医疗告知义务研究
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摘要
长期以来,由于在医疗服务过程中过分地强调技术因素和设备因素,忽视对患者的人文关怀,某些医务工作者缺乏基本的人文素质和修养,与病人难以进行有效地沟通。沟通,是构建和谐医患关系的重要途径。在沟通过程中,医疗机构及医务人员正确地履行告知义务,使患者或其近亲属了解与疾病的诊断、治疗相关的信息,可以有效地改善医患关系,减少医疗纠纷的发生。
从法理意义的角度上看,告知和知情是一对相互矛盾、互为制约的对立统一体,是法学意义上权利义务互为满足、转化的过程。知情同意权是患者权利实现的基础,它赋予患者自主选择并决定自我医疗的权利[3],是有效防范医疗侵权行为的一种手段。医疗告知是建立医患契约关系的必要条件,也是现代医患关系模式发展的内在要求。
医疗告知存在的问题是引起医疗纠纷的重要原因,主要有:告知不规范、知情同意分离、医患双方理解存在偏差、患方医学知识欠缺等。未履行告知义务或告知内容不充分可能会导致医疗机构的风险增加,所以正确地履行告知义务可以明显降低医疗纠纷的风险。医疗告知义务是公民知情同意权力实现的基础,它能平衡医患双方的信息不对称,防范医疗侵权行为,其实质是维护患者的知情权、选择权和同意权,目的是加强医患之间的沟通、建立良好的医患关系,保证正常的医疗秩序,促进医疗卫生事业健康发展。
本文从医疗告知的主体、对象、内容、告知方式和标准、告知时间等方面阐述医疗机构及医务人员履行医疗告知的相关内容,结合典型案例,分析现行法律对医疗告知规定的缺陷及医方履行告知义务过程中存在的问题,并分析其原因。最后通过上述问题的分析,结合实际情况和相关理论,提出完善医疗告知的措施和建议。
目的:
通过对医疗告知的对象、内容、方式、法律责任承担等方面的研究,分析现行法律对医疗告知规定的缺陷、医方履行告知义务存在的问题,提出完善医疗告知的措施。以实现医患之间良好的沟通,缓解日趋紧张的医患关系,达到减少医疗纠纷的目的。
方法:
本文采用文献研究法、案例分析法、演绎归纳法等研究方法,通过阅读相关书籍和论文,分析由于未履行告知义务或告知不充分所引发的医疗纠纷案例,针对医疗机构医务人员在履行医疗告知义务时存在的不足,提出完善医疗告知义务的比较明确、详细的对策和建议。
结果和结论:
本文在阅读了大量的国内外相关文献的基础上,针对目前有关医疗告知理论研究中存在的不足,提出自己的意见。对我国现有法律法规中有关医疗告知规定存在的问题,结合我国国情和社会现状,提出进一步完善相关立法的建议。为医疗机构正确履行告知义务提供可以操作的方法、对策。
For a long time, because of excessively emphasize technical factors and equipment factors in the medical service process, ignore the humanistic care to patients, some medical workers lack of basic humanistic quality and accomplishment, and can not effectively communicate with the patients. Communication, is an important ways to building a harmonious physician-patient relationship. In communication, medical institutions and medical staffs to correct inform obligation, make patients or their close relatives to understand the relevant information with disease diagnosis, treatment, can effectively improve the physician-patient relationship, reduce the occurrence of medical disputes.
From the angle of legal significance, inform and informed is a pair of contradictory unity of opposites, mutual restrictions on the meaning, is legal rights and obligations, the process of mutual satisfaction, transformation. Informed consent right is the realization patients' rights, it will give patients the right to decide and independently choose the right to self, it is an effective method to avoid medical infringement. Medical inform not only is the necessary conditions to establish the physician-patient contractual relationships, but also the modern physician-patient relationship model development intrinsic requirement.
Some problems of medical inform are the main reason cause of medical disputes, mainly:inform not norm and informed consent separation, physician and patient have understand deviation, the patient lack of medical knowledge ,etc. Fails to fulfill inform obligation or inform content not completely could lead to increased risk of medical institutions, so standard to perform inform obligation can be cut down the risk of medical disputes obviously. Medical inform obligation is the basis of realize the informed consent, its power can balance the physician-patient information asymmetry, prevent medical infringement, its essence is maintaining the right to be informed, the option right and the agreement right, the purpose is to strengthen the communication between the physician with the patient, establishing a good physician-patient relation,ensure normal medical order, and to promote the healthy development of public health care.
