Wagner R F, Torres A, Proper S
Department of Dermatology, University of Texas Medical Branch, Galveston, USA.
Dermatol Surg. 1995 Jun;21(6):555-9. doi: 10.1111/j.1524-4725.1995.tb00261.x.
This article continues our medicolegal series that addresses issues affecting current dermatology practice. Informed consent and informed refusal have become cornerstones of modern American healthcare, and can serve to facilitate communication and trust between physician and patient.
A format with an initial discussion of legal concepts is followed by hypothetical problems and a review of actual cases to illustrate the principles of informed consent and informed refusal.
A valid informed consent from a competent patient should be obtained before initiating most dermatologic treatment. When a competent patient refuses a recommended medical test or procedure, the physician should make sure the patient understands the potential negative consequences of refusal. Some form of written documentation in the medical record is advised in either situation.
Failure to obtain a patient's informed consent prior to beginning treatment or failing to obtain an informed refusal before accepting a patient's decision to forego a test or procedure may subject the dermatologist to multiple later allegations, most commonly negligence.
本文延续我们的法医学系列文章，探讨影响当前皮肤科实践的问题。知情同意和知情拒绝已成为现代美国医疗保健的基石，有助于促进医患之间的沟通与信任。
采用先初步讨论法律概念，接着列举假设问题并回顾实际案例的形式，以阐释知情同意和知情拒绝的原则。
在开始大多数皮肤科治疗前，应获得有行为能力患者的有效知情同意。当有行为能力的患者拒绝推荐的医学检查或治疗时，医生应确保患者理解拒绝可能带来的负面后果。在这两种情况下，建议在病历中进行某种形式的书面记录。
在开始治疗前未获得患者的知情同意，或在接受患者放弃检查或治疗的决定前未获得知情拒绝，可能会使皮肤科医生在日后面临多项指控，最常见的是疏忽指控。
