Delany C
School of Physiotherapy, The University of Melbourne, Carlton, Melbourne, Australia.
J Med Ethics. 2008 Sep;34(9):e3. doi: 10.1136/jme.2007.023804.
Obtaining patients' informed consent is an ethical and legal obligation in healthcare practice. Whilst the law provides prescriptive rules and guidelines, ethical theories of autonomy provide moral foundations. Models of practice of consent, have been developed in the bioethical literature to assist in understanding and integrating the ethical theory of autonomy and legal obligations into the clinical process of obtaining a patient's informed consent to treatment.
To review four models of consent and analyse the way each model incorporates the ethical meaning of autonomy and how, as a consequence, they might change the actual communicative process of obtaining informed consent within clinical contexts.
An iceberg framework of consent is used to conceptualise how ethical theories of autonomy are positioned and underpin the above surface, and visible clinical communication, including associated legal guidelines and ethical rules. Each model of consent is critically reviewed from the perspective of how it might shape the process of informed consent.
All four models would alter the process of obtaining consent. Two models provide structure and guidelines for the content and timing of obtaining patients' consent. The two other models rely on an attitudinal shift in clinicians. They provide ideas for consent by focusing on underlying values, attitudes and meaning associated with the ethical meaning of autonomy.
The paper concludes that models of practice that explicitly incorporate the underlying ethical meaning of autonomy as their basis, provide less prescriptive, but more theoretically rich guidance for healthcare communicative practices.
在医疗实践中，获得患者的知情同意是一项伦理和法律义务。虽然法律提供了规范性规则和指南，但自主性的伦理理论提供了道德基础。生物伦理文献中已经发展出同意实践模型，以帮助理解自主性伦理理论和法律义务，并将其融入获取患者治疗知情同意的临床过程中。
回顾四种同意模型，并分析每种模型如何纳入自主性的伦理意义，以及因此它们可能如何改变临床环境中获取知情同意的实际交流过程。
使用一个同意的冰山框架来概念化自主性伦理理论是如何定位并支撑上述表面的、可见的临床交流，包括相关的法律指南和伦理规则。从每种同意模型可能如何塑造知情同意过程的角度对其进行批判性回顾。
所有四种模型都会改变获取同意的过程。两种模型为获取患者同意的内容和时机提供了结构和指南。另外两种模型依赖于临床医生态度的转变。它们通过关注与自主性伦理意义相关的潜在价值观、态度和意义来提供同意的思路。
本文得出结论，明确将自主性的潜在伦理意义作为基础的实践模型，为医疗交流实践提供的规范性较少，但理论上更丰富。
