Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
Neurol Clin. 2010 May;28(2):459-73. doi: 10.1016/j.ncl.2009.11.007.
The requirement that doctors obtain valid consent from patients before providing medical treatment has long been ingrained in both legal doctrine and medical ethics. We summarize the foundations of the informed consent doctrine and discuss the recent evolution in thinking about consent and medical decision making. We show how consent has evolved from physicians merely providing patients information to shared decision making between patients and physicians. We then address three specific examples of situations common in neurological practice that pose challenges in obtaining valid consent: the administration of intravenous tPA following ischemic stroke, consideration of carotid endarterectomy for carotid artery stenosis, and implementation of do-not-resuscitate orders.
在提供医疗之前，医生需要从患者处获得有效同意，这一要求早已在法律理论和医学伦理中根深蒂固。我们总结了知情同意原则的基础，并讨论了最近关于同意和医疗决策的思维演变。我们展示了同意是如何从医生仅仅向患者提供信息演变为患者和医生之间的共同决策。然后，我们将讨论神经科实践中常见的三个具体情况，这些情况在获得有效同意方面带来了挑战：缺血性卒中后静脉内 tPA 的给药、颈动脉内膜切除术治疗颈动脉狭窄，以及实施不复苏医嘱。
