经济利益诱惑下医生尊重病人自主性的困惑探究

An Investigation on How Physician Can Respect the Patient’s Autonomy under the Financial Conflict of Interest

探讨医患之间的利益冲突及其应对方案既要借助经验调查结果,又要进行规范性论证。一项针对九省份45家医院的医生(n=5316)调查结果显示:当患者坚持要做在医生看来没有必要的核磁共振时,仅有15.0%的被调查医生明确表示自己不会为患者开出检查单。这项检查对病人没有健康收益,还会削弱病人的自主性,但却又可能给医生带来经济利益。为使病人达到所需的理解并且没有被迫选择,医生需要向病人提供必要的信息以使其理解自己的病情、诊断、可供选择的不同方案及其后果。经过医生、病人、家属三方面的充分交流、协商来达致决策的过程,可能是类似情况下真正尊重病人自主性的最佳方式。

Fully exploring the issue of financial conflicts of interests between physicians and patients requires both survey conducting and normative pursuit.This paper first reports that only 15%of the physicians out of randomly-selected 45 hospitals would refuse prescribing a magnetic resonance imaging(MRI)scan for a patient who requests such a scan,although,it is not medically indicated or needed for the patient according to the physician’s professional judgment.Such diagnostic procedure can bring about financial benefit to the physician.How then should a physician act in these cases to manifest genuine respect for the patient’s autonomy?We discuss four different choices a physician faces and argue that in the Chinese familist medical cultural context,the physician should engage both with the patient and family in an adequate elaboration and manage to follow the final consensus of both the patient and family to fully respect the patient’s autonomy.