Lidz C W, Appelbaum P S, Meisel A
Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213.
Arch Intern Med. 1988 Jun;148(6):1385-9.
The doctrine of informed consent has been controversial since its inception. In spite of the professed ideal of improving physician-patient communication, many commentators have argued that it interferes with the relationship. However, the problem may not be the doctrine itself but rather the manner in which it is usually implemented. This article describes two different ways in which informed consent can be implemented. The event model treats informed consent as a procedure to be performed once in each treatment course, which must cover all legal elements at that time. The process model, in contrast, tries to integrate informing the patient into the continuing dialogue between physician and patient that is a routine part of diagnosis and treatment. We suggest that the process model has many benefits.
自知情同意原则诞生以来,它一直颇具争议。尽管其宣称的理想是改善医患沟通,但许多评论家认为它干扰了医患关系。然而,问题可能不在于该原则本身,而在于其通常的实施方式。本文描述了实施知情同意的两种不同方式。事件模型将知情同意视为在每个治疗过程中只需执行一次的程序,该程序必须涵盖当时所有的法律要素。相比之下,过程模型试图将告知患者融入医患之间持续的对话中,而这种对话是诊断和治疗的常规组成部分。我们认为过程模型有诸多益处。