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來源文獻資料
摘要
外文摘要
引文資料
題名:
病人自主與知情同意
書刊名:
醫學教育
作者:
李明濱
作者(外文):
Lee, Ming-been
出版日期:
1997
卷期:
1:4
頁次:
頁3-14
主題關鍵詞:
自主原則
;
醫主原則
;
知情同意
;
醫學倫理教育
;
Patient's autonomy
;
Paternalism
;
Informed consent
;
Medical ethics education
原始連結:
連回原系統網址
相關次數:
被引用次數:期刊(
27
) 博士論文(
3
) 專書(0) 專書論文(0)
排除自我引用:
27
共同引用:
64
點閱:11
自主原則係指患者在理性狀態下有權決定自己的行為,包括決定及選擇醫療專業人員及治療方式;醫療人員認為對患者有益的醫療行為亦應先得到患者之充分授權或認可。因此自主原則常被認為易與傳統的醫主原則相衝突,整合或協調「病人自主」與「醫主」兩大原則,有賴於良好的醫病溝通;其基本前提在於醫師應能充分提供患者可理解的病情知識與治療方法及可能引起的利與弊,以獲取病人的同意。健康照顧的基礎在於建立及尊重患者之「自主性」,本大主要以此為主軸,並以「知情同意」為範例,討論其內涵及相關之影響因素與衍生之問題。「知情同意」常用的表達方式為同意書簽署,其主要功能在於表現其對患者「自我決定權」的尊重,鼓勵患者能更積極主動地參與治療決定。簽署同意書應視為一動態「過程」,而不是一紙靜態的「證明文件」。簽署的過程包含了資訊的提供、患者之充瞭解、主動意願、同意簽署、醫事人員之教育患者而獲患者之主動同意;整個簽署過程對於治療進行通常具有正面價值。自主原則為人性醫療的根本準則,其徹底落實有賴於倫理教育品質的提昇;以個案為中心、以實例為基礎之啟發性討論式教學,配合臨床實習與督導,及師長的床邊教學與臨場示範等身教方式都是培養醫學生未來能尊重及創造患者「自主」的有效方式。
以文找文
The principle of autonomy indicates that rational individuals should be permitted to be self-determining. Respecting patients' autonomy has been considered as the basis of health care. The emphasis on autonomy in a medical ethical system asserts that the patient has the rights to make personal decisions about the health-related issues including choosing therapists, diagnostic procedures and recommended treatment modalities. However, patient's autonomous actions that harm oneself, or another, or are offensive to law and morality are not to be defended. How to integrate and balance the patient's autonumy and the professional's paternalism in patient care depends on effective patient-physician communication. This review focuses on the issues of informed consent and truth telling, which are major rules derived from the principle of autonomy. These provide a corrective mechanism to paternalism and give the pateents the opportunity and encouragement to be more actively involved in decision making. Informed consent is not only a legal doctrine, but a series of dynamic interactional processes that provids an autonomous patient with the information and understanding needed to choose autonomously to authorize a procedure. Its most important function is expressing respect for the self-determination of patients. The essential components of the consent process, all basic to clinical medicine, should contain: 1) disclosure of adequate information including recommended investigations, benefits, risks, and alternatives; 2) patient's comprehension of the provided information; and 3) voluntaries and active consent. Effective communication skill and supportive techniques on the parts of medical professionals are strongly needed to facilitate patients' understanding and willingness to give consent during the process. In addition, physicians' positive attitudes that are important to enhance the validity of informed consent include the following: emotional security about possible rejection of medical advice, readiness to accept variants of patients' personal values, acknowledging medical uncertainty, and willingness to converse patiently with the patient. It is clear that respect for patients' autonomy is necessary to ensure the quality of health care. The effective implementation of this principle depends on the education of medical students toward not only ethical reasoning, but also medical humanity. A proposed teaching strategy is to use a case-centered, problem-based, small-group tutorial mode in addition to integrated didactic lectures. Furthermore, courses that focus on the formal practice of medical ethics and medical humanity through giveing students the chance to practice and learn under the teacher's guidance in daily clinical settings are exphasized.
以文找文
期刊論文
1.
Parker, Malcolm A.(1995)。Autonomy, problem-based learning, and the teaching of medical ethics。J Med Ethics,21(5),305-310。
2.
Fox, E.、Arnold, R. M.、Brody, B.(1995)。Medical Ethics Education: Past, Present and Future。Academic Medicine,70(9),761-769。
3.
李明濱、李宇宙、林信男、謝博生、陳恆順(19970600)。利用小組教學方式實施醫學倫理教學。醫學教育,1(2),63-77。
延伸查詢
4.
Appelbaum, P. S.、Grisso, T.(1988)。Assessing patients' capacities to consent to treatment。The New England Journal of Medicine,319,1635-1638。
5.
Novack, D. H.、Freireich, E. J.、Vaisrub, S.(1979)。Changes in physicians' attitudes toward telling the cancer patient。JAMA,241,897-900。
6.
