知情同意的风险决策能力评估探究

On the Assessment of Risk-related Decision-making Ability of Informed Consent

能力是知情同意的"守门人"概念,风险相关决策能力将患者的行为能力与具体决策风险结合起来,并充分考量其法律依据与医学特点。一般情况下,临床实践并不需要评估患者的决策能力。但是,当患者拒绝医生提出的最有利患者的建议,患者同意会伤害其本身利益的决策,以及患者前后决策相互矛盾且后期决策会伤害患者健康的情况下,需要评估。风险相关决策能力评估需要考察患者的沟通能力、信息理解能力、评估能力和道德推理能力。其道德合理性在于"行善"的价值辩护,在实践操作中需要借助个体的"实践智慧"。

Ability is the "gatekeeper" of informed consent.Risk-related decision-making ability combines patients’ behavior ability with specific decision-making risk,and weighs its legal ground and medical characteristics thoroughly.In general,there is no need to assess the patient’s decision-making ability in clinical practice.However,it needs to be evaluated when patients refuse the optimum decision,when their decisions harm their own interests and inconsistent,especially when later decisions harm the patient.Risk-related decision-making ability evaluation inspects patients’ ability of communication,information understanding,evaluation and moral reasoning.The moral rationality of risk-related decision-making ability can be defended with the "good will",which needs the help of individual "practical wisdom" in practice.