手术签字与患者的知情同意权

由于我国现今法律法规未能明确手术签字与患者知情同意之间的关系,使得医院和患者之间的权利义务关系不甚明确.随着医疗市场的进一步规范,我们有必要尽快地明确手术签字与患者知情同意权之间的关系.文章从手术签字与患者知情同意及医院免责之间的关系等五个关键性问题入手对两者的关系作了阐述.     

患者不予签字同意的问题研究

知情同意是患者最基本的权利。知情同意一般分为四个环节:告知、知情、同意、签字。其中,"签字"是知情同意的最终行为方式。由于其在具体实践中常受到告知方式、理解能力、意识状态、法理缺陷等诸多因素的影响而突显出它的复杂性。我国于20世纪70年代后期开始将知情同意引入,并逐渐由医师执业道德范畴过渡到了法律规范的范畴。知情同意在我国发展的几十年中,最为典型的形式就是术前签字制度。文章将集中对患者不予签字同意进行分析和阐述,并从一般状态、患者或近亲属无明确意思表示以及紧急情况三个方面提出笔者的几点设想。     

追问手术签字制度

我国现行的手术签字制度是把同意手术的签字权给了包括家属在内的第三者,这种作法既有悖于医学伦理的知情同意原则,又不符合保障生命权的有关规定,同时易引发医患纠纷。因此,非法定事由,同意手术的签字权,理应归于患者本人。     

谈手术签字与医院免责的关系

本文讨论手术签字与医院免责的关系,实质上是讨论当手术出现风险时,如何界定医患双方的权利义务,医院能否免责的问题。国务院于1994年2月26日发布、1994年9月1日起施行的《医疗机构管理条例》第三十三条规定:“医疗机构施行手术、特殊检查或者特殊治疗时,必须征得患者同意,并应当取得其家属或者关系人同意并签字;无法取得患者意见时,应当取得家属或者关系人同意并签字;无法取得患者意见又无家属或者关系人在场,或者遇到其他特殊情况时,经治医师应当提出医疗处置方案,在取得医疗机构负责人或者被授权负责人员的批准后实施”。据此看出,手术签字已经成为一项制度。但是,随着患者权利意识的增强,我国相关法律法规的健全,也暴露出一些缺陷。国务院颁布的于2002年9月1日起施行的《医疗事故处理条例》对医患双方的权利义务作了规定,但关于手术签字后如果出现医疗事故,医疗能否免责未作规定。笔者试图从手术签字后,医院是否可以免责谈谈见解。     

危急疾病治疗过程中的几个关键法律问题——“丈夫拒签手术单致孕妻死亡”案的法律启示

危急疾病治疗过程中涉及到几个关键法律问题。第一，危急疾病患者向医院表明自己要接受医疗服务的意思并且这种意思传达到医院，患者和医院的医疗合同即告成立。第二，手术同意单本质上是知情同意书。第三，知情同意权应由患者行使，其家属的知情同意权应当受到严格限制。第四，医院在患者家属拒签手术单的不实施手术仍应承担违约责任。     

未成年少女堕胎手术知情同意主体探析

因未成年人意外妊娠而实施的堕胎手术日渐增多，但很多当事人都不愿意将情况告诉其监护人，所以手术同意书的签字问题就成了实施堕胎手术的一个难以逾越的法律障碍。本文试从未成年人保护的角度，分析将监护人、医院、卫生行政部门、少女救助中心作为少女堕胎手术知情同意主体的可行性，探讨合法合理地解决这一问题的方案，使未成年人意外妊娠的事后救济得以顺利进行。     

紧急避险制度在急危患者医疗知情同意中的应用研究

患者知情同意作为患者的一项重要权利在医患关系中具有重要的地位,完善我国的医疗知情同意,尤其是急危患者医疗知情同意相关的法律法规已迫在眉睫,在法律上对于急危患者知情同意如何保护,以及在患者医疗知情同意与生命冲突时,作为医生应如何选择进行了研究。本文试图运用紧急避险理论对医生救治急危病人的法律责任的免除,急危病人生命的保护提供思路和有益探索。     

论患者知情同意的适用范围——以美国近期案例为参照

患者知情同意的适用范围,在美国也仍有争议,从外科领域到侵袭性,从侵袭性到似乎不受限制。手术并不是知情同意的当然范围,比较简单的一级手术是否知情同意需综合考量;侵袭性可以作为手术的补充标准,采用风险说比较合理,但仍应受发生危险的可能性、损害后果的严重性限制;任何医疗行为都应知情同意的观点,没有可能,也无必要。     

患者知情同意权之适用限制

我国现行法律、法规有关患者知情同意权均有类似之规定,但在概念以及构成要件上却语焉不详,这直接造成了实际适用上的无序;为此,在实际实务中应慎重适用患者知情同意权而不应扩大其适用范围,同时,对其适用范围做相应的限制,使得医生的医疗裁量权得以复归;在知情同意权与医疗裁量权之间找到契合的平衡点,这样才能真正解开医患之间知情同意的死结,才能构建医患之间良好的信任关系。     

论医疗知情同意理论

知情同意作为一项有利于实现医疗目的的私法原则,具有其独立的利益设计和价值取向。告知说明义务的履行是实现知情同意原则的前提,而知情同意理论的要件是具体落实知情同意原则的关键,其中判断患者是否具备同意能力是知情同意的重要因素。但在适用知情同意原则时应注意识别几种例外情势。为了切实保障知情同意原则的实现,减少和防范医疗纠纷的发生,构建和谐的医患关系,有必要进一步完善我国知情同意理论体系。     

Legal prerequisites for clinical trials under the revised Declaration of Helsinki and the European Convention on Human Rights and Biomedicine.

