急診病人侵入性檢查及治療同意書簽署人之研究

Who Gives Informed Consent on Behalf of Emergency Patients?

李芳年(Fang-Niarn Lee)

《台灣公共衛生雜誌》 29卷1期 (2010/02) Pp. 65-75

https://doi.org/10.6288/TJPH2010-29-01-08

摘要

Objectives: Informed consent is intended to insure that a patient fully understands the procedures, benefits, and risks involved in a procedure or treatment. Informed consent is necessary not only for ethical and legal reasons, but also to help improve the quality of care and prevent errors. Unfortunately, little is known about who gives informed consent on behalf of patients before a procedure or treatment in an emergency department. This study investigated the signing of informed consent forms by patients or their relatives in such a setting. Methods: We conducted a review of medical records from 252 cases (234 patients) from January to February 2008 in a general hospital's emergency department in Northern Taiwan in order to determine who signed the consent forms for patients about to receive invasive examinations or treatment. Data were analyzed using T-test and MANOVA. Results: In only 81 cases (32.14%) was the consent form signed by the patient. All of the cases who were assigned triage category-I had the consent forms signed by their parents or other legal guardians. Patient under age 20 had the consent forms signed by their parents, while patient over 65 had consent by proxy. Male patients frequently signed the consent forms themselves, while female patients had consent by proxy. Before invasive procedures, patients frequently signed the consent forms themselves. Conclusions: Patients have the right to participate fully in decisions regarding their treatment in order to make decisions that correlate with their personal values. Frequently, this does not happen. Physicians should seek informed consent from patients unless they are incompetent or unconscious.

關鍵字

告知後同意 ； 同意書 ； 急診

並列摘要

Objectives: Informed consent is intended to insure that a patient fully understands the procedures, benefits, and risks involved in a procedure or treatment. Informed consent is necessary not only for ethical and legal reasons, but also to help improve the quality of care and prevent errors. Unfortunately, little is known about who gives informed consent on behalf of patients before a procedure or treatment in an emergency department. This study investigated the signing of informed consent forms by patients or their relatives in such a setting. Methods: We conducted a review of medical records from 252 cases (234 patients) from January to February 2008 in a general hospital's emergency department in Northern Taiwan in order to determine who signed the consent forms for patients about to receive invasive examinations or treatment. Data were analyzed using T-test and MANOVA. Results: In only 81 cases (32.14%) was the consent form signed by the patient. All of the cases who were assigned triage category-I had the consent forms signed by their parents or other legal guardians. Patient under age 20 had the consent forms signed by their parents, while patient over 65 had consent by proxy. Male patients frequently signed the consent forms themselves, while female patients had consent by proxy. Before invasive procedures, patients frequently signed the consent forms themselves. Conclusions: Patients have the right to participate fully in decisions regarding their treatment in order to make decisions that correlate with their personal values. Frequently, this does not happen. Physicians should seek informed consent from patients unless they are incompetent or unconscious.

並列關鍵字

informed consent ； consent form ； emergency department

參考文獻

楊秀儀(2002)。病人，家屬，社會：論基因年代病患自主權可能之發展。台大法學論叢。31，1-31。

Committee on Pediatric Emergency Medicine(2003).Consent for emergency medical services for children and adolescents.Pediatrics.111,703-706.

Hanisco CM.(2000).Acknowledging the hypocrisy: granting minors the right to choose their medical rreatment.NYL Sch J Hum Rts.16,899-901.

Katz J.(1998).Reflections on informed consent: 40 years after its birth.J Am Coll Surg.186,466-474.

Salgo v. Leland Stanford Jr. University Board of Trustees(1957).(154 Cal. App. 2d 560;317 P.2d 170).