Respect for Patients’ Right to Autonomy

In this review article we examine the laws and rulings regarding informed consent.It is well known that the patient must give valid consent to medical treatment;and it is his or her prerogative to refuse treatment even if the said treatment will save his or her life.No doubt this raises many ethical debates and falls at the heart of medical law today.There is widespread refusal of or withdrawal from medical treatment by patients suffering from illnesses,including communicable and non-communicable diseases.In Papua New Guinea(PNG)while a patient has a right to refuse treatment,there is no legal right to demand treatment.The paper seeks to clarify the nature,extent and importance of a patient’s right to respect for autonomy from the practitioner.We will attempt to conceptualise the patient’s autonomy by exploring the legal framework of consent or more specifically informed consent.Where the law of PNG differs from the laws of other parts of the world we have focused on the laws of the former.The legal aspects and guidance by the regulatory authorities apply only to PNG.

Patient-centered care in diabetes care-concepts,relationships and practice

We still do not have comprehensive knowledge of which framework of patientcentered care(PCC)is appropriate for diabetes care,which elements of PCC are evidence-based,and the mechanism by which PCC elements are associated with outcomes through mediators.In this review,we elaborate on these issues.We found that for diabetes care,PCC elements such as autonomy support(patient individuality),cooperation and collaboration(system-level approach),communication and education(behavior change techniques),emotional support(biopsychosocial approach),and family/other involvement and support are critically important.All of these factors are directly associated with different patient outcomes and indirectly associated with outcomes through patient activation.We present the practical implications of these PCC elements.

Patients' preferred mode of travel to the orthopaedic theatre

AIM: To determine the preferred mode of travel to the operating theatre for elective orthopaedic patients. METHODS: Data was collected prospectively over a 2-wk period at an elective Orthopaedic Treatment Centre. Patients were asked to complete a patient satisfaction questionnaire following their surgery on their experience and subsequent preferred mode of transport to theatre. The data was then recorded in a tabulated format and analysed with percentages. Fisher's exact test was used to determine if there was any statistical association between patients' preference to walk and various groups; in-patient or day case procedures, and whether patients were < 60 years or > 60 years of age.RESULTS: Seventy patients(40 females and 30 males) fully completed the questionnaire. In total there were 33 d-cases and 37 in-patients. The spectrum of orthopaedic sub-specialties included was knee(41%), hip(17%), foot and ankle(24%), spine(13%) and upper limb(4%). Patient satisfaction for overall experience of travelling to theatre was either excellent(77%) or good(23%). Following their experience of travelling to theatre, 87%(95%CI: 79%-95%) of the total cohort would have preferred to walk to the operating theatre. There was a statistically significant association(P = 0.003) between patients' preference to walk and whether they were daycase or in-patients. Similarly, there was a statistically significance association(P = 0.028) between patients' preference to walk and whether they were < 60 years or > 60 years of age.CONCLUSION: This study confirms the majority of Orthopaedic elective patients would prefer to walk to theatre, when given the choice and if practically possible.

Patient’s Perception of Autonomy Support and Shared Decision Making in Physical Therapy

Background: Shared Decision Making (SDM) is primarily intended to enhance patient autonomy. To date, the relationship between patients’ perceived levels of involvement and autonomy support has never been investigated in the field of physical therapy. Based on the recently reported extremely low level of observed SDM in physical therapy, similarly poor patient perceptions are expected. Objective: The main objectives of this study were to examine patients’ perceptions of SDM and autonomy support in physical therapy and to explore the relationship between both. Design: Patient survey after real consultations in physical therapy. Methods: Patients completed the Dyadic Observing Patient Involvement (Dyadic OPTION) instrument and the Health Care Climate Questionnaire (HCCQ) to examine patients’ perceived levels of SDM and autonomy support, respectively. Multilevel analyses were applied to determine the relationship between both perceptions. Results: Two hundred and twenty-nine patients, who were recruited by 13 physical therapists, agreed to participate. The median Dyadic OPTION score was 72.9 out of a total possible score of 100. The median HCCQ score was 94.3 out of a total possible score of 100. Patients’ experienced level of SDM (b = 0.14;p < 0.001) and patients’ age (b = 0.12;p = 0.001) contributed to patients’ perceived autonomy support. None of the physical therapist characteristics were related to patients’ perceived autonomy support. Limitations: Only 13 out of 125 therapists who were personally contacted agreed to participate. Conclusion: Using patients’ perceptions, we found that a relationship between SDM and autonomy support existed. In contrast to observational studies, our study also demonstrated that the participating physical therapists individually tailored patient support by adapting their implementation of SDM to each patient.