Biomedical research is a perennially controversial subject. While the provisions of the Revised Declaration of Helsinki enjoy world-wide acceptance, they are increasingly placed in question--not least by the Council of Europe's Bioethics Convention, which allows non-therapeutic research in restricted cases on those incapable of giving informed consent. Taking as its starting-point the fundamental conflict between the general interest in research and the individual interests of the patients concerned, this article analyses the conditions under which medical experimentation on human beings is permissible. The article recognises the model of risk/benefit analysis and the doctrine of informed consent as equally valid core principles which do not conflict with restricted, non-therapeutic research, whether on patients who lack the capacity to consent or in placebo-controlled trials.     

Race, religion, and informed consent--lessons from social science.

That minority patients have not figured at all in the literature about informed consent is an egregious omission which this article begins to repair. Moreover, the article demonstrates that by addressing identifiable harms which informed consent law now causes to racial, religious, and ethnic minority patients, the law may also better address many of the concerns legal commentators have been discussing for years with only majority patients in mind. Ironically, the solution to the discrimination felt by the excluded members of society may turn out to provide the remedy for the informed consent doctrine as a whole.     

Reconciling Autonomy and Beneficence in Treatment Decision-Making for Companion Animal Patients

This article explores how the concept of consent to medical treatment applies in the veterinary context, and aims to evaluate normative justifications for owner consent to treatment of animal patients. We trace the evolution of the test for valid consent in human health decision-making, against a backdrop of increased recognition of the importance of patient rights and a gradual judicial espousal of a doctrine of informed consent grounded in a particular understanding of autonomy. We argue that, notwithstanding the adoption of a similar discourse of informed consent in professional veterinary codes, notions of autonomy and informed consent are not easily transferrable to the veterinary medicine context, given inter alia the tripartite relationship between veterinary professional, owner and animal patient. We suggest that a more appropriate, albeit inexact, analogy may be drawn with paediatric practice which is premised on a similarly tripartite relationship and where decisions must be reached in the best interests of the child. However, acknowledging the legal status of animals as property and how consent to veterinary treatment is predicated on the animal owner’s willingness and ability to pay, we propose that the appropriate response is for veterinary professionals generally to accept the client’s choice, provided this is informed. Yet such client autonomy must be limited where animal welfare concerns exist, so that beneficence continues to play an important role in the veterinary context. We suggest that this ‘middle road’ should be reflected in professional veterinary guidance.     

Competence to give informed consent for medical procedures

This study shows that referrals to psychiatry for evaluation for competence to give informed consent generally were made on patients who refused medical treatment. In this sample of referred patients, the only patients found to be incompetent to give informed consent were those with organic brain syndromes. No one with either schizophrenia or depression was found to be incompetent. It is possible that schizophrenic and depressed patients may generally be competent to give informed consent to medical treatment. This finding might be true notwithstanding the fact that many such patients have been found in other studies to be incompetent to consent to voluntary psychiatric treatment. For example, a patient may have delusions that others can read his mind and thoughts, but he still can understand that he needs dialysis for renal failure. Alternatively, it may be relatively rare that an emergency procedure is necessary before a patient's psychosis can be brought under control and consequently internists and surgeons themselves may prefer to wait. The significance of the results is unclear. Because of active interest in the doctrine of informed consent for psychiatric and medical patients by both physicians and attorneys and the few studies within this population, there is a strong need for more study regarding competence to give informed consent. Further study is especially important for psychotic patients for whom psychiatric consultation is not requested.(ABSTRACT TRUNCATED AT 250 WORDS)     

由谁来行使知情同意的权利:患者还是家属?

知情同意权是患者的一项基本权利,但是在我国目前的医疗实务中,该项权利却普遍地由患者的家属予以行使。本文围绕应当由谁来行使“有同意能力的患者”的知情同意权这一问题,由现行法的态度出发,从正反两个角度论证了应当由患者本人行使其知情同意权的观点。     

Medical: informed consent--designate health care professionals to obtain informed consent. Final rule

This document amends U.S. Department of Veterans Affairs (VA) medical regulations on informed consent. The final rule authorizes VA to designate additional categories of health care professionals to obtain the informed consent of patients or their surrogates for clinical treatment and procedures and to sign the consent form.     

Breaking through the silence: illegality of performing resuscitation procedures on the "newly-dead"

Israeli author Daniel Sperling brings to a light a disturbing practice that is taking place in some teaching hospitals throughout the world--the practice of resuscitation procedures on newly dead patients without the consent of the next-of-kin. Mr. Sperling examines some of the policies and procedures in place to prevent such practice and also looks at the ethical principles that should guide such procedures. The paper also reviews the general issue of consent in the context of medical decision-making and discusses potential legal claims that might be available to persons who have not been consulted or informed before such procedures are performed. The evolving jurisprudence surrounding the treatment of the newly dead is analyzed and Mr. Sperling concludes by suggesting ways to improve upon the procedures currently in place at some teaching facilities.     

法医病理司法鉴定纠纷产生的原因及其防范

法医病理司法鉴定在刑事案件、民事纠纷、保险理赔等方面发挥着重要的作用。通过鉴定工作实践,总结出法医病理司法鉴定纠纷产生的各种原因,结合中华人民共和国司法部第107号令《司法鉴定程序通则》第17条规定,在进行司法鉴定前必须签署司法鉴定协议书的实施情况,同时借鉴医疗活动中知情同意的做法,针对性地提出预防法医病理司法鉴定纠纷的对策。