Marta J, Lowy F H
Département de psychiatrie, Université de Toronto, Ontario.
Can J Psychiatry. 1993 Oct;38(8):547-51. doi: 10.1177/070674379303800804.
Is it desirable to extend the practice of explicit informed consent to psychotherapy? Is it possible? How? This article offers preliminary answers to these questions following a literature review and reflection on the theory of informed consent and psychotherapy. It explores the advantages and the possibility of using explicit informed consent in place of the implicit consent obtained currently. Explicit consent for psychotherapy would be interactive, iterative, repeated and revokable. It would take into account specific characteristics of psychotherapy, such as the fact that it is a process rather than a procedure, its relative unpredictability, the active part the patient plays in treatment, and the importance of the unconscious, transference and counter-transference. It would have the advantages of respecting the patients' autonomy without sacrificing their well-being, of having meaning not only for medico-legal protocols but for the patient, and would improve satisfaction with and the efficacy of psychotherapy as a treatment modality. The proposed model provides direction for future research, both empirical and theoretical.
将明确知情同意的做法扩展到心理治疗领域是否可取？是否可行？如何实施？在对知情同意理论和心理治疗进行文献综述与思考之后，本文对这些问题给出了初步答案。它探讨了使用明确知情同意来取代当前所获得的默示同意的优势及可能性。心理治疗的明确同意将具有互动性、迭代性、重复性且可撤销。它会考虑到心理治疗的具体特征，比如它是一个过程而非程序这一事实、其相对不可预测性、患者在治疗中所起的积极作用，以及无意识、移情和反移情的重要性。它将具有在不牺牲患者福祉的情况下尊重患者自主权的优势，不仅对医学法律规程有意义，对患者也有意义，并且会提高对心理治疗作为一种治疗方式的满意度及疗效。所提出的模型为未来的实证研究和理论研究提供了方向。