This paper will discuss from the medical inform object, content, inform mode and standards, the inform time, implementing the situation of medical inform in medical institutions, and combining with China's existing laws and regulations, to discuss the medical inform obligation in legal level. Analysis of the implementation of the medical inform of the positive influence to improve physician-patient relationship. Examples of the latest case, analyzes the current medical care inform obligation of inadequate and analyze reasons. Finally, through the analysis of medical inform behavior, and connecting with the practice and related theory, will give some suggestions and measures to reduce the medical risk in actual operation.
Purpose:
Through research of the medical inform object, content, way and legal liability, and other aspects of the research, and to know the defects that exist in the current law on medical inform performance, the medical institutions and medical staff inform obligation existing problems, and puts forward the measures of improving medical inform, in order to realize the good physician-patient communication, alleviate the increasingly nervous physician-patient relationship, reduce the medical disputes.
Methods:
This paper adopts the literature method, case analysis method, deduce induction method, by reading related books and papers,analysis the medical dispute cases which due to not perform inform obligation or fails to perform a fully informed, in view of the medical institutions and medical staffs have shortcomings in medical inform obligation in the perfect medical treatment, and puts forward the inform obligation to clear, detailed measures and suggestions.
Results and conclusion:
This paper through in reading a lot of related literature of our country and other countries, and according to the deficiency on the basis of the theory in the medical inform, proposed own opinions. According to the related provisions' problems on our country's existing laws and regulations in medical inform, combine with China's national conditions and social situation, proposed further perfect the relevant legislation suggestion. To provide operational methods and countermeasures for medical institutions right inform obligation.
从法理意义的角度上看,告知和知情是一对相互矛盾、互为制约的对立统一体,是法学意义上权利义务互为满足、转化的过程。知情同意权是患者权利实现的基础,它赋予患者自主选择并决定自我医疗的权利[3],是有效防范医疗侵权行为的一种手段。医疗告知是建立医患契约关系的必要条件,也是现代医患关系模式发展的内在要求。
医疗告知存在的问题是引起医疗纠纷的重要原因,主要有:告知不规范、知情同意分离、医患双方理解存在偏差、患方医学知识欠缺等。未履行告知义务或告知内容不充分可能会导致医疗机构的风险增加,所以正确地履行告知义务可以明显降低医疗纠纷的风险。医疗告知义务是公民知情同意权力实现的基础,它能平衡医患双方的信息不对称,防范医疗侵权行为,其实质是维护患者的知情权、选择权和同意权,目的是加强医患之间的沟通、建立良好的医患关系,保证正常的医疗秩序,促进医疗卫生事业健康发展。
本文从医疗告知的主体、对象、内容、告知方式和标准、告知时间等方面阐述医疗机构及医务人员履行医疗告知的相关内容,结合典型案例,分析现行法律对医疗告知规定的缺陷及医方履行告知义务过程中存在的问题,并分析其原因。最后通过上述问题的分析,结合实际情况和相关理论,提出完善医疗告知的措施和建议。
目的:
通过对医疗告知的对象、内容、方式、法律责任承担等方面的研究,分析现行法律对医疗告知规定的缺陷、医方履行告知义务存在的问题,提出完善医疗告知的措施。以实现医患之间良好的沟通,缓解日趋紧张的医患关系,达到减少医疗纠纷的目的。
方法:
本文采用文献研究法、案例分析法、演绎归纳法等研究方法,通过阅读相关书籍和论文,分析由于未履行告知义务或告知不充分所引发的医疗纠纷案例,针对医疗机构医务人员在履行医疗告知义务时存在的不足,提出完善医疗告知义务的比较明确、详细的对策和建议。
结果和结论:
本文在阅读了大量的国内外相关文献的基础上,针对目前有关医疗告知理论研究中存在的不足,提出自己的意见。对我国现有法律法规中有关医疗告知规定存在的问题,结合我国国情和社会现状,提出进一步完善相关立法的建议。为医疗机构正确履行告知义务提供可以操作的方法、对策。
For a long time, because of excessively emphasize technical factors and equipment factors in the medical service process, ignore the humanistic care to patients, some medical workers lack of basic humanistic quality and accomplishment, and can not effectively communicate with the patients. Communication, is an important ways to building a harmonious physician-patient relationship. In communication, medical institutions and medical staffs to correct inform obligation, make patients or their close relatives to understand the relevant information with disease diagnosis, treatment, can effectively improve the physician-patient relationship, reduce the occurrence of medical disputes.