Informed Consent under the Ghana Health Service Patients Charter: Practice and Awareness

Background: Every human being of adult years and sound mind has a right to determine what shall be done with his/her own body. Patient autonomy and the practice of informed patient consent are now pivotal in medical practice. Aim: To assess patient’s knowledge of Patients’ Rights Charter and whether patients receive adequate information to enable them make an informed consent to a particular treatment. Methodology: Patients who were undergoing elective surgery from selected surgical departments of Komfo Anokye teaching hospital in Kumasi were randomly selected and assisted to answer structured questionnaire without the knowledge of their doctors. The study period was in June to December (2014). Descriptive analysis was done using SPSS (II) of the results. Results: 84.7% (144) had no idea about the Patients’ Rights Charter of the Ghana Health Service. 75% (128) did not know or had not heard of informed patient consent. Of those who knew of the charter, 85% (37) had ever stayed in a developed country. 60% (102) did not know of their diagnosis. 79% (134) said the doctor only asked them to either sign or thumb print the consent document without giving them treatment options or possible complications. Conclusion: Most of respondents undergoing various surgical procedures at the Komfo Anokye Teaching Hospital were not aware of the existence of the Patients’ Rights Charter of the Ghana Health Service. Again, practitioners did not provide sufficient information to patients for them to make an informed decision about their health.

The Conflict between Patient Autonomy and the Dying Patient Law in Israel

The Dying Patient Law is very controversial in Israel; there are opinions that the reason for the Law was to prevent the court from making decisions on the subject of end of life according to democratic principles. I decided to do this study because I wanted to know if the legal principles of the Law are democratic as were the court rulings or they are only, or mostly, Jewish principles and meant to prevent a democratic ruling in the courts. The work is a review of the Law and the Dying Patient Committee discussions as well as the chairman＇s writings on the Law, critique articles, and a review of democratic and bioethical principles. In this project, I have seen that the underlying basis of the Dying Patient Law is Jewish principles and not democratic principles, although Israel is a declared democratic state. This law illustrates the problem in Israel being both a democratic and a Jewish state. It raises the question： What can be done to resolve the conflict between the Jewish principles and democratic and/or bioethical principles？

将病人利益置于首位原则的现实挑战与理性对待

将病人利益置于首位原则在实践中遭遇现实挑战。如何重新认识和理性对待将病人利益置于首位原则,是医学伦理学再启程必须回应的现实诘难和学术命题。回顾了将病人利益置于首位的历史演绎,即从德性范式到原则范式,包含了从个体德性到公共规范、从病人健康到病人利益、从感性经验到理性原则三个维度的提升。然后讨论了将病人利益置于首位原则面临的现实挑战,主要来自市场化背景下医方利益、家属决策和病人利益判断的复杂性等。理性客观看待将病人利益置于首位原则,需要认识病人利益的正当性、实现利益的程序合理性以及病人利益与他人/社会利益的权衡。

善终权:我国台湾地区的经验与启示

我国台湾地区所谓“病人自主权利法”是对善终权的专门立法,明确尊重病人的自主并保障其善终权益,其内容主要包括贯彻病人的知情同意权、意愿人预立医疗决定、设立医疗委任代理人、病人拒绝医疗时所必经之程序的严谨等,所呈现出的特点可凝练为告知义务的对象主要是病人、仅病人本人有拒绝医疗的权限、拒绝医疗后的处置范围较广等,对我国内地地区未来善终权立法及当下之善终权相关制度的构建,立法规范善终权利主体的权利与义务、建立善终权代理制度和确立善终权的侵权责任和相关救济措施等方面,均不乏启示。

