University of East London, Romford Rd, Stratford, London E15 4LZ, UK.
Physiotherapy. 2018 Mar;104(1):67-71. doi: 10.1016/j.physio.2017.07.006. Epub 2017 Aug 7.
This paper discusses the concept of informed consent in the context of contemporary biomedical ethics. A change in UK law regarding what information should be provided to patients has brought to the fore the role of physiotherapists in the process of gaining informed consent. It is important that physiotherapists are aware of how this change in the law will affect their practice. For an individual to consent, they need to have both the capacity and freedom to exercise rational thought. These concepts are challenged in contemporary biomedical ethics. An individual's ability to make rational decisions has been increasingly questioned by empirical evidence from behavioural psychology. In addition, the concept of freedom in contemporary neoliberal societies has also been critically examined. Liberal paternalism has been advocated by some as a means of helping patients to make better decisions about their care. Actualised as a 'nudge', liberal paternalism has been influential in a number of health policies, and has recently been discussed as a means of gaining consent from patients for assessments and treatments. Physiotherapists engage directly with patients and, through this engagement, construct a therapeutic environment that aims to build mutual trust. This paper questions the legitimacy of informed consent, and presents the argument that, through communicative actions, physiotherapists nudge patients into consenting to assessments and treatments.
本文讨论了当代生物医学伦理学中知情同意的概念。英国法律关于应向患者提供哪些信息的规定发生了变化，这使得物理治疗师在获得知情同意的过程中扮演了重要角色。了解法律的这一变化将如何影响他们的实践，这对物理治疗师来说很重要。为了使个人同意，他们需要有能力和自由行使理性思维。这些概念在当代生物医学伦理学中受到了挑战。个体做出理性决策的能力受到行为心理学的实证证据的质疑。此外，当代新自由主义社会中的自由概念也受到了批判性的审视。一些人提倡自由家长主义，作为帮助患者更好地决定自己护理的一种手段。作为一种“助推”，自由家长主义在许多卫生政策中产生了影响，并最近被讨论为从患者那里获得评估和治疗同意的一种手段。物理治疗师直接与患者接触，并通过这种接触，构建一个治疗环境，旨在建立相互信任。本文质疑知情同意的合法性，并提出论点，即通过交际行为，物理治疗师会推动患者同意评估和治疗。
