尊重病者知情权的伦理思考

Respect patients' right to know :ethical consid-erations

病人约章的推行,显示香港医院管理局的决心,把医疗服务建立在医疗护理人员与病人开明的伙伴关系上.在鼓吹尊重病人的大气候下(世界医学会,1980;美国医院协会,1973)。

In recent decades, patients' rights to informed consent has become increasingly formalized in different parts of the world . The introduction of the Patient Charter in Hong Kong in 1994 is an example . Health care professionals are expected to shoulder the responsibility of safeguarding patients' best interests and at the same time upholding their right to information. On the one hand ,health care professionals have to respect patients' autonomy in self-determination of treatment deci sions by providing them with information about themselves including, diagnosis, prognosis, treatment available , and the possible consequence. On the other hand ,they have to protect those vulnerable patients by fostering substitute or surrogate decisions which represent the patients' best interests. How to protect the best interests of a vulnerable patient has attracted much discussion recently in medical ethics discourse. The most debatable issues are how to identify which groupsof patients are vulnerable and need to have decisions made for them selves, and who can legitinately represent patient's best interests in making a treatment decision. In defining the vulnerable group who require protection on the bart of the health care professionals , patients' competency to exercise their autonomy in self determination is the most crucial consideration . Patient competency in informed consent has different definitions,and the most generally accepted one is that the patient should have the capacity to com-predend relevant information, the ability to weigh the benefits and risks of the proposed procedure , and the capacity to arrive at a rational decision.