scholarly journals 臨床知情同意在中國的一些實踐及反思

2013 ◽  
Vol 11 (1) ◽  
pp. 21-32
Author(s):  
Wenqing ZHAO
Keyword(s):  
Clinical Practice ◽  
Informed Consent ◽  
Individual Autonomy ◽  
Clinical Practices ◽  
Empirical Reality ◽  
Medical Practitioners ◽  
Republic Of China ◽  
Institutional Settings ◽  
Digital Commons ◽  
History Of

LANGUAGE NOTE | Document text in Chinese; abstract also in English.“患者利益至上”知情同意是當代西方生命倫理學的一個核心概念，在規範臨床醫療實踐中的應用十分廣泛，相關的法規和指引更是層出不窮。隨著自由主義理論和權利觀念在全世界範圍內的流行，中國也開始注意到知情同意原則在臨床實踐中的重要意義，並逐步引入西方的相關規範。然而，大部分規範的制定缺乏對知情同意倫理基礎的考察，對臨床知情同意在中國的實踐也沒有足夠的關注。本文分析作為知情同意的道德基礎，並通過對一線醫務工作人員的訪談，了解臨床知情在中國實踐情況及限制，希望能為相關規範的制定提供一些思路。Informed consent is considered to be one of the most important conceptual developments in contemporary bioethics, and is strongly implicated in the regulation of clinical practices in the West. Over the past decade, the growing prevalence of both liberal arguments supporting individual autonomy and rights-based debates focusing on equality has brought the concept of informed consent into the purview of Chinese legislation pertaining to healthcare and clinical practice. However, most of the laws and regulations are made by Chinese authorities in ignorance of the concept’s ethical groundings. In addition, lawmakers have not taken into account the empirical reality and specific situations of clinical practice in contemporary China. This essay contends that the history of informed consent legislation in China since 1994, exemplified by the recently adopted Article 55 of the Tort Law of the People’s Republic of China, reveals conflicting understandings of the ethical foundation of the notion of informed consent. The essay also presents extensive interviews conducted by the author with four frontline medical practitioners in first-tier cities that demonstrate how their experiences with informed consent are largely shaped by current institutional settings and influenced by traditional Confucian ethical norms, (e.g., an emphasis on interdependence among family members, which requires the doctor to consult with the family rather than the patient). The essay concludes that we must take into serious consideration the Chinese ethical tradition and its unique application in practice when cross-fertilizing the concept of informed consent.DOWNLOAD HISTORY | This article has been downloaded 116 times in Digital Commons before migrating into this platform.

scholarly journals 知情同意臨床實踐實證研究——第一人稱視角的考察

2017 ◽  
Vol 15 (2) ◽  
pp. 9-20
Author(s):  
Hua CHEN ◽  
Yonghui MA
Keyword(s):  
Informed Consent ◽  
Individual Autonomy ◽  
Medical Treatments ◽  
Legal Implications ◽  
Patient’S Autonomy ◽  
Digital Commons ◽  
Consent Document ◽  
Informed Consent Document ◽  
China Today ◽  
Medical Policy

