医疗告知研究

发布时间：2018-03-14 09:39

本文选题：医疗告知　切入点：知情同意　出处：《遵义医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:2009年《侵权责任法》颁布,第五十五条规定:医务人员在诊疗活动中应向患者说明病情和医疗措施,医务人员未尽到告知义务,造成患者损害,医疗机构应承担赔偿责任。但从医疗告知造成的医疗纠纷中可以看出医疗告知仍面临许多困境,本研究将进一步拓展关于医疗告知、医患沟通这一领域的研究,将研究聚焦在“增加医患沟通、改善医患关系、保障知情、提高医疗质量”上,探索在面对医疗告知困境的同时提出适合我国国情的医疗告知对策。方法:采用文献研究法、案例分析法。通过中国知网、万方、维普、Pubmed、Medline、读秀、超星、百度等数据库,广泛收集有关医患关系、医患沟通、医疗告知、知情同意的文献,包括论文、论著、书籍、报告、报纸、法律文件等,整理分析,明确医疗告知的组成要素、医疗告知的理论基础,并从案例的角度出发,从医疗告知主体、客体及法律三个角度分析医疗告知面临的困境。结果:1946年《纽伦堡法典》颁布,第一次提出“知情同意”概念,此后,世界各国相继建立了“告知同意理论”,1981年世界医学会制定《里斯本患者权利宣言》,该宣言中患者享有11项权利,其中包含知情同意权。医疗告知包括二大类:医学研究告知和医学临床告知,本研究的医疗告知主要指医学临床告知。我国从1951年开始就有法律文件体现知情同意、医疗告知,但医疗告知仍面临人文教育缺失、医患沟通模式失效、告知内容不当、家庭主义的利与弊、患者知情同意能力评估不准确及法律法规不完善等多方面的困境。结论:医疗告知是医务人员必须履行的义务,其本质是医患沟通。针对目前医疗告知面临的困境,国家应该合理配置医疗卫生资源,政府增加卫生经费支出比例,发挥“健康守门人”的作用;规范患者代理权制度,代理人必须提供和患者关系的法律证明,代理情形明朗化,代理人的医疗决策必须保证患者的利益;规范知情同意书,在此笔者以普外科常见手术——腹腔镜胆囊切除手术(LC)手术为例,设计知情同意书,充分发挥患者主观能动性;做到人文告知:改善医疗告知环境,选择正确的告知时间,移情患者情感。最后,从法律法规角度规范医疗告知制度。
[Abstract]:Objective: in 2009, the Tort liability Law was promulgated. Article 55th stipulates that medical personnel should explain their illness and medical measures to the patients in the diagnosis and treatment activities, and the medical personnel have failed to fulfill their obligation to inform the patients, thus causing damage to the patients. Medical institutions should be liable for compensation. However, from the medical disputes caused by medical notification, we can see that medical notification still faces many difficulties. This study will further expand the research on the field of medical notification and doctor-patient communication. Focusing on "increasing doctor-patient communication, improving doctor-patient relationship, ensuring knowledge and improving medical quality", this paper explores the countermeasures of medical information that are suitable for China's national conditions while facing the plight of medical information. Case study. Through the databases of China Zhiwang, Wanfang, Weipu Pubmedan Medline, Yuxiu, Chaoxing, Baidu and so on, we have extensively collected literature on doctor-patient relations, doctor-patient communication, medical information, informed consent, including papers, treatises, books, reports, etc. Newspapers, legal documents, etc., sorting out and analyzing the elements of medical notification, the theoretical basis of medical notification, and starting from the perspective of cases, from the perspective of the main body of medical notification, Results: in 1946, the Nuremberg Code was promulgated, and the concept of "informed consent" was first put forward. In 1981, the World Medical Association formulated the Lisbon Declaration on patients' Rights, in which patients enjoy 11 rights. It includes the right of informed consent. There are two categories of medical notification: medical research notification and medical clinical notification. The medical information in this study mainly refers to medical clinical notification. Since 1951, China has had legal documents embodying informed consent and medical notification. However, medical information still faces the lack of humanistic education, the failure of doctor-patient communication mode, the improper content of notification, the advantages and disadvantages of family doctrine, Conclusion: medical notification is the duty of medical staff, whose essence is doctor-patient communication. The state should rationally allocate medical and health resources, the government should increase the proportion of expenditure on health expenditure, give play to the role of "health gatekeeper," standardize the system of patient agency rights, agents must provide legal proof of their relationship with patients, and the situation of agency becomes clear. The agent's medical decision must ensure the benefit of the patient, standardize the informed consent form, take the common operation of general surgery, laparoscopic cholecystectomy and LC as an example, design the informed consent form and give full play to the subjective initiative of the patient. Humanistic informing: improve the environment of medical information, choose the right time to inform, empathy patient emotion. Finally, from the perspective of laws and regulations to standardize the system of medical notification.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：D922.16;R-05

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