Becker W, Deutsch E, Knappen F J, Nüssgens K
HNO. 1976 Jun;24(6):181-96.
The obligation of the physician to inform the patient--which he has to prove in case of a suit--is based on the patient's right of self-determination. This self-decision information was subject of the panel discussion. Not discussed in detail were the information concerning diagnosis and prognosis, and the instruction of the patient regarding his conduct postoperatively and during medical treatment. Not considered was the so-called malpractice and negligence respectively. Medical liability suits are increasing for various reasons and are frequently directed at a failure to inform the patient becuase the patient is often unable to prove a negligence of the physician ("surrogate liability"). The dimension of the duty of disclosure (complete information--no information at all) is discussed in general and with special regard to the Ear-Nose- and Throat field. Special questions are answered regarding otoplasty, middle ear surgery, transplantations, extension of laryngeal surgery without prior informed consent, paranasal sinus and rhino-basis operations as well as surgery in minors and foreigners. In cases of non-vital indication and particularly in plastic-cosmetic procedures and outsider methods the requirements for informed consent are particularly important. The so-called rate of complications has perhaps a relative, but never an absolute meaning, and even this only in connection with the other circumstances of an individual case. The evidence of an adequate informed consent which must be included in a physician--patient-dialogue is most convincing by means of a written consent and the additional signature of a witness, perhaps also of the patient. The value, the problems and even the risks of an information based only on forms or brochures is discussed in detail. The panel discussion from the four points of view of the organizers should be no means confuse the otorhinolaryngologist. It should inform him about the medicolegal aspects of his activity and protect him from avoidable burdens.
医生告知患者的义务——在诉讼情况下他必须对此进行举证——基于患者的自我决定权。这种自我决定信息是小组讨论的主题。未详细讨论的内容包括诊断和预后信息,以及关于患者术后行为和治疗期间行为的指导。也未考虑所谓的医疗事故和过失。由于各种原因,医疗责任诉讼不断增加,且常常针对未告知患者的情况,因为患者往往无法证明医生存在过失(“替代责任”)。本文总体讨论了告知义务的范围(从完全告知到完全不告知),并特别关注了耳鼻喉领域。针对耳整形手术、中耳手术、移植手术、未经事先知情同意的喉部手术扩展、鼻窦和鼻基手术以及未成年人和外国人的手术等特殊问题进行了回答。在非关键适应症的情况下,尤其是在整形美容手术和外部手术方法中,知情同意的要求尤为重要。所谓的并发症发生率可能具有相对意义,但绝无绝对意义,而且这仅与个别病例的其他情况相关。在医患对话中必须包含的充分知情同意的证据,通过书面同意以及证人(可能还有患者)的额外签字最具说服力。详细讨论了仅基于表格或手册进行告知的价值、问题甚至风险。组织者从四个角度进行的小组讨论绝不应使耳鼻喉科医生感到困惑。它应告知他其医疗活动的法医学方面,并保护他免受可避免的负担。