LANGUAGE NOTE | Document text in Chinese; abstract also in English.知情同意作為一項權利，患者成為闡述其體驗的首要主體。實證調查表明，患者對於其權利認知還存在不足，多數偏好於患者與家庭共用模式；在實踐中，知情與同意在主體層面存在分離現象。對於病情的告知傾向於任選模式，但家庭是不可或缺的告知物件，對於診療、護理等相關資訊，傾向於患者模式；在同意方面，家屬成為獲取同意的主體。經濟因素成為患方“不同意”的首要原因。對於不同維度的調查表明，基於女性相對脆弱性特點，他們對於家庭的依賴性更強，其維權意識更強；在年齡層面，青少年對於權利的認知更理性，具有現代契約精神。在地域層面，縣級以上城市居民對於權利認知度更高；職業往往與教育程度相關，表明農民的個體依賴性更強；政府機關以及事業單位人員個體主體性更強。為此，需要加強患者權利教育，提升主體意識；對醫務人員加強職業道德教育，履行告知義務，強化醫患信任；深化醫療衛生體制改革，為知情同意的踐行提供空間與時間。An informed consent document is vital for all surgical procedures and medical treatments. Proper documentation and counseling of patients is important for informed consent. Opinion polls conducted in this essay show that the majority of people in China today have accepted informed consent as a legally binding medical policy, yet they do not fully understand the ethical and legal connotations involved, particularly the idea of the patient’s autonomy. As a result, the patient’s own experience as a first-person narrative is often ignored and his/her subjectivity is blurred when his/her family’s subjectivity intervenes. According to the essay, the problem appears when liberalism—which emphasizes individual autonomy and rights—does not square with the Confucian tradition that emphasizes family as a coherent unit. The essay also points out that there is a huge difference in patients’ perceptions of “individual rights,” due to their different levels of education. The author argues that informed consent could be better practiced if both doctors and patients were “well informed” and understood the moral and legal implications of informed consent.DOWNLOAD HISTORY | This article has been downloaded 97 times in Digital Commons before migrating into this platform.

scholarly journals 知情同意臨床實踐中倫理學技術研究

2002 ◽  
Vol 4 (2) ◽  
pp. 38-48
Author(s):  
Guobin CHENG
Keyword(s):  
Clinical Practice ◽  
Informed Consent ◽  
Logical Consequence ◽  
Field Research ◽  
Fundamental Rights ◽  
Self Determination ◽  
Cultural Traditions ◽  
Digital Commons ◽  
The Right ◽  
Theoretical Issues

LANGUAGE NOTE | Document text in Chinese; abstract also in English.具體實踐中的知情同意是一種倫理學技術，注重利用現有的文化傳統、理論資源和法律工具，合理有效地分析問題、解決問題，強調它作為體現對病人基本權利的尊重和調節醫患關係手段的作用。在民主社會，知情同意乃是建立醫患權責餘的必要條件。知情同意來自於醫療活動的自發秩序：醫患雙方通過知情同意活動，明確醫療活動中雙方的權利和責任界限，進行有成效的醫療實踐。知情同意既是對基本人權的尊重，又是確保雙方責任的工具。具體實踐中的知情同意，提供一種促進多種價值觀和平共存、通過學習和對話實現平衡的運行機制，在社會整體利益優先與個人最基本權利不可侵犯的框架下滿足雙方不同的價值需求。臨床“知情同意”活動的目的在於：促進患者自主權的行使；明晰醫療活動中的權責關係，在合法限度內為醫療活動的正常進行提供保護。實踐中追求資訊的“充分”取決於患方要求的“主觀的充分”。臨床醫療活動中，醫方要不斷提高患方知情的充分程度。隨著知情程度的增加，患方自主程度隨之自動上升。目前關於“知情向意”的理論研究中，缺少對知情同意的狀況、分佈及相關因素的實地調查和量化分析，研究多集中在道德、文化理論上，實踐策略的指導意義不強。應當把知情同意視作貫穿於整個臨床醫療活動的一個連續的整體。要關注本社區成員的文化和心理結構的特殊性，從本社區歷史特點出發，建立本社區知情同意情況的常規模式和量化標準。還應當設計臨床知情同意調查制度，作為醫方制定知情同意策略的依據，同時又可作為說明醫療活動發生的真實過程的法律檔。Informed consent is an ethical technique which emphasizes using the existing cultural traditions, theoretical resources and legal instruments to analyze and solve the problems reasonably and effectively. Informed consent can thus play a significant role in adjusting the relationship between patients and physicians. As an ethical technique, it focuses on the method of applying various ethical resources and not simply on the combination of the logical consequence and criteria. In a democratic society, informed consent is a necessary requirement for the right-duty relationship between patients and physicians. Informed consent is seen as a prerequisite obligation to physicians and implies certain rights for patients. Patients and physicians are bound by informed consent so that they are able to "trade" equally. Informed consent is not only a means to confirming the property rights but also a tool of reducing the costs of "trade". In practice, informed consent helps to promote and achieve the peaceful co-existence of pluralistic values. It can do so by learning and having conversations with the other sides so that different parties can satisfy under the framework which gives priority to the total interests of society and guarantees the fundamental rights of individuals.The aims of informed consent in clinical practice are to promote the self-determination of patients and to clarify rights and duties in medical activities. In practice, the sufficiency of information depends on the subjective sufficiency of patients. Physicians should ensure that the patient comprehend the information and follow the appropriate procedure to manage and supervise. The most active method for physician to take is to increase the degree of informational sufficiency. The degree of the patient's self-determination increases accordingly with the increase of informational sufficiency. Their relationship can be described by a curve like "S".The current studies on informed consent in China lack the empirical data from field research. Most studies focus on the theoretical issues of morality and culture. As a result, research results are hardly applicable in clinical practice. Informed consent should a holistic entity in clinical practice. We should pay more attention to the specificity of the cultural and psychological structure of members of every community. We should establish the ordinary model and criteria of informed consent in the particular community. We should also design an applicable and legally-bond system of informed consent to regulate clinical practice.DOWNLOAD HISTORY | This article has been downloaded 13 times in Digital Commons before migrating into this platform.

