Sadan B
Hadassah Medical Organization, Jerusalem.
Med Law. 2000;19(3):545-57.
Patients' autonomy and rights have become inalienable values in most western countries. The instrument by which de facto patient autonomy in the healthcare system is practiced is the "informed consent" form. Despite the unquestionable importance of this tool, there are numerous inadequacies in this practice. One of the reasons is due to the fact that the physicians' autonomy to offer their patients the best care available has undergone considerable diminution due to financial considerations in the managed care environment. The healthcare system is a multifaceted one, made up of many agents and interested parties who lay down the laws and make the rules of the game. A physician-patient encounter does not take place in a void, and physicians are far less free to act than they have ever been before. This diminished independence is particularly felt in the milieu of managed care and has led to informed consent taking on a new and much greater significance when there are patient-"unfriendly" agendas.
在大多数西方国家，患者的自主权和权利已成为不可剥夺的价值观。在医疗保健系统中实际践行患者自主权的工具是“知情同意”书。尽管这一工具具有毋庸置疑的重要性，但在实践中存在诸多不足之处。原因之一是，在管理式医疗环境下，由于经济因素，医生为患者提供最佳可用医疗服务的自主权已大幅减少。医疗保健系统是一个多方面的体系，由许多制定法律和游戏规则的机构及利益相关方组成。医患会面并非在真空中进行，医生的行动自由比以往任何时候都少得多。在管理式医疗环境中，这种独立性的减弱尤为明显，并且当存在对患者“不友好”的议程时，这使得知情同意具有了新的、更为重要的意义。
