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。     

论HIV感染者家属权利保护的正当性——以知情权、生命健康权为视角

以HIV感染者家属知情权和生命健康权的保护为出发点,从法律角度,对HIV感染者家属的知情权及生命健康权易受侵害的原因进行分析,从尊重人权、法律公平、平等、道德正当、禁止权利滥用、社会契约论角度,论证保护HIV感染者家属权利的正当性。提出合理保护HIV感染者家属的知情权和生命健康权,应完善我国婚检制度和告知制度,同时对HIV感染者不告知家属的行为进行定性,以保护HIV感染者家属的权利,有效防控艾滋病的流行与发生。     

对手术签字的法律思考

手术签字是医生在为患者实施手术前的一种知情权的表示,它要求患者或其委托人在手术协议书鉴字以表示同意手术的一种民事法律行为,其作用是让患者和家属对手术行为,特别是对手术风险有一定的认识,同时也是一个医患双方沟通和交流的过程.在医学实践中,除急救外,惟有此签字,医方才获得了患者及家属的授权,才能进行有效治疗.那么在医疗纠纷的司法实践中,又应该如何来认定这种签字的法律效力呢?     

关于器官捐献中"推定同意"原则的再推定——兼与颜青山博士商榷

《医学与哲学》2 0 0 1年第 1期 ,发表了颜青山博士撰写的《论“推定同意”的伦理限制》一文 (以下简称颜文 ) ,该文就邱仁宗先生所倡导的器官捐献中的“推定同意”问题提出了质疑 ,无疑给人以新意和启迪 ,但正如作者所“推定”的 ,是否确实有“言过其实”之处。笔者在此就“推定同意”问题略陈管见 ,以期与颜先生共勉。1　关于推定同意的形而上基础首先 ,颜文认为 :“自愿捐献因为高度尊重个人的自主性 ,因此其形而上基础是个人主义的”[1] 。不知颜先生在此所指的“个人主义”是何意 ?一般而言 ,个人主义指称以个人为本位 ,强调个人利益的…     

论患者紧急救治权与知情同意权的冲突及对策——对北京朝阳医院孕妇胎儿双亡事件的法律思考

2007年11月21日14时,怀孕9个月的李丽云在朝阳医院京西院区就诊,因病情危重医院决定欠费收入院治疗,并建议剖宫产手术,因家属肖志军拒绝手术签字未能施行。当晚19时,李丽云因病情危重救治无效母子双亡。北京市卫生局对事件调查并组织专家评审后做出结论：孕妇死亡不可避免,但剖宫产手术可能会挽救胎儿生命;朝阳医院京西分院的做法符合法律规定,并无过失。     

亲子鉴定中婚生未成年子女权益保障探讨

以女性主义为视角,从亲子鉴定中婚生未成年子女权益被忽视的现象入手,解读亲子争执涉及的多元冲突.在分析亲子鉴定法制现状的基础上,借鉴先进国家和地区的立法,建构我国的亲子鉴定法律制度:细化未成年人特殊保护原则、完善婚生推定与否认制度、限定DNA亲子鉴定的启动和实施、配套相关制度.     

我国《人体器官移植条例》评析

我国《人体器官移植条例》对有推定同意权的“亲属”的限定范围过窄,阻却了第二、第三顺序亲属实施推定同意的权利;临床应用与伦理委员会的人员组成未排除实施器官移植的专家的参与,可能影响论证结果的客观性,且伦理审查时限不明;在违反《条例》的法律责任中,排除了公民生前未表示不同意捐献器官且其家属也未表示同意捐献尸体器官,而对其实施器官摘除的情形。缺失了医疗机构及其医务人员在明知器官来源不合法或实为买卖器官却加以利用并实施器官移植的法律责任。建议尽快根据《条例》制定具体的实施细则,以确保《条例》的正确实施。     

