急危患者知情同意权研究

发布时间：2018-12-29 18:50

【摘要】：目的:既往法律关于急危患者知情同意权有效行使的规定尚未具体明确。2010年起实施的《侵权责任法》第56条规定进一步细化了部分内容,但其仅表述了“不能取得患者或者其近亲属意见”的情况,未能涵盖已取得患方知情同意决定而该决定明显违背医疗科学等情况。本课题拟调研不同群体对未恰当行使知情同意权的急危患者,医师处置方式的认同选择,并比较该社会认知状况与现行法律的偏差,以期为对《侵权责任法》相关规定进行完善的可能性、必要性提供实证依据。方法:本课题采用文献回顾、相关案例分析、进而问卷设计调查的实证研究方法,通过分层随机抽样对重庆、泸州、遵义三地的医师、法律人、社会大众(患者或家属)等三类不同群体就基于现行《侵权责任法》,对在患者因病情危重需立即接受相关医疗抢救措施才有机会挽救其生命或保全其肢体或重要器官功能的紧急情况下,患方无法恰当行使知情同意权时医师处置方式的认同选择进行调研。调查指标主要包括对前述情况相关的六种预设下各种医师处置方式的认同选择,并比较不同群体、不同地区和不同选择的差异。通过预调查计算样本量,采用行×列表χ2检验或双向无序R×C表Fisher确切概率法进行数据统计分析,P0.05为差异有统计学意义;通过样本率计算总体率,采用0.05双侧检验水平,估计95%总体率可信区间。结合调查结果与法理分析,进一步提出具体处理建议及流程。结果:预估最小样本量为406例,发放问卷600例,有效回收559例,回收率93%。各种预设下:三类群体选择的差异均有统计学意义(各P0.05);而三个地区选择的差异均无统计学意义(各P0.05)。按“尊重(/等待)患者(/家属)意见”或“尊重医师意见”合并数据分析提示:当患者拒绝抢救而家属同意抢救或患者无意思表达能力的几种合并情况(家属拒绝抢救、数个家属意见分歧、家属拒绝签字或无家属)下,被调查人群总体中多数选择“尊重医师意见”(选择人数百分比分别为:65.47%、58.68%、72.81%、82.11%、93.20%)。患者无意思表达能力时,家属拒绝抢救或家属意见分歧,选择尊重医师意见的被调查者倾向于通过第三方机构参与决策。结论:除患者及家属均拒绝抢救情况外,不同社会群体认同:当患者病情急危且无法取得其有效知情同意时,其知情同意权应被适当限制、生命健康权应优先受到重视而视情况接受紧急救治。相关现行法律有待完善:(一)明确“患者病情急危时,近亲属意见明显违反医学科学或医学伦理者”应视为符合《侵权责任法》第56条规定之情形;(二)将紧急救治列入法定免责事由,对因此造成的损害予以适度减轻责任;(三)以完全民事行为能力标准判断患者意思表达能力;(四)建立医疗机构紧急救治行为的监督机制,避免权利滥用。
[Abstract]:Objective: the provisions of previous laws on the effective exercise of informed consent of patients at risk have not yet been specified. Article 56 of the Tort liability Law, which came into force in 2010, further refines some of the contents. But it only states that "the patient or his close relatives cannot be consulted" and fails to cover cases where informed consent has been obtained and the decision is manifestly contrary to medical science. This subject intends to investigate the different groups of patients who do not properly exercise the right to informed consent, doctors' treatment of the identification of choice, and compare the social cognitive status and the current law deviation, The purpose is to provide empirical evidence for the possibility and necessity of perfecting the relevant provisions of Tort liability Law. Methods: using literature review, relevant case analysis, questionnaire design and empirical research methods, stratified random sampling of doctors and legal persons in Chongqing, Luzhou and Zunyi, including Chongqing, Luzhou and Zunyi, was carried out. Three different groups, such as the general public (patients or family members), are based on the existing Tort liability Act, In the event of an emergency in which a patient needs immediate medical treatment in order to save his life or to preserve the functions of his or her limbs or vital organs as a result of his or her critical condition, When the patient fails to exercise the right of informed consent properly, the identification of the physician's disposal mode is investigated. The survey indexes mainly include the identification and selection of the six presupposition treatments, and compare the differences among different groups, regions and different choices. The sample size was calculated by pre-survey, and the statistical analysis was carried out by using the row 脳 list 蠂 2 test or the Fisher exact probability method of two-way disordered R 脳 C table. The difference was statistically significant (P0.05). The total rate was calculated by sample rate and the 95% confidence interval was estimated by using 0.05 bilateral test level. Combined with the investigation results and legal theory analysis, further put forward the specific treatment suggestions and procedures. Results: the estimated minimum sample size was 406 cases, the questionnaire 600 cases, the effective recovery 559 cases, the recovery rate 93%. All kinds of presupposition: the differences of the three groups were statistically significant (P0.05), while the differences of the three regions were not statistically significant (P0.05). According to "respect (/ wait) patient (/ family) opinion" or "respect doctor's opinion" combined data analysis suggested that: when the patient refused to rescue and the family agreed to rescue or the patient had no ability to express the meaning of the combination (family refused to rescue, The majority of the people surveyed chose to "respect the doctor's opinion" (the percentage of the selected people was: 65.47%, 58.68% and 72.81%), and 82.11% of the respondents chose to "respect the opinion of the doctor". 93.20%) When the patient has no ability to express his will, the family refuses to rescue or the family members disagree with each other, and the respondents who choose to respect the doctor's opinion tend to participate in the decision through the third party organization. Conclusion: except for the patients and their families who refuse to rescue, different social groups agree that the right to informed consent should be restricted when the patient is in a critical condition and cannot obtain effective informed consent. The right to life and health should be given priority and emergency treatment as appropriate. Relevant existing laws need to be improved: (1) to make clear that "close relatives' opinions obviously violate medical science or medical ethics when the patient is in critical condition" should be regarded as conforming to the provisions of Article 56 of the Tort liability Law; (2) to include emergency medical treatment as a statutory reason for exemption, and to reduce the liability for the damage caused by it moderately; (3) to judge the patient's ability to express his will according to the standard of complete civil capacity; (4) establish supervision mechanism of emergency treatment in medical institutions to avoid abuse of rights.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：D923;R-051

【相似文献】