Fogel B S, Mills M J, Landen J E
Hosp Community Psychiatry. 1986 Feb;37(2):154-8. doi: 10.1176/ps.37.2.154.
In a medical emergency, a delirious patient can be treated without consent under the common law doctrine of implied consent, but in nonemergency situations legal guidelines are less clear. Implied consent may be extended if measures are taken to safeguard the patient's interests; these include involving family members in the treatment decision, obtaining a second clinical opinion, and seeking administrative consultation. Time permitting, if there are several alternative treatments and the risk of intervention is great, a court should appoint a temporary guardian. Documentation of the course of action is strongly recommended. The authors discuss the appropriateness of diagnostic procedures and the use of antipsychotic drugs to treat combative delirious patients. Legal precedents are offered and clinical examples given.
在医疗紧急情况下，根据普通法中的默示同意原则，可在未经同意的情况下对神志不清的患者进行治疗，但在非紧急情况下，法律准则则不太明确。如果采取措施保障患者利益，默示同意的范围可能会扩大；这些措施包括让家庭成员参与治疗决策、寻求第二种临床意见以及进行行政咨询。如果时间允许，且有几种替代治疗方法且干预风险很大，法院应指定一名临时监护人。强烈建议记录行动过程。作者讨论了诊断程序的适当性以及使用抗精神病药物治疗好斗的神志不清患者的问题。文中提供了法律先例并给出了临床实例。
