Atras Andrzej, Patryn Rafał, Marczewski Krzysztof
Zakład Etyki Akademii Medycznej w Lublinie, Lublin.
Przegl Lek. 2007;64(7-8):525-7.
Contemporary medicine, together with the increase in invasiveness into the patient's body, exerts mounting pressure on state institutions and medical chambers aiming at the development of suitable regulations protecting patients against excessive interference with their bodies and psyche, and also allowing for their full autonomy. A gradual shift in the doctors' behaviour from a paternalistic approach towards partnership becomes more apparent. Its purpose is to take shared decisions concerning diagnostic methods and treatment. This process is best noticed when it comes to the issue of taking medical measures after obtaining patient's conscious agreement. The term 'conscious agreement' emerged in the legal terminology fairly late, in 1957, during the lawsuit Salgo vs. Leland Stanford Junior University Board of Trustees. Much later it found its place in the legal regulations concerning everyday medical routines. The fundamental factor of the patient's autonomy and simultaneously a remedy to the risk of patients acting against their own good is the process of obtaining the sick person's conscious agreement prior to anticipated medical measures, both therapeutic and diagnostic. The patient's informed conscious agreement to diagnostic process and treatment is not only the crucial prerequisite of doctor's lawful behaviour but also a significant evaluation criterion with regard to doctor's deeds and intentions. We requested doctors to share their opinion, in the form of an anonymous feedback form, on the issue of obtaining from patients their conscious agreement to diagnostic and therapeutic measures. The survey was carried out among 231 physicians of different specialisations from the Lublin Province and Podkarpackie Province employed both in hospitals, outpatient clinics and in health centres for basic medical care. Almost all the respondents declared the knowledgw of the regulations on the protection of patients' rights; however, only half of the surveyed persons expressed the opinion that the regulations concerning patient's rights refer also to diagnostic examination. Doctors clearly differed with regard to the meaning of the notion of 'giving conscious consent by the patient' and tended to associate such a patient's declaration only with invasive procedures. The survey results allowed us to outline the level of knowledge and the degree of compliance with patient's rights related to the necessity of obtaining conscious consent to medical treatment.
当代医学，随着对患者身体侵入性的增加，给国家机构和医学协会带来了越来越大的压力，这些机构和协会致力于制定适当的法规，以保护患者免受对其身体和心理的过度干预，并确保患者的充分自主权。医生的行为正逐渐从家长式作风向伙伴关系转变，这种转变愈发明显。其目的是就诊断方法和治疗方案共同做出决策。在获得患者的明确同意后采取医疗措施这一问题上，这一过程体现得最为明显。“明确同意”这一术语在法律术语中出现得相当晚，是在1957年“萨尔戈诉利兰·斯坦福初级大学董事会”一案的诉讼过程中出现的。很久之后，它才在有关日常医疗程序的法律法规中得以确立。患者自主权的根本要素，同时也是应对患者做出不利于自身健康行为风险的一种补救措施，是在预期的医疗措施（包括治疗和诊断）之前获得患者明确同意的过程。患者对诊断过程和治疗的知情明确同意，不仅是医生合法行为的关键前提，也是评估医生行为和意图的重要标准。我们要求医生以匿名反馈表的形式，就从患者那里获得其对诊断和治疗措施的明确同意这一问题发表意见。这项调查在卢布林省和喀尔巴阡省不同专业的231名医生中进行，这些医生受雇于医院、门诊诊所和基层医疗保健中心。几乎所有受访者都宣称了解保护患者权利的法规；然而，只有一半的受访者认为有关患者权利的法规也适用于诊断检查。医生们在“患者给予明确同意”这一概念的含义上存在明显分歧，并且倾向于仅将患者的此类声明与侵入性程序联系起来。调查结果使我们能够勾勒出与获得医疗治疗明确同意的必要性相关的患者权利知识水平和遵守程度。
