Leavitt F J, Peleg R, Peleg A
The Centre for Asian and International Bioethics, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel.
J Med Ethics. 2005 Dec;31(12):689-92. doi: 10.1136/jme.2004.010769.
Doctors have been known to treat or give consultation to patients informally, with none of the usual record keeping or follow up. They may wish to know whether this practice is ethical.
To determine whether this practice meets criteria of medical ethics.
Informal medicine is analysed according to standard ethical principles: autonomy, beneficence and non-maleficence, distributive and procedural justice, and caring.
Hospital, medical school, and other settings where patients may turn to physicians for informal help.
No generalisation can be made to the effect that informal medicine is or is not ethical. Each request for informal consultation must be considered on its own merits.
Informal medicine may be ethical if no payment is involved, and when the patient is fully aware of the benefits and risks of a lack of record keeping. When an informal consultation does not entail any danger to the patient or others, the physician may agree to the request. If, however, any danger to the patient or others is foreseen, then the physician must insist on professional autonomy, and consider refusing the request and persuading the patient to accept formal consultation. If a reportable infectious disease, or other serious danger to the community, is involved, the physician should refuse informal consultation or treatment, or at least make a proper report even if the consultation was informal. If agreeing to the request will result in an unfair drain on the physician's time or energy, he or she should refuse politely.
众所周知，医生会对患者进行非正式治疗或提供咨询，且不进行任何常规的记录保存或随访。他们可能想知道这种做法是否符合伦理道德。
确定这种做法是否符合医学伦理标准。
根据标准伦理原则对非正式医疗进行分析：自主性、行善和不伤害、分配和程序公正以及关怀。
医院、医学院以及患者可能向医生寻求非正式帮助的其他场所。
不能一概而论地说非正式医疗是否符合伦理道德。每一次非正式咨询请求都必须根据其自身的优缺点来考虑。
如果不涉及收费，并且患者充分了解不进行记录保存的益处和风险，那么非正式医疗可能是符合伦理道德的。当非正式咨询对患者或他人不构成任何危险时，医生可以同意该请求。然而，如果预见到对患者或他人有任何危险，那么医生必须坚持职业自主性，并考虑拒绝该请求并说服患者接受正式咨询。如果涉及可报告的传染病或对社区的其他严重危险，医生应拒绝非正式咨询或治疗，或者即使咨询是非正式的，至少也要进行适当报告。如果同意该请求会导致医生的时间或精力被不公平地消耗，他或她应该礼貌地拒绝。