台湾地区安宁疗护立法的改革与启示

历经近30年实践,台湾地区已形成较为成熟的安宁疗护立法。为克服改革前“安宁缓和医疗条例”的适用困境,2019年开始在岛内施行的“病人自主权利法”通过扩大安宁疗护的适用范围、明确病人最新医疗意愿的认定依据和设定安宁疗护决策执行中的医方免责情形,支持特定临床条件下的非末期病人预先做出安宁疗护决策。从实施效果看,改革后的台湾地区安宁疗护立法在保障病人善终权益、促进医患关系等方面更具优势,但在可行性上仍有不足。以台湾地区制度实践的得失为参照,中国内地应在患者权利保护法的框架下推进安宁疗护立法,并在立法理念上强调以协助决定范式促进临终患者医疗自主的实现。以此为基础,中国内地立法原则上应将安宁疗护的适用对象限定为末期患者,承认患者的拒绝维生医疗权,在患者安宁疗护意愿的认定和执行环节体现对医方专业自主的尊重,并结合监护制度完善安宁疗护的替代决策规则。

山东省乡村医生信任患者现状及其影响因素研究

目的:了解山东省乡村医生信任患者现状以及影响因素,为提升医生信任患者提供依据,进而缓解紧张的医患关系。方法:选择山东省1077名乡村医生作为调查对象,分别采用人口学资料调查问卷,工作相关内容调查问卷,医师信任患者量表等内容对医生信任患者及其两个维度的现状以及影响因素进行调查,并采用线性回归分析医生信任患者及其两个维度的影响因素。结果:1077名乡村医生信任患者平均得分为(40.89±10.62)分。侮辱/暴力、近期离职意向、吸烟以及其他支持均与医生信任患者相关。侮辱/暴力、近期离职意向、吸烟、家庭支持以及其他支持均与患者角色维度相关。侮辱/暴力、朋友支持以及其他支持与尊重人际关系维度相关。结论:受过侮辱/暴力、有离职意向以及吸烟的乡村医生,他们对患者的信任水平较低。通过构建良好的医患关系,关注村医的离职意向,强化法律政策的保护,加强社会支持网络,改善和提高乡村医生对患者的信任度。

公民逝世后器官捐献激励政策的伦理研究

近年来,随着公民逝世后器官捐献与移植事业的快速发展,国家及地方相继出台了激励政策。为保障公民逝世后器官捐献者及其家属的合法权益,本文从伦理学视角对公民逝世后器官捐献激励政策现状进行梳理与分析,结合公正、尊重自主、不伤害、有利原则,梳理我国当前在实践公民逝世后器官捐献激励政策中存在的问题,如精神激励缺乏延续性心理干预、人道救助在实践中被曲解及间接经济激励对个人捐献自主性的影响等,并从政府、社会和个人三个层面提出相关对策与建议,以期为完善我国公民逝世后器官捐献激励政策提供参考,促进我国器官捐献事业的发展。

从伦理视角看医患共同决策的多种模式

医患共同决策是一种道德要求,源于医务人员接受患者或患者家属的基本权利,如自主权、知情同意权和选择权。为实现医患共同决策,医务人员和患者担任了不同的角色,医务人员的任务是引入专业知识和具体经验,为患者提供诊断和治疗选择的多项建议,而患者的任务是根据其对治疗效果目标、健康价值、基本权利等医学和伦理知识的理解程度,选择其在共同决策中认可的治疗方案。从伦理视角出发,立足于医患共同决策,深入分析其伦理意义,围绕伦理基本要求,从医生-患者共同参与模式、医生-患者-家属共同参与模式、医生-护士-患者共同参与模式、医务部介入的高风险病例谈话模式、多学科团队共同协作模式等多种实践模式,展开多角度、深层次的探讨,为进一步促进医患共同决策的实现,提供一些参考依据。

Navigating the ethical terrain:Off-label and experimental treatments in medical case reports

This article explores the ethical considerations surrounding the reporting of offlabel and experimental treatments in medical case reports,with a focus on fields such as oncology,psychiatry,and pediatrics.It emphasizes the balance between innovation and evidence-based medicine,highlighting the critical role of case reports in disseminating clinical experiences and advancing medical knowledge.The discussion delves into the ethical framework guiding case reporting,including principles of patient autonomy,informed consent,non-maleficence,beneficence,justice,and transparency.Challenges such as negative outcome reporting,commercial interests,and the balance between innovation and caution are examined.Recommendations for ethical vigilance,the development of comprehensive guidelines,and the role of regulatory bodies are proposed to ensure patient safety and uphold scientific integrity.The article concludes by underscoring the importance of a collaborative effort among clinicians,researchers,ethicists,and regulatory bodies to foster the responsible advancement of medical science while adhering to the highest ethical standards.