scholarly journals 知情同意的權利主體: 儒家倫理視角下的考察

2008 ◽  
Vol 6 (1) ◽  
pp. 17-28
Author(s):  
Tongwei YANG ◽  
Zhangqi FENG
Keyword(s):  
Informed Consent ◽  
Family Relationship ◽  
Family Values ◽  
Reciprocal Relationship ◽  
Confucian Ethics ◽  
Individual Autonomy ◽  
Digital Commons ◽  
The Family ◽  
Physician Relationship ◽  
The Right

LANGUAGE NOTE | Document text in Chinese; abstract also in English.“ 知情同意”這個在西方文化背景中產生的倫理和法律術語在中國仍然是一個比較新的概念。尤其是對於知情同意的權利主體這一基本問題，在立法實踐和臨床實務中仍存在認識模糊和不一致之處。本文基於儒家家庭倫理的基本精神——尊重個人意願與家庭關懷的統一，提出了關於知情同意權利主體的立法建議。在儒家倫理中，主張“和而不同”、“互以對方為重”，體現了尊重個人意願的思想。在儒家倫理中還主張“父慈子孝”、“兄友弟恭”、“夫婦和順”，體現了家庭關懷。可見，在儒家倫理視野下，知情同意權利並非由家屬包辦，也非僅僅屬於患者而和家庭無關，而是在患者做主前提下的家庭參與，是患者做主與家庭關懷的統一。所以，對於有同意能力的患者而言，其本人所作的同意表示才具有法律效力；只有在某些特殊的情形下患者家屬才可以代為簽署知情同意書或者代行知情同意權利。Informed consent has been a core principle endorsed by modern Western medical ethics. It involves patient-physician relationship as well as family relationship. It has been a focus of debates since it was introduced to the Chinese world whether informed consent is agreeable to the cultural ethos of China, and if not, whether it can be applied transculturally. This paper first discusses three principles in the policy of informed consent: 1. the principle of individual autonomy; 2. the principle of non-maleficence; and 3. the principle of effectiveness. Then the paper explores the issue informed consent within the framework of the Confucian concept of family and family values, indicating that in Confucian ethics, the idea of“ harmony in diversity” acknowledges the importance of individuality whereas the notion of reciprocal relationship emphasizes the interconnectedness of everyone in family and society at large. We should always look for a balanced point between the right of the patient and the duty of the physician, and between the interest of an individual person and the interest of the family as a unit.DOWNLOAD HISTORY | This article has been downloaded 183 times in Digital Commons before migrating into this platform.

scholarly journals 履行知情同意原則在中國傳統倫理下的困境

2008 ◽  
Vol 6 (1) ◽  
pp. 29-49
Author(s):  
Yan LI
Keyword(s):  
Informed Consent ◽  
Medical Information ◽  
Sense Of Self ◽  
Well Being ◽  
Individual Autonomy ◽  
Traditional Values ◽  
Moral Framework ◽  
Digital Commons ◽  
The Family ◽  
Communal Responsibility

