Hoehner Paul J
Department of Anesthesiology, University of Virginial Health System and the Department of Religious Studies, University of Virginia School of Arts and Sciences, Charlottesville, VA 22908-0710, USA.
J Clin Anesth. 2003 Dec;15(8):587-600. doi: 10.1016/s0952-8180(02)00505-6.
Informed consent is a cornerstone and routine component of the ethical practice of modern medicine. Its full theoretical application to specific clinical situations, however, presents a number of ethical dilemmas for health care providers. Obstetric anesthesia, in particular, presents many unique challenges to the process of informed consent. In this review, the ethical background to the doctrine of informed consent within the context of "principlism" is explored and critiqued. The application of principlism to actual clinical situations, the limitations of principlism in the peculiarities of the patient-physician encounter, as well as possible alternative models of ethical discourse is discussed. The process of informed consent can be broken down into seven elements: Threshold elements or preconditions, which include 1) decision-making capacity or competency of the patient, 2) freedom or voluntariness in decision-making, including absence of over-riding legal or state interests; informational elements, including 3) adequate disclosure of material information, 4) recommendation, and 5) an understanding of the above; consent elements, which include 6) decision by the patient in favor of a plan and 7) authorization of that plan. Each of these elements is discussed in turn, and their implications, especially for the anesthesiologist and the obstetric patient, are addressed.
知情同意是现代医学伦理实践的基石和常规组成部分。然而，将其完整的理论应用于具体临床情况时，会给医疗服务提供者带来诸多伦理困境。尤其是产科麻醉，在知情同意过程中存在许多独特的挑战。在本综述中，将探讨并批判“原则主义”背景下知情同意原则的伦理背景。讨论原则主义在实际临床情况中的应用、原则主义在医患接触特殊性方面的局限性，以及可能的替代性伦理话语模式。知情同意过程可细分为七个要素：阈值要素或先决条件，包括1）患者的决策能力或行为能力，2）决策的自主性或自愿性，包括不存在压倒一切的法律或国家利益；信息要素，包括3）充分披露重要信息，4）建议，以及5）对上述内容的理解；同意要素，包括6）患者对某一方案的赞成决定，以及7）对该方案的授权。将依次讨论这些要素，并阐述其影响，尤其是对麻醉医生和产科患者的影响。