我国生前预嘱的法律规制研究

我国国家立法层面和地方立法中均对“生前预嘱”有一定探索,它符合我国《民法典》意思自治原则,契合生命尊严保护理念,《深圳经济特区医疗条例》(2022年修订)以立法方式予以认可。文章对我国生前预嘱的立法动因、立法现状进行分析,对适格的主体、有效的内容、符合法定的程序生前预嘱的要素进行阐述,并提出生前预嘱的立法构想。

“权利束”视域下安宁疗护权利基础之建构

我国安宁疗护的现行规定多为组织管理性的或技术层面的操作要求,而对实体权利的规范相对缺乏,对此,学界提出“生命权说”“病人自主权说”“健康权说”以明确安宁疗护的权利基础,但均存在缺陷,因为单一权利无法回应安宁疗护的丰富内涵。为解决这些缺陷,当引入“权利束”分析框架,而无须创设新型权利并分析其构造。“权利束”基于同一价值目标,从动态视角分析多组权利,具有灵活性和系统性,可将末期病人生命尊严作为有效“束点”,整合多主体多项权利,合理划定各权利边界,建构安宁疗护的权利基础。

物联网医疗实践中的伦理问题研究

随着物联网技术的飞速发展与广泛应用,其在医疗领域所展现出的潜力与价值逐渐受到人们的关注。这给传统的医疗实践方式带来了前所未有的变革与创新,越来越多的个性化以及更具效率的服务在影响着医疗实践方式。然而,物联网医疗在带来便利与效率的同时,也引发了一系列复杂的伦理问题。本文旨在深入探讨物联网医疗实践中的伦理问题,并提出针对性的解决策略,以期为物联网医疗的健康发展提供伦理指导。

患者自主权视域下生前预嘱的法律障碍及破解路径研究

在中国传统医疗体制下,患者个人意愿被忽视是患者自主权丧失的主要因素。笔者从患者最佳利益出发,以保护患者自由意志和生命尊严为目的,探讨了生前预嘱制定者的资格和决策范围,如何完善生前预嘱实施的法律程序,以及医疗机构的审慎义务和病人自主的可行路径,这有助于深入研究和补充制定生前预嘱法律、保障患者自主权和预防法律风险。

精神障碍患者麻醉知情同意的临床伦理分析

在临床实践中,麻醉技术的知情同意仍是麻醉学科的独特领域,但麻醉科医生轻视精神障碍患者的知情同意成为临床工作的薄弱环节。在人类原始道德本能的加持下,基于对精神障碍患者同情的道德关怀,代理同意被认为有利于患者,但现实中存在多种因素制约患者在麻醉知情同意上享有权利。在医患共同决策医学模式下,应尽可能让轻症精神障碍患者参与知情同意过程,其提供信息的深度和广度取决于患者的自知力。获取精神障碍患者麻醉知情同意的路径尚待优化,可通过多学科合作等多种方式,达到患者真正知情同意,保障精神障碍患者的合法权益。

医学父权主义的二重性:历史、价值与规制方式

医学父权主义经常被理解为是一种无视患者尊严与权利的行为方式,但这种观点没有认识到医学父权主义可以分为独断的和慈爱的两大类型,前者是指医生在做出医疗决定时无视患者的意愿,而后者则指医生有意阻止患者的自我损害行为。医学父权主义理念具有悠久的历史,但只是到了近代后期才逐渐成为普遍的行为事实。独断的医学父权主义是恶的,而慈爱的医学父权主义则具有行善的属性。对于不同的医学父权主义应当采取不同的规制方式。

试析深度脑刺激技术对患者、医生、科研人员的伦理挑战

深度脑刺激是一种在大脑中植入电极,对特定脑区实施电刺激的侵入性治疗,为运动性和精神性的神经疾病带来了新的治疗希望。该技术与人类意识关系密切,引发了有关意识自主、人格完整等主题的激烈争论。从保护患者的核心原则出发,探讨意识自主与医疗自主原则在深度脑刺激实践中的争议性问题,并分别从患者、临床医生、科研工作者的角度,讨论了知情同意、患者纳入、信息采集以及前沿科学领域的伦理考量。