Gillon, R.(1985)。Telling the truth and medical ethics。Br. Med. J.,291,1556-1557。
7.
Oken, D.(1961)。What to tell cancer patients。JAMA,175,1120-1128。
8.
Miles, S. H.、Lane, Weiss L.、Bickel, J.、Walker, R. M.、Cassel, C. K.(1989)。Medical ethics education: coming of age。Acad Med,64(12),705-714。
9.
Thomasma, D. C.(1983)。Beyond medical paternalism and patient autonomy: a model of physician conscience for the physician-patient relationship。Annals of Internal Medicine,98(2),243-248。
10.
戴正德(19970300)。Medicine and Morality。醫學教育,1(1),11-20。
延伸查詢
11.
Veatch, R. M.、Sollito, S.(1976)。Medical ethics teaching: report of a national survey。JAMA,235,1030-1033。
12.
Mitchell, K. R.、Lovat, T. J.、Myser, C. M.(1992)。Teaching bioethics to medical students: the Newcastle experience。Med Educ,26(4),290-300。
13.
Childress, J. F.(1990)。The place of autonomy in bioethics。Hastings Center Report,20,12-47。
14.
Brody, H.(1989)。Transparency: informed consent in primary care。Hastings Center Report,19,5-9。
15.
Leeder, S.、Little, J. M.(1996)。Logic, hermeneutics, and informed consent。European J Surgery,162,3-10。
16.
Finkelstein, D.、Smith, M. K.、Faden, R.(1993)。Informed consent and medical ethics。Arch Ophthalmol,111,324-326。
17.
Cassileth, B. R.、Zupkis, R. V.、Sutton Smith, K.、March, V.(1980)。Informed consent--why are its goals imperfectly realized?。New England Journal of Medicine,302(16),896-900。
18.
Katz, J.(1986)。Informed consent: are "miracle, mystery and authority" better medicine?。Conneticut Med,50,457-460。
19.
Kraushar, M. F.、Steinberg, J. A.(1986)。Informed consent。Arch Ophthalmol,104,352-355。
20.
Appelhaum, P. S.、Roth, L.(1981)。Clinical issues in the assessment of competency。Am J Psychiatry,138,1462-1467。
21.
Lee, M. B.、Hsieh, B. S.(1997)。Medical humanity and medical education。J Med Educ,3,353-355。
22.
Shatz, D.(1986)。Autonomy beneficence and informed consent: rethinking the connections。Cancer Investigation,4(3),257-269。
23.
Silva, M. C.、Sorrell, J. M.(1984)。Factors influencing comprehension of information for informed consent: ethical implications for nursing research。Intern Journay Nursing Studies,21(1),233-240。
圖書
1.
嚴久元(1990)。當代醫事倫理學。橘井文化。
延伸查詢
2.
Munson, R.(1996)。Intervention and Reflection: Basic Issues in Medical Ethics。Wadsworth Publishing Company。
3.
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research(1983)。Deciding to Forego Life-Sustaining Treatment。Washington, DC:U.S. Government Printing Office。
4.
English, D. C.(1994)。Bioethics。New York:W. W. Norton Company, Inc.。
5.
Northhouse, P. G.、Norlhouse, L. L.(1992)。Health Communication。Norwalk:Appleton & Lange。
6.
Annas, G.(1988)。Judging Medicine。Clifton, NJ:Humana Press。
7.
Jaksa, J. A.、Pritchard, M. S.(1998)。Communication Ethics: Methods of Analysis。Belmont, CA:Wadsworth Publishing Company。
8.
Goodwin, G. L.(1984)。Ethics in medicine。Duluth, MN:College of St. Scholastica。
9.
Jonsen, A. R.、Siegler, M.、Winslade, W. J.(1982)。Clinical Ethics。New York:MacMillan Publishing Co. Inc.。
圖書論文
1.
Beauchamp, T. L.、Childress, J. F.(1994)。Respect for autonomy。Principles of Biomedical Ethics。New York:Oxford University Press。
2.
Veatch, R. M.(1981)。Why not always benefit the patient: personal and social consequence。A Theory of Medical Ethics。New York:Basic Books。
3.
Engelhardt, H. T. Jr.(1986)。The principle of bioethics。The Foundations of Bioethics。New York:Oxford University Press。
4.
Childress, J. F.(1979)。Paternalism and health care。Medical Responsibility。New Jersey:Humana Press。
5.
Szasz, T. S.、Hollender, M. H.(1975)。A contribution to the philosophy of medicine: the basic models of the doctor-patient relationship。Medical Behavioral Science。Philadelphia:W. B. Saunders。
6.
Auerbach, V. S.、Banja, J. D.(1993)。Competency determinations。Medical Psychiatric Practice。Washington, DC:American Psychiatric Press, Inc.。
7.
Siegler, M.、Goldblatt, A. D.(1981)。Clinical intuition: a procedure for balancing the rights of patients and the responsibilities of physicians。The Law-Medicine Relation: A Philosophical Exploration。Dordrecht:D. Reidel Publishing Co.。
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