LANGUAGE NOTE | Document text in Chinese; abstract also in English.知情同意是尊重人的自主原則在診療環節的重要實踐，也是當代生命倫理學的重要組成之一，但在中國的履行卻體現出與其在西方社會建立起來的原有狀態中不同的特色。本文試圖探討形成這樣的特色與中國傳統倫理因素——例如“儒家、道家”——之間的關係，挖掘其可能的思想、制度、倫理淵源。在文章的最後，還對中國傳統倫理在當代正在發生變革的現狀及其對履行知情同意原則的積極作用進行了簡單的闡釋。The informed consent has been practiced as a clinical and ethical principle for many years in China. With traditional emphasis on the family as a whole and a hierarchical social structure there is a strong ethic of indebtedness and obligations for one family member to others. Within this moral framework there is a special need for evoking a sense of self-restraint and communal responsibility towards the well-being of a family instead of an individual. As a result, the implementation of the informed consent in China sometimes takes a different direction. This paper intends to explore how traditional values systems, namely Confucianism, Daoism, Buddhism inf luence the way of the informed consent is interpreted and practiced. The paper has offered several specific medical cases to show the diff iculties in excising the principle of informed consent due to an absence of individual autonomy needed for a general requirement of competency and a lack of public medical information. Finally, I shall discuss the possibility of“ modernizing” traditional ethics.DOWNLOAD HISTORY | This article has been downloaded 146 times in Digital Commons before migrating into this platform.

The History of the Psychopharmacology of Schizophrenia

1997 ◽  
Vol 42 (2) ◽  
pp. 152-162 ◽  
Author(s):  
Heinz E Lehmann ◽  
Thomas A Ban
Keyword(s):  
Clinical Practice ◽  
Literature Review ◽  
Drug Treatment ◽  
Historical Development ◽  
Antipsychotic Drugs ◽  
Theoretical Models ◽  
Clinical Practices ◽  
Close Collaboration ◽  
Psychopharmacological Treatment ◽  
History Of

Objective: To review the historical development of the psychopharmacological treatment of schizophrenia. Method: A chronological literature review of the clinical practices and theoretical models that have controlled drug treatment of schizophrenia at different times. Results: Effective treatment of schizophrenia was achieved only after the introduction of antipsychotic drugs, in the 1950s, and is still progressing. Conclusion: Close collaboration between basic neuroscience and careful and informed clinical practice are likely to lead to continued progress.

Informed Consent in Clinical Practice

1990 ◽  
Vol 35 (1) ◽  
pp. 38-39
Author(s):  
Stephen L. Golding
Keyword(s):  
Clinical Practice ◽  
Informed Consent

Klein with Lacan: A Study on the Reception of Lacanian Ideas in Uruguay and Its Effects on Clinical Practices (1955–82)

2020 ◽  
Vol 22 (3) ◽  
pp. 341-361
Author(s):  
Gonzalo Grau-Pérez ◽  
J. Guillermo Milán
Keyword(s):  
Clinical Practice ◽  
Clinical Material ◽  
Clinical Practices ◽  
Before And After ◽  
The Difference ◽  
The 1960S ◽  
The Relationship ◽  
Discursive Approach ◽  
The Way ◽  
Clinical Cases

In Uruguay, Lacanian ideas arrived in the 1960s, into a context of Kleinian hegemony. Adopting a discursive approach, this study researched the initial reception of these ideas and its effects on clinical practices. We gathered a corpus of discursive data from clinical cases and theoretical-doctrinal articles (from the 1960s, 1970s and 1980s). In order to examine the effects of Lacanian ideas, we analysed the difference in the way of interpreting the clinical material before and after Lacan's reception. The results of this research illuminate some epistemological problems of psychoanalysis, especially the relationship between theory and clinical practice.