From the angle of legal significance, inform and informed is a pair of contradictory unity of opposites, mutual restrictions on the meaning, is legal rights and obligations, the process of mutual satisfaction, transformation. Informed consent right is the realization patients' rights, it will give patients the right to decide and independently choose the right to self, it is an effective method to avoid medical infringement. Medical inform not only is the necessary conditions to establish the physician-patient contractual relationships, but also the modern physician-patient relationship model development intrinsic requirement.
Some problems of medical inform are the main reason cause of medical disputes, mainly:inform not norm and informed consent separation, physician and patient have understand deviation, the patient lack of medical knowledge ,etc. Fails to fulfill inform obligation or inform content not completely could lead to increased risk of medical institutions, so standard to perform inform obligation can be cut down the risk of medical disputes obviously. Medical inform obligation is the basis of realize the informed consent, its power can balance the physician-patient information asymmetry, prevent medical infringement, its essence is maintaining the right to be informed, the option right and the agreement right, the purpose is to strengthen the communication between the physician with the patient, establishing a good physician-patient relation,ensure normal medical order, and to promote the healthy development of public health care.
This paper will discuss from the medical inform object, content, inform mode and standards, the inform time, implementing the situation of medical inform in medical institutions, and combining with China's existing laws and regulations, to discuss the medical inform obligation in legal level. Analysis of the implementation of the medical inform of the positive influence to improve physician-patient relationship. Examples of the latest case, analyzes the current medical care inform obligation of inadequate and analyze reasons. Finally, through the analysis of medical inform behavior, and connecting with the practice and related theory, will give some suggestions and measures to reduce the medical risk in actual operation.
Purpose:
Through research of the medical inform object, content, way and legal liability, and other aspects of the research, and to know the defects that exist in the current law on medical inform performance, the medical institutions and medical staff inform obligation existing problems, and puts forward the measures of improving medical inform, in order to realize the good physician-patient communication, alleviate the increasingly nervous physician-patient relationship, reduce the medical disputes.
Methods:
This paper adopts the literature method, case analysis method, deduce induction method, by reading related books and papers,analysis the medical dispute cases which due to not perform inform obligation or fails to perform a fully informed, in view of the medical institutions and medical staffs have shortcomings in medical inform obligation in the perfect medical treatment, and puts forward the inform obligation to clear, detailed measures and suggestions.
Results and conclusion:
This paper through in reading a lot of related literature of our country and other countries, and according to the deficiency on the basis of the theory in the medical inform, proposed own opinions. According to the related provisions' problems on our country's existing laws and regulations in medical inform, combine with China's national conditions and social situation, proposed further perfect the relevant legislation suggestion. To provide operational methods and countermeasures for medical institutions right inform obligation.
引文
1袁耀钦.医疗告知及其医疗纠纷的相关性研究[D].吉林大学.2007.
2李桂杰.医疗机构的告知义务与患者知情同意权的现状分析[D].吉林大学.2009.
3张宝珠,刘鑫.医疗告知与维权指南:知情同意权理论与实践[M].北京:人民军医出版社,2004.
4周芸玲,杨永太.医疗纠纷现状与防范[J].中国卫生事业管理,2005,3:162-163.
5曹荣桂.以医院管理年为契机提高医院医务水平[J].中国医院,2005,9(7):1-5.
6程华刚,余舰.浅论我国医疗告知制度[J].遵义医学院学报,2005,28(2):212.
7郭玲玲,朱晓卓.知情同意在医患沟通中的实践[J].中国农村卫生事业管理,2007,27(7):528-531.
8唐海洲.医疗告知与患者纠纷防范实用指南[M].第一版.黑龙江人民出版社,2006:18.
9周东海,袁申元.化解医疗纠纷的最佳途径[M].中国协和医科大学出版社.2007:36.
