the war more likely to be proportionate. If democratic states are better able than non-democratic states and sub-state groups to gain their community's authorization, this means that some wars will be proportionate if fought by democracies, disproportionate if not.     

贯彻落实患者知情同意权刻不容缓

近年来,有关知情同意权方面的医疗纠纷在全部医疗纠纷事件中所占比重的逐年上升,贯彻落实知情同意权越发显得刻不容缓。本文着重从医疗管理角度出发,探讨如何做好相关宣传学习及完善相关制度。     

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。     

浅析脑胶质瘤临床试验中知情同意的问题

通过对医院目前开展的脑胶质瘤临床试验知情同意过程中的观察,综合科室脑胶质瘤临床试验的开展情况,针对不同类型脑胶质瘤病人尤其是功能区受损以及伴有认知功能受限的病人,分析签署知情同意过程中存在的问题,经探讨并提出整改及解决办法。通过规范的签署知情同意,针对病情不同的脑胶质瘤受试者采取个体化签署知情同意,充分尊重受试者意愿,保证临床试验顺利进行,使受试者权益得到充分保障,促进临床试验规范、安全、有序的开展。

     

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。     

纸质与视频补充材料对手术知情同意体验的影响：以腹腔镜胆囊切除手术为例

知情同意书在医患沟通中起着间接传递信息的重要作用。以159名大学生为被试,通过操纵不同的知情同意方式,考察了纸质或视频补充信息对患者知情同意满意度、理解程度以及患者信息需求的满足程度影响。结果发现,接受纸质补充知情同意或视频补充知情同意的被试对知情同意过程的满意度、对手术信息的理解程度与知情同意信息需求的满足程度显著高于接受普通知情同意的被试。同时,纸质补充知情同意使得“治疗信息需求的满足程度”最高。这表明,纸质补充知情同意更能满足患者对治疗信息的需求。     

美国的患儿同意及借鉴意义

准确地评定患儿的同意能力,保障患儿的同意权得以有效行使,有利于尊重患儿的人格尊严,促进患儿身心健康。从患儿同意能力和同意权的角度出发,简要回顾了美国患儿同意产生的背景,介绍了美国患儿同意的现状,并对其进行了一定的分析和评价,希望对促进我国患儿同意的发展起到一定的借鉴作用。     

Male/Male Sex in Hong Kong: Privacy,Please?

In August 2005, the age of consent for male/male sexual activity in Hong Kong was held to be arbitrarily and discriminatorily targeting gay men and thus in violation of an individual’s right to privacy and his right of equality on the basis of sexual orientation. While the decision has since been affirmed on appeal, it has been argued that judicial recourse to equality rights where privacy rights would have sufficed for the provisions to be struck down was a misguided, if not mistaken, effort that merely reinforced the stereotype that gay men are “hypersexualized” and was a setback for the gay rights movement in Hong Kong. This article examines whether the argument is a well-founded one and discusses the implications of confining a man’s right to have consensual sex with another man to his privacy rights alone.

In Defense of Practical Reasons for Belief

Many meta-ethicists are alethists: they claim that practical considerations can constitute normative reasons for action, but not for belief. But the alethist owes us an account of the relevant difference between action and belief, which thereby explains this normative difference. Here, I argue that two salient strategies for discharging this burden fail. According to the first strategy, the relevant difference between action and belief is that truth is the constitutive standard of correctness for belief, but not for action, while according to the second strategy, it is that practical considerations can constitute motivating reasons for action, but not for belief. But the former claim only shifts the alethist's explanatory burden, and the latter claim is wrong—we can believe for practical reasons. Until the alethist can offer a better account, then, I argue that we should accept that there are practical reasons for belief.     

Uninformed Consent? The Effect of Participant Characteristics and Delivery Format on Informed Consent

Although many people choose to sign consent forms and participate in research, how many thoroughly read a consent form before signing it? Across 3 experiments using 348 undergraduate student participants, we examined whether personality characteristics as well as consent form content, format, and delivery method were related to thorough reading. Students repeatedly failed to read the consent forms, although small effects were found favoring electronic delivery methods and traditional format forms. Potential explanations are discussed and include participant apathy, participants trying to save time by not reading the consent form, and participant assumptions about consent forms.     

Why Care about Being an Agent?

The question ‘Why care about being an agent?’ asks for reasons to be something that appears to be non-optional. But perhaps it is closer to the question ‘Why be moral?’; or so I shall argue. Here the constitutivist answer—that we cannot help but have this aim—seems to be the best answer available. I suggest that, regardless of whether constitutivism is true, it is an incomplete answer. I argue that we should instead answer the question by looking at our evaluative commitments to the exercise of our other capacities for which being a full-blown agent is a necessary condition. Thus, the only kind of reason available is hypothetical rather than categorical. The status of this reason may seem to undermine the importance of this answer. I show, however, that it both achieves much of what we want when we cite categorical reasons and highlights why agency is valuable.     

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.