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。     

Adolescents' capacities to provide voluntary informed consent

Minors' capacities to provide a valid informed consent for the treatment of medical and psychological disorders are contingent in part on the determination of whether they can make voluntary treatment decisions. The gravity of a medical dilemma and the nature of parental influence are two factors hypothesized to effect and perhaps compromise the voluntariness of treatment decisions made by adolescents. In the present study 40 14- and 15-year-old subjects were asked to note their conviction for treatment decisions they had made in response to hypothetical medical dilemmas in which parental influence varied. It was found that adolescents making treatment decisions are generally deferent to parental influence, although they are more likely to resist parental influence when the consequences of the decision have serious implications for the hypothetical adolescent's health.This investigation was supported in part by a grant from the American Psychology-Law Society/ Division 41 of the American Psychological Association, whose assistance is gratefully acknowledged. Gratitude is also extended to the Albemarle County School District, the Blue Ridge School. and St. Anne's-Belfield for their kind cooperation. The authors wish to thank William Gardner, Jeanne Smith, and Edith Lawrence for their work on behalf of this project. Special recognition is due to Lois A. Weithorn for her guidance and support of this research endeavor.     

Substituted consent: from lunatics to corpses

This analysis traces the origins and evolution of the doctrine of surrogate or substituted judgment, especially its application to medical treatment, including non-therapeutic sterilisation, decisions regarding life and death choices, and more recently, removal of sperm or eggs from incompetent, dying or dead males and females. It argues that the doctrine, which has been acknowledged to be a legal fiction, has an effect of devolving legal and moral responsibility for life and death choices, as well as non-consensual, non-beneficial intrusive procedures, from the competent decision-makers to the incompetent patient. It focuses on the subjective nature of the substituted judgment standard; the problematic nature of evidence propounded to establish the putative choices of the incompetent person; lack of transparency relating to the conflict of interest in the process of substituted judgment decision-making; and the absence of voluntariness, which is an essential element of a valid consent.     

Competence to consent to treatment as a psycholegal construct

The issue of whether civilly committed patients should be extended the right to accept or refuse treatment has generated much controversy and litigation during the past 15 years. In general, the current rule is that in nonemergency situations, individuals who are competent to give informed consent to treatment should be extended the right to refuse it. Obviously, the manner in which this rule is implemented partly depends on how competence to consent to treatment is defined and measured. Most researchers have implicitly assumed that an understanding of treatment information is the sole criterion of competence. It is argued that such a definition may be incomplete and is in need of reexamination. Following a review and analysis of the relevant legal and psychological literature, a comprehensive construct of competency to consent to treatment is proposed and future directions for research are discussed.     

患者知情同意权

让患者知情同意义务是近些年来在医疗诉讼过程中逐步从一般注意义务中分化出来的特殊注意义务。IC产生有其深刻的社会背景,医师在医疗行为时要对患者进行充分的告知并取得患者的同意以保障患者自我决定权的实现。     

患者知情同意权

让患者知情同意义务是近些年来在医疗诉讼过程中逐步从一般注意义务中分化出来的特殊注意义务。IC产生有其深刻的社会背景，医师在医疗行为时要对患者进行充分的告知并取得患者的同意以保障患者自我决定权的实现。