Sprung C L, Winick B J
Department of Medicine, Veterans Administration Medical Center, University of Miami School of Medicine, FL.
Crit Care Med. 1989 Dec;17(12):1346-54. doi: 10.1097/00003246-198912000-00022.
The theoretical, legal, and medical doctrines of informed consent are analyzed. The elements of informed consent include disclosure of information, competency, understanding, voluntariness, and decision-making. The doctrine is ground in deference to individual autonomy and recognition that the exercise of self-determination in matters of health is a liberty interest honored by our history and traditions. The exceptions to informed consent including emergency, incompetency, therapeutic privilege, and waiver are especially important in critically ill patients and reflect a balancing of autonomy values and society's interest in the promotion of health. Legal decisions inevitably are based on atypical physician-patient encounters and focus on a particular problem or procedure rather than on overall medical care. In addition, they often reflect an artificial view of the doctor-patient relationship. Medical decision-making is a complex, evolving pursuit of a diagnosis and proper treatment regimen. Moreover, patients are not always interested in the role assigned to them by law. A reconceptualization of informed consent doctrines utilizing sliding scale standards based on variables pertinent to each individual patient is suggested.
对知情同意的理论、法律和医学原则进行了分析。知情同意的要素包括信息披露、行为能力、理解、自愿性和决策。该原则基于对个人自主性的尊重，并认识到在健康问题上行使自决权是一项受我们的历史和传统所尊重的自由利益。知情同意的例外情况包括紧急情况、无行为能力、治疗特权和放弃，这些在重症患者中尤为重要，反映了自主性价值观与社会促进健康利益之间的平衡。法律裁决不可避免地基于非典型的医患互动，关注特定问题或程序而非整体医疗护理。此外，它们往往反映了对医患关系的人为看法。医疗决策是对诊断和适当治疗方案的复杂且不断发展的追求。而且，患者并不总是对法律赋予他们的角色感兴趣。建议利用基于与每个患者相关变量的滑动标尺标准对知情同意原则进行重新概念化。