10杨立新.医疗侵权法律与适用[M].第1版.北京:法律出版社,2008.
11赵晓瑞.告知艺术在护理安全管理中的应用[J].中国误诊学杂志,2005,5(5):984—985.
12中华人民共和同主席令第五号.中华人民共和国执业医师法[S].1998.
13中华人民共和国国务院令第351号.医疗事故处理条例[S].2002.
14国务院令第149号.医疗机构管理条例[S].1994.
15雷锦程.医患关系中的病人权利让渡——对某些特定医疗行为的伦理及法律分析[J].医学与哲学,2002(11):23.
16郭永松.论病人权利让渡与医生告知义务[J].中国医院管理,2004,24(10):30-31.
17冯俊平.在医疗活动中医务人员必须认真履行告知义务[J].中国医院,2006,10(4) :34-36.
18陈方,谢君辉,邓利强等.我国医疗知情、同意及告知方面存在的问题[J].中国医院,2008,12(4):4-6.
19栾伟,丁学易,赵爱平.病人隐私文化在护理服务过程中的思考[J].护士进修杂志,2005.20(11):985—986.
20刘炜,徐宇杰.医疗纠纷的成因及防范[J].中国医院管理, 2005, 25(11): 47-48 .
21庄一强,钟晨,刘杰等. 5家三级医院投诉管理现状调查与分析[J].中华医院管理杂志, 2006,22(1):45-4.
22王蒂楠,杨云滨.对某综合医院315例医疗纠纷的回顾性分析[J].中山大学学报论丛,2007, 27(11):32-36.
23肖绍文,张成福,林力等.44起赔付的医疗纠纷特点分析与预防对策[J].基层医学论坛,2008,12(1):57-59.
24首都医科大学宣武医院,北京同仁医院,上海中医药大学曙光医院等.履行知情同意原则的指导意见[J].医学与哲学,2004 ,25 (9) :5- 8.
25 Vallance JH, Ahmed M, Dhillon B. Cataract surgery and consent: Recall anxiety and attitude toward trained surgeons preoperatively and postoperatively[J].Cataract Refract Surg,2004;30:1479-1485. Montgomery
26 Montgomery C, Lydon A, Lloyd K. Psychological distress among cancerpatients and informed consent[J]. Psychosom Res, 1999;46 (3):241-245.
27李克,宋才发.以案说法丛书-医疗事故纠纷案例[M].第1版.北京:人民法院出版社,2004.
28 http://news.163.com/09/1219/10/5QSVD52N000120GR.html.
29 http://news.hxyjw.com/meiti/401896/.
30陈婉珍,薛金增,李忠丽等.住院患儿人性化护理问题及分析对策[J].中华护理杂志,2005,40(6):450-452.
31陈少禹.深化改革依法执业崇尚医德注重沟通——努力构建和谐的医患关系[J].中医药管理杂志,2007,15(9):646-648.
32柴家财,王亮,杜受业.正确认识知情同意书[J].中国病案,2005,6(3):22-23.
33吕毅.充分履行知情同意权是构建和谐医患关系的基础[J].中国医院杂志,2005,9(11).
34方红丽,张桂青.知情同意所引发的医务人员心理问题原因探究[J].中国临床康复,2006,26(7):64-65.
35赵丽华.礼仪在手术室护理工作中的应用[J].中国实用护理杂志,2004,20(11A):77.
36梁维萍,郑建中,贺鹭.医生防御性医疗行为的社会成因分析[J].中华医院管理杂志,2004,20(3):132.
[1]参见《执业医师法》第26条、《医疗事故处理条例》第11条、《医疗机构管理条例》第33条、《医疗机构管理条例实施细则》第62条、《侵权责任法》第55条。
[2]储殷,谭馨海.病人家属参与医疗决定之法律研究[J].法律与科学——西北政法学院学报,2005,23(4):97-102.
[3]侯雪梅.患者的权利理论探微与实务指南[M].北京:知识产权出版社,2005:156-157.
2李桂杰.医疗机构的告知义务与患者知情同意权的现状分析[D].吉林大学.2009.
3张宝珠,刘鑫.医疗告知与维权指南:知情同意权理论与实践[M].北京:人民军医出版社,2004.