证券内幕交易行为主体界定的比较研究

内幕交易的行为主体是内幕交易的重要构成要素 ,美国和欧洲各国对内幕交易的行为主体都已建立了一个完备的理论体系 ,而我国学界对其研究尚有待深入。美国法上关于内幕交易行为主体的界定理论 ,包括获取或不公平理论、信托义务理论和信息泄露理论 ,欧洲法在此问题上的法理基础与美国法基本相同或相近。结合我国法律制度的要求 ,针对公司内部人、推定的内部人以及泄密链条中不是公司内部人或推定内部人的泄密人和受密人 ,我国进行法律规制的法理基础应是信托义务理论 ;针对与公司及其相关人员没有信托关系或者传递关系的知悉内幕信息的人 ,我国进行法律规制的法理基础应是内幕信息属于公司 (包括信息源泉人 )财产的理论。同时 ,我国的相关法律法规也要作相应的修改     

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。     

医患不同群体对手术知情同意书签字的态度调查

调查长沙、湘潭两地8家医院的内、外、妇科医生、护士、患者和家属共801人,了解医患不同群体对手术知情同意书签字的态度及影响因素.结果显示,医患双方的态度存在差异(P=0.000);患者与家属的态度也有差异(P=0.008);不同性别的医生、不同科别的患者、与患者关系不同的家属,其态度均有差异(P<0.05).     

急症产科子宫切除术知情同意的分析

为保留产妇的生命权而牺牲其生育权的子宫切除术,仍是控制产科出血的最后手段。产科急症时,患者本人无法做出意思表示,子宫切除术的知情同意权由其法定代理人行使。子宫切除围术期,实施知情同意,仍存在许多法律盲点及实践困难。本文阐述了产科子宫切除术告知的法律义务、行为主体,以及告知患者子宫切除的方式。     

术前谈话与患者的知情同意权

告知说明义务是医师的法定义务,知情同意权是患者的法定权利,术前谈话是外科医师履行告知说明义务和手术患者实现知情同意权的共同方式。外科医师应深入理解患者的知情同意权,合理履行告知说明义务,临床实践中做到告知说明内容充分,变更手术重新告知说明,避免使用穷尽式列举,确定签字人身份合法且具有完全民事行为能力。     

Brain activations associated with sign production using word and picture inputs in deaf signers

Effective literacy education in deaf students calls for psycholinguistic research revealing the cognitive and neural mechanisms underlying their written language processing. When learning a written language, deaf students are often instructed to sign out printed text. The present fMRI study was intended to reveal the neural substrates associated with word signing by comparing it with picture signing. Native deaf signers were asked to overtly sign in Chinese Sign Language (CSL) common objects indicated with written words or presented as pictures. Except in left inferior frontal gyrus and inferior parietal lobule where word signing elicited greater activation than picture signing, the two tasks engaged a highly overlapping set of brain regions previously implicated in sign production. The results suggest that word signing in the deaf signers relies on meaning activation from printed visual forms, followed by similar production processes from meaning to signs as in picture signing. The present study also documents the basic brain activation pattern for sign production in CSL and supports the notion of a universal core neural network for sign production across different sign languages.     

A PROGRAM FOR INCREASING MANUAL SIGNING BY AUTISTIC AND PROFOUNDLY RETARDED YOUTH WITHIN THE DAILY ENVIRONMENT

A program was implemented to increase the manual signing of five profoundly retarded and four autistic youth within their daily environment. Each participant was nonvocal or minimally vocal. The program was based on modified incidental teaching strategies and was implemented by direct care personnel under supervision in an institutional setting. Specific components included rearranging the physical environment to prompt signing, altering routine staff-resident interactions to prompt, manually guide and/or reinforce signing; and conducting mini-training sessions. Additionally, staff modeled signs intermittently throughout the day. The program was sequentially implemented during two staff work shifts on each of two resident living modules. Observations conducted at four separate time periods during the day indicated that significant increases in signing occurred for all participating youth and that the increases generally maintained during follow-up checks at 5 and 17 weeks. Differential effects of the increased signing on frequency of vocalizations were noted across residents. A staff acceptability survey indicated favorable staff reports on the usefulness of signing to communicate with the youth. Results are discussed regarding the significance of manual signing for seriously developmentally disabled persons and the importance of ensuring that signing skills are used in the daily environment and not exclusively in formal training sessions. Also, areas for continued research are noted in terms of more refined analyses of client skills and subsequent progress in manual communication programs.     

