Department of Legal Medicine, University of Genoa, Genoa, Italy.
Minerva Med. 2009 Oct;100(5):429-34.
Therapy dissent and refusal are the situations most debated in the medical profession, that lead to various interpretations with regards to life and health, and even more in case of death risk. In the last decades, the medical treatment consent matter has become such an interesting and central issue that it has considerably modified the doctor-patient relationship. In particular, thanks to a fecund discussion on doctrine and case law, the informed consent became an autonomy act through which the patient exercises his/her personal health right. There are two international provisions that deserve to be mentioned for the matter: article no. 3 of the Charter of Fundamental Rights of the European Union, adopted in Nice on December 7, 2000, and the Oviedo Convention of April 4, 1997, which Italy passed under article no. 145, March 28, 2001. Both laws are symptomatic for the growing attention toward the person's self-determination, and for the impossibility to perform treatment in absence of personal, informed, recent and at any time revocable consent of the person concerned. Actually, these different and opposite ways of thinking correspond to a variable attitude of the case law that, in absence of a clear legislation regarding this matter, induces a deep insecurity in the physician's act on the one hand, and, does not allow the patient to totally avail him/herself of the self-determination principle on the other hand, particularly regarding the will and choices on health care.
治疗异议和拒绝是医疗行业中最具争议的情况，它们导致了对生命和健康的各种解释，在涉及死亡风险的情况下更是如此。在过去的几十年中，医疗同意事项已成为如此有趣和核心的问题，以至于它极大地改变了医患关系。特别是，通过对教义和判例法的深入讨论，知情同意已成为一种自治行为，通过这种行为，患者行使了其个人健康权利。在这个问题上，有两项国际规定值得一提：2000 年 12 月 7 日在尼斯通过的《欧洲联盟基本权利宪章》第 3 条，以及意大利于 2001 年 3 月 28 日根据第 145 条通过的 1997 年 4 月 4 日《奥维耶多公约》。这两条法律都表明了人们对个人自主的日益关注，以及在没有有关人员个人、知情、最新和随时可撤销同意的情况下，不可能进行治疗。实际上，这种不同和相反的思维方式对应着判例法的一种可变态度，在没有明确立法的情况下，一方面会使医生的行为产生深深的不安全感，另一方面也使患者无法完全行使自主原则，特别是在医疗保健方面的意愿和选择。
