论安宁疗护患者知情同意权

The Right of Informed Consent of Hospice Care Patients

安宁疗护试点所强调的患者“充分知情、自愿选择”是患者知情同意权的体现。患者与家属权利冲突持续存在,知情同意权行使还有医疗伦理及技术上的困难。患者知情同意具有明显人格属性,保护的是患者身体利益,属身体权。安宁疗护应遵循“告知后同意”规则。医务人员告知应以患者知情为优先,采具体病患标准说,并以“预期生存期6个月以内”为进入安宁疗护标准。当患者决定权与社会公共利益相冲突时,应以公益性为原则;法定情形下让位于近亲属决定权;患者通过预先医疗指示行使决定权的,被委任的家属依据委托规则行使代理决定权。

The hospice care pilot in China emphasizes the principle of"fully informed,voluntary choice",which is the embodiment of the patient’s right to informed consent.The conflicts between the rights of patients and their families are sustained,and the exercise of informed consent is always trapped by the dilemma of medical ethics and technology.Informed consent shows distinct personality attribute,which is the body right protecting patients’physical benefits.Hospice care should follow the rule of informed consent.Patients’right to know should be the priority.Medical staff need to individualize the contents of the notification.6-month expected lifetime is the access to hospice care.When patients’right to decide conflicts with public interests,public welfare should be prioritized.It is placed after the decision right of close relatives under legal circumstances.If the patient exercises the right to decide through advance medical directive,the appointed family members shall exercise the proxy discretion according to the entrustment rules.