4周芸玲,杨永太.医疗纠纷现状与防范[J].中国卫生事业管理,2005,3:162-163.
5曹荣桂.以医院管理年为契机提高医院医务水平[J].中国医院,2005,9(7):1-5.
6程华刚,余舰.浅论我国医疗告知制度[J].遵义医学院学报,2005,28(2):212.
7郭玲玲,朱晓卓.知情同意在医患沟通中的实践[J].中国农村卫生事业管理,2007,27(7):528-531.
8唐海洲.医疗告知与患者纠纷防范实用指南[M].第一版.黑龙江人民出版社,2006:18.
9周东海,袁申元.化解医疗纠纷的最佳途径[M].中国协和医科大学出版社.2007:36.
10杨立新.医疗侵权法律与适用[M].第1版.北京:法律出版社,2008.
11赵晓瑞.告知艺术在护理安全管理中的应用[J].中国误诊学杂志,2005,5(5):984—985.
12中华人民共和同主席令第五号.中华人民共和国执业医师法[S].1998.
13中华人民共和国国务院令第351号.医疗事故处理条例[S].2002.
14国务院令第149号.医疗机构管理条例[S].1994.
15雷锦程.医患关系中的病人权利让渡——对某些特定医疗行为的伦理及法律分析[J].医学与哲学,2002(11):23.
16郭永松.论病人权利让渡与医生告知义务[J].中国医院管理,2004,24(10):30-31.
17冯俊平.在医疗活动中医务人员必须认真履行告知义务[J].中国医院,2006,10(4) :34-36.
18陈方,谢君辉,邓利强等.我国医疗知情、同意及告知方面存在的问题[J].中国医院,2008,12(4):4-6.
19栾伟,丁学易,赵爱平.病人隐私文化在护理服务过程中的思考[J].护士进修杂志,2005.20(11):985—986.
20刘炜,徐宇杰.医疗纠纷的成因及防范[J].中国医院管理, 2005, 25(11): 47-48 .
21庄一强,钟晨,刘杰等. 5家三级医院投诉管理现状调查与分析[J].中华医院管理杂志, 2006,22(1):45-4.
22王蒂楠,杨云滨.对某综合医院315例医疗纠纷的回顾性分析[J].中山大学学报论丛,2007, 27(11):32-36.
23肖绍文,张成福,林力等.44起赔付的医疗纠纷特点分析与预防对策[J].基层医学论坛,2008,12(1):57-59.
24首都医科大学宣武医院,北京同仁医院,上海中医药大学曙光医院等.履行知情同意原则的指导意见[J].医学与哲学,2004 ,25 (9) :5- 8.
25 Vallance JH, Ahmed M, Dhillon B. Cataract surgery and consent: Recall anxiety and attitude toward trained surgeons preoperatively and postoperatively[J].Cataract Refract Surg,2004;30:1479-1485. Montgomery
26 Montgomery C, Lydon A, Lloyd K. Psychological distress among cancerpatients and informed consent[J]. Psychosom Res, 1999;46 (3):241-245.
27李克,宋才发.以案说法丛书-医疗事故纠纷案例[M].第1版.北京:人民法院出版社,2004.
28 http://news.163.com/09/1219/10/5QSVD52N000120GR.html.
29 http://news.hxyjw.com/meiti/401896/.
30陈婉珍,薛金增,李忠丽等.住院患儿人性化护理问题及分析对策[J].中华护理杂志,2005,40(6):450-452.
31陈少禹.深化改革依法执业崇尚医德注重沟通——努力构建和谐的医患关系[J].中医药管理杂志,2007,15(9):646-648.
32柴家财,王亮,杜受业.正确认识知情同意书[J].中国病案,2005,6(3):22-23.
33吕毅.充分履行知情同意权是构建和谐医患关系的基础[J].中国医院杂志,2005,9(11).
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[1]参见《执业医师法》第26条、《医疗事故处理条例》第11条、《医疗机构管理条例》第33条、《医疗机构管理条例实施细则》第62条、《侵权责任法》第55条。
[2]储殷,谭馨海.病人家属参与医疗决定之法律研究[J].法律与科学——西北政法学院学报,2005,23(4):97-102.
[3]侯雪梅.患者的权利理论探微与实务指南[M].北京:知识产权出版社,2005:156-157.
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