Gamble Nathan K, Pruski Michal
Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada.
London School of Tropical Medicine and Hygiene, University of London, London, UK.
J Intensive Care Soc. 2021 Nov;22(4):335-341. doi: 10.1177/1751143720969267. Epub 2020 Oct 29.
Informed consent, when given by proxy, has limitations: chiefly, it must be made in the interest of the patient. Here we critique the standard approach to parental consent, as present in Canada and the UK. Parents are often asked for consent, but are not given the authority to refuse medically beneficial treatment in many situations. This prompts the question of whether it is possible for someone to consent if they cannot refuse. We present two alternative and philosophically more consistent frameworks for paediatric proxy consent. The first allows meaningful consent (parents may say 'yes' or 'no' to treatment), provided that parents are medically informed/competent and intend the health and well-being of their child. In the second solution, medical practitioners or the state consent for treatment, with parents only being consulted to help give insight to the child's circumstances. While we contend that either of these two options is superior to the insincerity of the present paradigm, we suggest that the first solution is preferable.
主要是，它必须是为了患者的利益而做出。在此，我们批判加拿大和英国现行的父母同意的标准做法。父母经常被要求给予同意，但在许多情况下却没有拒绝医学上有益治疗的权力。这就引发了一个问题：如果某人不能拒绝，他们是否有可能给予同意。我们提出了两种替代性的、在哲学上更一致的儿科代理同意框架。第一种允许有意义的同意（父母可以对治疗说“是”或“否”），前提是父母具备医学知识/有行为能力且意图孩子的健康和幸福。在第二种解决方案中，由医生或国家同意治疗，仅咨询父母以帮助了解孩子的情况。虽然我们认为这两种选择中的任何一种都优于当前模式的不真诚，但我们建议第一种解决方案更可取。
