Lara M C, de la Fuente J R
Mexican Institute of Psychiatry, Mexico City, Mexico.
Bull Pan Am Health Organ. 1990;24(4):419-24.
The question of whether patients should influence medical decisions, and if so how much, is not simple. Among other things, it is necessary to decide whether the patient's well-being should take precedence over respect for the patient's autonomy, or vice versa; whether or not the patient has the capacity to exercise true autonomy; what information should be furnished in order to provide the patient with the basis for making a decision about treatment; and how such information should be provided. This article examines these matters, reviews the pros and cons of various methods for obtaining patients' informed consent, presents some broad guidelines for dealing with informed consent issues in a therapeutic setting, and discusses ethical principles that should be applied in obtaining patients' informed consent to participate in clinical research.
患者是否应该影响医疗决策,如果应该,影响程度如何,这并非简单的问题。除其他事项外,还必须决定患者的福祉是否应优先于对患者自主权的尊重,反之亦然;患者是否有能力行使真正的自主权;应提供哪些信息以便为患者提供做出治疗决策的依据;以及应如何提供此类信息。本文探讨了这些问题,回顾了获取患者知情同意的各种方法的利弊,提出了在治疗环境中处理知情同意问题的一些宽泛指导原则,并讨论了在获取患者参与临床研究的知情同意时应适用的伦理原则。