Yousuf R M, Fauzi A R M, How S H, Rasool A G, Rehana K
Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Malaysia.
Singapore Med J. 2007 Jun;48(6):559-65.
Informed consent is now accepted as the cornerstone of medical practice, with reasonable patient standards typically considered to be appropriate in the developed countries; however it is still challenged in many developing countries. The objective of this descriptive study was to evaluate the perceptions and practices among attending medical professionals in matters relating to informed consent in selected hospitals.
A questionnaire-based cross sectional survey among doctors in the two tertiary care hospitals, one in Malaysia and the other in Kashmir, was performed.
Awareness on informed consent was universal with "reasonable physician standard" as the most popular choice. As compared to doctors in Malaysia, doctors from Kashmir showed a tendency to reservedly disclose medical information (p-value equals 0.051) and withhold it, if it was deemed potentially harmful (p-value is less than 0.001) or requested so by relatives (p-value is less than 0.023). They also withheld some information from female patients (p-value is less than 0.001). When consent was refused despite needing lifesaving intervention, the majority of both respondents (73 percent versus 80 percent) considered intervention without consent to be justified. Respondents from Malaysia felt that parents could refuse treatment on their children's behalf on the basis of their beliefs (p-value is less than 0.001).
Despite a very high awareness of informed consent, the model chosen reflected age-old medical paternalism. Doctors' opinions are accorded a larger role in clinical decision-making in Kashmir. The results emphasise the need for doctors to change their attitude and acknowledge the patient's autonomy, which is the basis of modern medical ethics, and yet still be aware of the cultural and religious views of the local population.
知情同意现已被视为医疗实践的基石，在发达国家，通常认为合理的患者标准是恰当的；然而，在许多发展中国家，这一理念仍面临挑战。这项描述性研究的目的是评估选定医院中主治医疗专业人员在知情同意相关问题上的认知和做法。
对马来西亚和克什米尔的两家三级护理医院的医生进行了基于问卷的横断面调查。
对知情同意的认知普遍存在，“合理的医生标准”是最受欢迎的选择。与马来西亚的医生相比，克什米尔的医生倾向于谨慎披露医疗信息（p值等于0.051），如果认为某些信息可能有害（p值小于0.001）或亲属要求隐瞒，则会隐瞒这些信息（p值小于0.023）。他们还会对女性患者隐瞒一些信息（p值小于0.001）。当尽管需要进行挽救生命的干预但患者拒绝同意时，大多数受访者（73%对80%）认为未经同意进行干预是合理的。马来西亚的受访者认为，父母可以基于自己的信仰代表子女拒绝治疗（p值小于0.001）。
尽管对知情同意的认知度很高，但所选择的模式反映了由来已久的医疗家长主义。在克什米尔，医生的意见在临床决策中发挥着更大的作用。研究结果强调，医生需要改变态度，承认患者的自主权，这是现代医学伦理的基础，同时仍要了解当地人群的文化和宗教观点。
