Rajput Meena, Sharma Luv
Department of Community Medicine, Sharma Post-Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak, Haryana, India.
Hum Vaccin. 2011 Jul;7(7):723-7. doi: 10.4161/hv.7.7.15411. Epub 2011 Jul 1.
The doctrine of informed consent forms an integral part of any doctor-patient relationship. It serves two-fold as it develops trust and confidence in the patient for the doctor after being told about the plan of action; conversely the doctor can carry out planned medical interventions in a more composed manner, being confident in the protection of this doctrine if anything untoward occurs. Informed consent gives a blanket shield against compensation and criminal negligence charges filed by patients if the doctor has not deviated from standard practices of treatment or intervention or if no evidence of mal intention is forthcoming. Informed consent is applicable in most of the treatment modalities in which any intervention/invasive procedure is to be done or if any risk of complication is well known or documented. Surprisingly, even when serious life threatening complications are not only reported but on a steady rise due to vaccines, informed consent in vaccination is neither in vogue nor practice. Even in the US, there is no federal requirement for informed consent before vaccination, even though National Childhood Vaccine Injury Act and the Vaccine Compensation Amendments are in place. This paper attempts to present an overall comment on the necessity of informed consent before any vaccination especially in the Indian context in the backdrop of the beginning of vaccine compensation claims and litigation against the complications of vaccination in India.
知情同意原则是医患关系的一个重要组成部分。它有两方面的作用,在患者被告知治疗行动计划后,能增强患者对医生的信任;反之,医生在有了这一原则的保障后,若出现任何意外情况,也能更从容地实施计划好的医疗干预措施。如果医生没有偏离标准的治疗或干预方法,或者没有恶意意图的证据,那么知情同意能为医生提供全面的保护,使其免受患者提出的赔偿和刑事过失指控。知情同意适用于大多数治疗方式,包括任何干预性/侵入性操作,或者已知或有记录的任何并发症风险的情况。令人惊讶的是,即使严重危及生命的并发症不仅有报道,而且因疫苗而呈稳步上升趋势,但疫苗接种中的知情同意既不流行也未得到实践。即使在美国,尽管有《国家儿童疫苗伤害法案》和《疫苗赔偿修正案》,但在接种疫苗前也没有联邦层面关于知情同意的要求。本文试图就在印度疫苗赔偿索赔开始以及针对疫苗接种并发症的诉讼背景下,尤其是在印度的情况下,接种疫苗前进行知情同意的必要性给出总体评论。