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[在父母冲突情况下未成年人的患者护理、知情权及同意权。西班牙法律背景下的临床指南]

[Patient care, right to information and consent for minors in situations of parental conflict. Clinical guidelines in the context of Spanish legislation].

作者信息

Pina-Camacho Laura, Vidal Jorge, Picouto María Dolores, Justo Ortiz Encarna, de Montalvo Jääskeläinen Federico, Moreno Carmen, Arango Celso, Hernández-Sampelayo Teresa, Parellada Mara

机构信息

Servicio de Psiquiatría del Niño y Adolescente, Instituto de Psiquiatría y Salud Mental, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, Facultad de Medicina, Universidad Complutense, Madrid, España.

Servicio de Psiquiatría del Niño y Adolescente, Instituto de Psiquiatría y Salud Mental, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, Facultad de Medicina, Universidad Complutense, Madrid, España.

出版信息

An Pediatr (Engl Ed). 2021 May;94(5):338.e1-338.e7. doi: 10.1016/j.anpedi.2020.09.007. Epub 2020 Oct 29.

Abstract

Among the main social and legislative changes as regards family matters that have taken place in Spain in the last few years, are included: (i) the gradual increase in legal disputes between parents, and (ii) the introduction of Law 26/2015 on Child Protection, which modified Law 41/2002 on the Freedom of the Patient. These searched for a balance between the rights of minors and the powers of the parents, particularly when the former had not reached 16 years or had sufficient maturity or, having reached it, the decision puts their life or health at severe risk. Likewise, it has led to a jurisprudence that determines that, for any minor, there are particularly sensitive, "special" or "important" health care actions, such as psychotherapy or surgical treatments, which require, with exceptions, the consent of both parents for it to be carried out. All this, however, subject to the discretion of the doctor responsible, who must always look after the best interests of the minor. For this reason, healthcare for minors, occasionally, lead to complex conflicts as regards information and consent by the parents, particularly when they do not agree. A review is presented on the current legislative framework and the main legal concepts that regulate the healthcare of minors as regards information and consent relative to health, as well a healthcare protocol for the care of minors in situations of conflict between parents, developed in the Gregorio Marañón Hospital of Madrid, and endorsed by the Official Medical Collegiate of Madrid.

摘要

在西班牙过去几年发生的有关家庭事务的主要社会和立法变革中,包括:(i)父母之间法律纠纷的逐渐增加,以及(ii)2015年第26号《儿童保护法》的出台,该法修改了2002年第41号《患者自由法》。这些变革旨在寻求未成年人权利与父母权力之间的平衡,特别是当未成年人未满16岁或尚未具备足够成熟度时,或者虽已达到该年龄但相关决定会使其生命或健康面临严重风险时。同样,这也导致了一种判例法,即对于任何未成年人,都存在特别敏感、“特殊”或“重要”的医疗保健行为,如心理治疗或手术治疗,除特殊情况外,这些行为需要父母双方的同意才能实施。然而,所有这些都需由负责的医生自行决定,医生必须始终关注未成年人的最大利益。因此,未成年人的医疗保健偶尔会引发关于父母信息告知和同意方面的复杂冲突,尤其是当他们意见不一致时。本文对当前的立法框架以及规范未成年人医疗保健中与健康相关信息告知和同意的主要法律概念进行了综述,同时还介绍了马德里格雷戈里奥·马拉尼翁医院制定并得到马德里官方医学协会认可的父母冲突情况下未成年人护理医疗协议。

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