病人自主與知情同意

李明濱

doi:10.6145/jme.199712_1(4).0002

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P377 - 388

Health & Medical Care > Medical Sciences
Social Sciences > Education

DOI： 10.6145/jme

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病人自主與知情同意

Patient's Autonomy and Informed Consent

李明濱(Ming-Been Lee)

醫學教育； 1卷4期 (1997 / 12 / 01) ， P377 - 388

繁體中文 DOI： 10.6145/jme.199712_1(4).0002

自主原則；醫主原則；知情同意；醫學倫理教育； patient's autonomy ； paternalism ； informed consent ； medical ethics education

Abstract │ Times Cited (23) │ Altmetrics

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The principle of autonomy indicates that rational individuals should be permitted to be self-determining. Respecting patients' autonomy has been considered as the basis of health care. The emphasis on autonomy in a medical ethical system asserts that the patient has the rights to make personal decisions about the health-related issues including choosing therapists, diagnostic procedures and recommended treatment modalities. However, patient's autonomous actions that harm oneself, or another, or are offensive to law and morality are not to be defended. How to integrate and balance the patient's autonomy and the professional's paternalism in patient care depends on effective patient-physician communication.
This review focuses on the issues of informed consent and truth telling, which are major rules derived from the principle of autonomy. These provide a corrective mechanism to paternalism and give the patients the opportunity and encouragement to be more actively involved in decision making. Informed consent is not only a legal doctrine, but a series of dynamic interactional processes that provides an autonomous patient with the information and understanding needed to choose autonomously to authorize a procedure. Its most important function is expressing respect for the self-determination of patients.
The essential components of the consent process, all basic to clinical medicine, should contain: 1) disclosure of adequate information including recommended investigations, benefits, risks, and alternatives; 2) patient's comprehension of the provided information; and 3) voluntaries and active consent. Effective communication skill and supportive techniques on the parts of medical professionals are strongly needed to facilitate patients' understanding and willingness to give consent during the process. In addition, physicians' positive attitudes that are important to enhance the validity of informed consent include the following: emotional security about possible rejection of medical advice, readiness to accept variants of patients' personal values, acknowledging medical uncertainty, and willingness to converse patiently with the patient.
It is clear that respect for patients' autonomy is necessary to ensure the quality of health care. The effective implementation of this principle depends on the education of medical students toward not only ethical reasoning, but also medical humanity. A proposed teaching strategy is to use a case-centered, problem-based, small-group tutorial mode in addition to integrated didactic lectures. Furthermore, courses that focus on the formal practice of medical ethics and medical humanity through giving students the chance to practice and learn under the teacher's guidance in daily clinical settings are emphasized. (Full Text in Chinese)

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