Wade T C
Med Sci Law. 1990 Jul;30(3):259-62. doi: 10.1177/002580249003000315.
This study examined the issue of rational decision-making involved in the 'patient need' standard of informed consent. A majority of elective cholecystectomy patients (90% of 144) correctly identified their risk of death on a multiple choice questionnaire after preoperative counselling, but before surgery. However, many of those patients who answered correctly (54%) reported that they were not informed about the risk of death when questioned again after discharge. An attempt to discriminate patients who reported being informed from those who did not using measures of preoperative pain, emotional distress and medication was not successful. Faced with an inability to obtain informed consent from some patients, coupled with legal liability for failing to do so, surgeons are advised to obtain consent in writing, to provide comprehensive, multi-media counselling, and to be particularly conscientious with confused patients and those with complications.
本研究探讨了知情同意“患者需求”标准中涉及的理性决策问题。在术前咨询后但手术前，大多数择期胆囊切除术患者（144例中的90%）在多项选择题问卷中正确识别了自己的死亡风险。然而，许多回答正确的患者（54%）在出院后再次接受询问时表示，他们并未被告知死亡风险。试图通过术前疼痛、情绪困扰和用药情况来区分报告已被告知的患者和未被告知的患者，但未成功。面对无法从一些患者那里获得知情同意，以及因未这样做而承担法律责任的情况，建议外科医生获得书面同意，提供全面的多媒体咨询，并对困惑的患者和有并发症的患者格外尽责。
