Ladd R E
J Emerg Med. 1985;3(2):149-56. doi: 10.1016/0736-4679(85)90048-4.
Patients who use emergency department services generally have no choice of facilities or medical personnel. This fact affects the nature of the physician-patient relationship and the moral rules that govern it. Because a long-term relationship has not been developed, a more formal, legalistic relationship seems inevitable and appropriate. Moreover, the emotional stress of the emergency situation on the patient and the fact that the baseline mental status is unknown to the medical personnel often make it difficult to determine competency for decision-making, especially in cases of refusal of treatment. Although standards of informed consent apply in emergency care, there seem to be discrepancies between theory and practice, and emergency physicians may be more guilty than others of unjustified paternalism. Ways must be found to ensure patients the greatest degree possible of autonomy and informed consent analogous to what they would have in a nonemergency doctor-patient relationship.
使用急诊科服务的患者通常没有选择医疗机构或医务人员的余地。这一事实影响了医患关系的性质以及支配这种关系的道德准则。由于尚未建立长期关系，一种更为正式、拘泥于法律条文的关系似乎不可避免且恰当。此外，紧急情况给患者带来的情绪压力以及医务人员对患者基线精神状态不了解这一事实，常常使得难以确定其决策能力，尤其是在患者拒绝治疗的情况下。尽管知情同意标准适用于急诊护理，但理论与实践之间似乎存在差异，而且急诊医生可能比其他医生更易犯不合理家长作风的过错。必须找到方法，确保患者尽可能享有与非急诊医患关系中相当的最大程度的自主权和知情同意权。