Out of War

2018 ◽  
Author(s):  
Mariane C. Ferme
Keyword(s):  
Sierra Leone ◽  
Red Cross ◽  
Cultural Survival ◽  
Social Fabric ◽  
Rural Landscapes ◽  
Republic Of China ◽  
Liminal Spaces ◽  
Humanitarian Interventions ◽  
Sensory History ◽  
History Of

Out of War is an ethnographic engagement with the nature of intercommunal violence and the material returns of history during and after the 1991–2002 Sierra Leone civil war. The questions raised concern the nature and reckoning of time and reality, fact and fiction; the experience of violence and trauma; the reversibility of perpetrator and victim, friend and enemy; and past, present, and future in the colony and postcolony. The book is a reflection on West African epistemologies and ontologies that contribute to questions in counterpoint with those of international humanitarianism, struggling with the possibilities of truth and quandaries of justice. In the context of massive population displacements and humanitarian interventions, the ethnography traces strategies of psychological, political, and cultural survival and material dwelling in liminal spaces in the midst of the destruction of the social fabric engendered by war. It also examines the juridical creation of new figures of crimes against humanity at the Special Court for Sierra Leone. The Sierra Leone scene, in the aftermath of war, is visualized as a landscape of chronotopes, neologisms that summon the uncertainty of war: the sobel (“soldier by day, rebel by night”), pointing to the instability of distinctions between enemy and friend, or of opposing parties in the war (the rebels of the Revolutionary United Front [RUF] and soldiers in the national army), and the rebel cross, pointing to the possibility that the purported neutrality of the Red Cross masked partisan interests alongside the RUF. Chronotopes also testify to the difficulty of discerning between facts and rumors in war, and they freeze in time collective anxieties about wartime events. Finally, beyond the traumas of war, the book explores the returns of material traces in counterpoint to the more “monumental” presence of Chinese investments in Africa today, and it explores the forgotten sensory history of another China (Taiwan versus the People’s Republic of China) and another Africa inscribed in ordinary agrarian practices on rural landscapes, and in the fabric of domestic life, particularly since the non-aligned movement emerged from the Bandung conference in 1955.

ПАТОЛОГИЯ ЛИЧНОСТИ В ТЕОРЕТИЧЕСКИХ ПОСТРОЕНИЯХ ПРЕДСТАВИТЕЛЕЙ ОТЕЧЕСТВЕННОЙ МЕТАФИЗИЧЕСКОЙ ТРАДИЦИИ В ПСИХОЛОГИИ

1970 ◽  
Vol 7 (1) ◽  
pp. 208-215
Author(s):  
Александр Бреусенко-Кузнецов
Keyword(s):  
Clinical Practice ◽  
Subject Matter ◽  
Clinical Psychology ◽  
History Of Psychology ◽  
History Of ◽  
Metaphysical Tradition ◽  
The Given

Статья посвящена проблеме восстановления искусственно прерванной метафизической традиции в отечественной персонологии. Данная проблема принадлежит областям истории психологии и психологии личности, но имеет выходы и в предметные области многих других психологических наук, в частности – клинической психологии. Указана важность соотнесения персонологических концептуализаций учёных-метафизиков с клинической практикой в процессе их опытной верификации. Проведена реконструкция и анализ взглядов на психопатологию и психотерапию представителей метафизической традиции в отечественной психологии личности. Согласно данным взглядам, суть патологии личности – в её уклонении от своего назначения, от подлинного бытия ради неподлинных, онтологически неоправданных форм жизнедеятельности. The article is devoted to the problem of restoration of artificialy interrupted metaphysical tradition in domestic personology. The given problem belongs to the areas of history of psychology and psychology of personality, but provides outcomes in subject matter of many other psychological sciences, in clinical psychology in particular. Importance of correlation between personological conceptualizations of scientists-metaphysicists and clinical practice in the process of their skilled verification is pointed out. The reconstruction and analysis of views at psychopathology and psychotherapy by representatives of metaphysical tradition in domestic psychology of personality have been made. According to the mentioned views, the essence of pathology of personality is in its evasion from the purpose, from original life for the sake of not original, ontologically unjustified forms of ability to live.

Sign in / Sign up

Export Citation Format

Share Document