手术前签字与人文关怀

针对临床上存在的手术前患者本人签字有违人文关怀,提出对病人的主体地位和自由权的尊重体现了人文关怀的本质;必要时病人权利让渡也是尊重病人的表现,在临床上具有可取性;医患沟通的目的是为了促进病人的健康和幸福。     

The perception of rate in spoken and sign languages

The methods of magnitude production and estimation were used to scale the perception of signing rate by signers and observers. As in the case of voice level and speech rate, the autophonic scale of signing rate has a slope greater than unity and is steeper than the corresponding extraphonic scale; the obtained exponents of the two power functions for signing are, respectively, 2.66 and 1.56. When English-speaking subjects estimated their own rate of reading of the translated version of the signed passage, they produced an autophonic reading scale quite similar to that for signing (exponent of 2.51), but when they made magnitude estimations of English rates covering the same range of rates as the signed passage, the exponent of the extraphonic reading scale was significantly larger (1.89). This was also the case when French subjects estimated French reading rates. The difference between extraphonic signing and reading scales was confirmed by subjects who knew no Sign Language or French; their results appear to indicate, in addition, that the processes involved in extraphonic perception of rate are purely acoustic (speech) or visual (sign) and do not require, as one could have thought, deeper linguistic operations.     

Developmental Transformations of Self and Identity in the Context of Oppression

We explore the developmental progression to false consciousness in oppressed groups by integrating theories and research in social, political, and developmental psychology. We identify necessary conditions for development of critical consciousness that may undo false consciousness and be empowering to members of oppressed groups. These principles are applied to research on a racially oppressed group in Guatemala, which has been the site for oppressive domination of Mayan-descent groups for more than three decades. Comparisons are made for the oppressed group in Guatemala in data collected before and after the signing of peace accords.     

A Comparative Empirical Study on Mobile ICT Services,Social Responsibility and the Protection of Children

The purpose of this paper is to analyse the Spanish mobile phone industry to determine how mobile phone companies and certain institutions can improve protection for children who use mobile phones. We carried out a multivariate statistical analysis using anonymous primary data from mobile phone companies, and institutions and associations that protect children, to compare these stakeholders’ opinions and to put forward solutions. We proved that, even though some European countries have made an effort to provide safer ICT services, all stakeholders still need to cooperate and agree on solutions to the commercial problems associated with children using mobile phones. This can be done by signing codes of conduct. We found that even though some companies implement measures to protect children from accessing harmful content via their mobile phones, they do so for reasons of legal and not social responsibility.     

Effects of Refutational Messages,Thought Provocation,and Decision Deadlines on Signing to Donate Organs1

Across three experiments college students were given refutational messages or other treatments encouraging signing drivers' licenses to donate bodily organs in case of accidental death. An attitudinal measure (willingness to sign) predicted observed signing behavior, but relatively weakly. A measure of behavioral expectation to sign or not to sign predicted more strongly. A discussion with family was encouraged, the impact of that discussion also predicted signing but less strongly so. In Study 1 groups given a refutational message signed at no greater rates than a group given a control message. In Study 2 a refutational message group and a group asked to think about donating for 2 min signed at higher rates than a true control group. In Study 3 groups asked to decide whether or not to sign by a certain date and time signed at a higher rate than a refutational message group as in earlier studies. These procedures are recommended for organ donation signing campaigns.