Walter T
Department of Social & Policy Sciences, University of Bath, Bath, UK.
J Med Ethics. 2008 Sep;34(9):675-8. doi: 10.1136/jme.2007.022558.
Informed consent needs to be practised within a culture of openness if it is to enhance public trust in medical procedures around death. Openness should entail patients not just receiving information from doctors, but also having the right to see certain medical procedures. This article proposes in particular that it would be desirable for the public to be allowed to attend an autopsy of a person they do not know. Evidence from the UK, where members of the public may go backstage to witness the process of cremation, the other technical process in which dead bodies are violently but legitimately assaulted, suggests benefits from a policy of openness. When a family consents to cremation in Britain, their consent is only minimally informed, but the system has nothing to hide, and trust is high. This suggests that the opportunity for lay people also to witness certain medical procedures might do more to restore public trust in medical procedures around death than a narrow interpretation of informed consent in which information is controlled by the profession.
如果要增强公众对围绕死亡的医疗程序的信任,就需要在开放的文化氛围中践行知情同意。开放不仅应包括患者从医生那里获取信息,还应包括患者有权观看某些医疗程序。本文特别提出,应该允许公众参加对他们不认识的人的尸检。来自英国的证据表明了开放政策的益处,在英国,公众可以进入后台观看火化过程,火化是另一种对尸体进行剧烈但合法处理的技术过程。在英国,当一个家庭同意火化时,他们的同意只是最低限度的知情,但该系统没有什么可隐瞒的,公众的信任度很高。这表明,让外行人士也有机会见证某些医疗程序,可能比专业人员对信息进行控制的狭义知情同意解释,更有助于恢复公众对围绕死亡的医疗程序的信任。