Kapp M B
Department of Medicine in Society, Wright State University School of Medicine, Dayton, Ohio 45401-0927.
JAMA. 1989 Apr 7;261(13):1935-8. doi: 10.1001/jama.261.13.1935.
The legal and ethical doctrine of informed consent is well accepted in modern medicine. Nonetheless, medical interventions sometimes take place in the absence of informed consent, particularly in the case of life-sustaining medical procedures. These procedures ordinarily are reimbursed by third-party payers. This article proposes as a strategy to ensure greater attention to patient preferences in medical decision making that financial reimbursement for each medical service be linked to a requirement of valid patient (or surrogate) consent to the service involved. Utilization review bodies could monitor informed consent in the same way that other aspects of necessity, appropriateness, and quality are now monitored.
现代医学中，知情同意的法律和伦理原则已被广泛接受。尽管如此，医疗干预有时在未获得知情同意的情况下进行，尤其是在维持生命的医疗程序中。这些程序通常由第三方支付者报销。本文提出一项策略，即在医疗决策中确保更加关注患者偏好，将每项医疗服务的财务报销与患者（或代理人）对所涉服务的有效同意要求相挂钩。利用审查机构可以像现在监测必要性、适当性和质量等其他方面一样，对知情同意进行监督。
