Worthington R
J Med Ethics. 2002 Dec;28(6):377-80. doi: 10.1136/jme.28.6.377.
On occasions, laws on consent are subject to modification, largely on account of being subject to common law rather than statute-for example, in the UK. Guideline publications such as the UK Department of Health Reference Guide to Consent for Examination or Treatment are intended to provide information for clinicians on when and how to apply current laws in everyday clinical situations. While the extent to which guidelines influence clinician behaviour depends on how much they are read and followed, what is also relevant, and sometimes omitted from consideration, is discussion about underlying philosophical concepts. This paper analyses philosophical weaknesses relating to English laws on consent, the main focus of attention being applied ethics and the rights of adults with incapacity. It draws comparisons between the US and the UK, and advocates changes in English law in order to help rectify weaknesses in patient protection. Discussion includes references to Scottish law, and the use of advance directives, and it voices concerns about over-reliance on "best interests" determinations. The problem is partly one of logical analysis, and what can happen is that best interests determinations fail to show proper respect for adults lacking the capacity to consent to examination or treatment on their own behalf. This is fundamentally a matter of rights, and requires further investigation and appropriate legal remedies in order to respond to ethical deficiencies in English law as it now stands.
有时，关于同意的法律会发生变化，这主要是因为这些法律属于普通法而非成文法——例如在英国。诸如英国卫生部《检查或治疗同意参考指南》之类的指南出版物旨在为临床医生提供信息，告知他们在日常临床情况下何时以及如何适用现行法律。虽然指南对临床医生行为的影响程度取决于其被阅读和遵循的程度，但同样相关且有时被忽视的是关于潜在哲学概念的讨论。本文分析了英国同意法的哲学缺陷，主要关注点是应用伦理学和无行为能力成年人的权利。文章对美国和英国进行了比较，并主张对英国法律进行修改，以帮助纠正患者保护方面的缺陷。讨论内容包括苏格兰法律以及预先指示的使用，并对过度依赖“最佳利益”判定表示担忧。这个问题部分涉及逻辑分析，可能出现的情况是，最佳利益判定未能充分尊重那些无法自行同意检查或治疗的成年人。这从根本上说是一个权利问题，需要进一步调查并采取适当的法律补救措施，以应对现行英国法律中的伦理缺陷。
