知情同意临床实践的伦理隐忧及其消解  

Ethical Concerns and Resolution in the Clinical Practice of Informed Consent

作　　者：陈化[1,2] CHEN Hua(School of Marxism,Southern Medical University,Guangzhou 510515,China;Office of Ethics,Pearl River Hospital,Southern Medical University,Guangzhou 510280,China)

机构地区：[1]南方医科大学马克思主义学院,广东广州510515 [2]南方医科大学珠江医院伦理办公室,广东广州510280

出　　处：《医学与哲学》2024年第20期11-16,共6页Medicine and Philosophy

基　　金：2023年国家社会科学规划基金一般项目(23BZX093)。

摘　　要：知情同意作为患者权利,成为理解现代临床实践的“金钥匙”。它在中国的规范性建设遵循了制度安排与社会变迁互动的渐进式主线,围绕消解自主与行善冲突的经典命题、医方义务与患者权利走向融合而展开。然而,其临床实践中基于利益分歧、沟通机制不完善而带来告知的家长主义、同意的家庭主义以及全流程的形式主义等伦理隐忧。为消解这些隐忧,需要在角色和行动层面明确医生、患者与家属的价值主体地位,厘清各自的权利责任边界,围绕患者最佳利益弥合分歧达成共识,方可建构权利共享与责任共担的医患共同体。Informed consent,as a patient right,has become the"golden key"to understand modern clinical practice.Its normative construction in China follows the gradual main line of the interaction between institutional arrangements and social changes,and revolves around the classic dilemma between autonomy and benevolence,and the integration of medical obligations and patient rights.However,its clinical practice brings ethical concerns such as informed paternalism,consent familism,and formalism throughout the process based on differences in interests and imperfect communication mechanisms.To address these concerns,it is necessary to clarify the value subject status of doctors,patients,and their families at the role and action level,clarify the boundaries of their respective rights and responsibilities,and reach a consensus around the best interests of patients to bridge differences and build a doctor-patient community with shared rights and responsibilities.

关 键 词：知情同意 临床实践 伦理隐忧 共同决策 

分 类 号：R-05[医药卫生]