权益冲突:医疗中知情同意权行使的困境与出路
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摘要
知情同意权行使过程中往往存在诸多权益冲突。其中最典型的有两种:其一,患者的最佳利益与他人的代为同意权的冲突;其二,患者的知情同意权与诊疗的自由裁量权的冲突。这些冲突的产生原因既有立法上不一致引起的混乱,也有医疗活动中的义务论和个人主义的功利论的冲突,同时,也不能忽视"家父思想"的影响。要解决医患纠纷,既需要立法从源头上解决制度问题,还需要全社会共同构建医患双方相互信赖的友好局面,需要涉医相关部门的统筹调和,解决卫生资源相对紧缺的现状。
There are many conflicts of rights and interests in the implementation of informed consent. Among these conflicts, there are two typical conflicts: first, the conflict between the best interests of the patient and the right of surrogate consent; second, the conflict between patients' right of informed consent and the right of treatment of doctors. These conflicts have been caused not only by the inconsistency of legislation, but also by the conflict between the obligation theory and the utilitarian theory of individualism in medical practices. At the same time, the influence of the paternalism cannot be ignored. In order to resolve the medical disputes, it is necessary to resolve the system problems by the improvement of legislation. Besides, it is necessary for the whole society to build a mutual trust and cooperation between doctors and patients, for the related medical departments to coordinate to resolve the situation of relative shortage of health resources.
There are many conflicts of rights and interests in the implementation of informed consent. Among these conflicts, there are two typical conflicts: first, the conflict between the best interests of the patient and the right of surrogate consent; second, the conflict between patients' right of informed consent and the right of treatment of doctors. These conflicts have been caused not only by the inconsistency of legislation, but also by the conflict between the obligation theory and the utilitarian theory of individualism in medical practices. At the same time, the influence of the paternalism cannot be ignored. In order to resolve the medical disputes, it is necessary to resolve the system problems by the improvement of legislation. Besides, it is necessary for the whole society to build a mutual trust and cooperation between doctors and patients, for the related medical departments to coordinate to resolve the situation of relative shortage of health resources.
引文
[1] 祝彬,张传伦.南通智障少女子宫切除案的法律思考:论智障者知情同意权的行使[J].法律与医学杂志,2007,14(2):140-144.
[2] 梅春英,王晓波.患者知情同意权保护中的权利冲突与协调[J].中国卫生事业管理,2017(5):364-366.
[3] 刘飞,王国平.论医疗侵权责任违法性阻却事由及医疗特殊干预权[C]//浙江省医学会医学伦理学与卫生法学会.2011年浙江省医学会医学伦理学与卫生法学学术年会论文汇编.杭州:浙江省医学会医学伦理学与卫生法学会,2011:120-123.
[4] 杨敏,梅文华.冲突与衡平:基于《侵权责任法》第56条的分析[J].中国卫生事业管理,2013(2):127-130.
[5] 徐连英,宋庆.特殊干预权与知情同意权冲突的义利观解析及伦理学研究[J].学习与探索,2013(11):70-73.
[6] 陈燕红.困境与出路:我国患者知情同意权法律保护与适用的完善建议[J].河北法学,2014,32(2):132-137.
[7] 王文颖.患者知情同意权的构成要件[J].辽宁医学院学报:社会科学版,2010,8(3):7-9.
[8] 张慧姝,图娅.关于医患权利冲突的法学思考:肖志军案中引出的医方特殊干预权和患方知情同意权之冲突辨析[J].中国医学伦理学,2010,23(2):32-34.
[2] 梅春英,王晓波.患者知情同意权保护中的权利冲突与协调[J].中国卫生事业管理,2017(5):364-366.
[3] 刘飞,王国平.论医疗侵权责任违法性阻却事由及医疗特殊干预权[C]//浙江省医学会医学伦理学与卫生法学会.2011年浙江省医学会医学伦理学与卫生法学学术年会论文汇编.杭州:浙江省医学会医学伦理学与卫生法学会,2011:120-123.
[4] 杨敏,梅文华.冲突与衡平:基于《侵权责任法》第56条的分析[J].中国卫生事业管理,2013(2):127-130.
[5] 徐连英,宋庆.特殊干预权与知情同意权冲突的义利观解析及伦理学研究[J].学习与探索,2013(11):70-73.
[6] 陈燕红.困境与出路:我国患者知情同意权法律保护与适用的完善建议[J].河北法学,2014,32(2):132-137.
[7] 王文颖.患者知情同意权的构成要件[J].辽宁医学院学报:社会科学版,2010,8(3):7-9.
[8] 张慧姝,图娅.关于医患权利冲突的法学思考:肖志军案中引出的医方特殊干预权和患方知情同意权之冲突辨析[J].中国医学伦理学,2010,23(2):32-34.