【摘要】：目的:既往法律關(guān)于急�；颊咧橥鈾�(quán)有效行使的規(guī)定尚未具體明確。2010年起實施的《侵權(quán)責(zé)任法》第56條規(guī)定進一步細化了部分內(nèi)容,但其僅表述了“不能取得患者或者其近親屬意見”的情況,未能涵蓋已取得患方知情同意決定而該決定明顯違背醫(yī)療科學(xué)等情況。本課題擬調(diào)研不同群體對未恰當(dāng)行使知情同意權(quán)的急�；颊�,醫(yī)師處置方式的認同選擇,并比較該社會認知狀況與現(xiàn)行法律的偏差,以期為對《侵權(quán)責(zé)任法》相關(guān)規(guī)定進行完善的可能性、必要性提供實證依據(jù)。方法:本課題采用文獻回顧、相關(guān)案例分析、進而問卷設(shè)計調(diào)查的實證研究方法,通過分層隨機抽樣對重慶、瀘州、遵義三地的醫(yī)師、法律人、社會大眾(患者或家屬)等三類不同群體就基于現(xiàn)行《侵權(quán)責(zé)任法》,對在患者因病情危重需立即接受相關(guān)醫(yī)療搶救措施才有機會挽救其生命或保全其肢體或重要器官功能的緊急情況下,患方無法恰當(dāng)行使知情同意權(quán)時醫(yī)師處置方式的認同選擇進行調(diào)研。調(diào)查指標(biāo)主要包括對前述情況相關(guān)的六種預(yù)設(shè)下各種醫(yī)師處置方式的認同選擇,并比較不同群體、不同地區(qū)和不同選擇的差異。通過預(yù)調(diào)查計算樣本量,采用行×列表χ2檢驗或雙向無序R×C表Fisher確切概率法進行數(shù)據(jù)統(tǒng)計分析,P0.05為差異有統(tǒng)計學(xué)意義;通過樣本率計算總體率,采用0.05雙側(cè)檢驗水平,估計95%總體率可信區(qū)間。結(jié)合調(diào)查結(jié)果與法理分析,進一步提出具體處理建議及流程。結(jié)果:預(yù)估最小樣本量為406例,發(fā)放問卷600例,有效回收559例,回收率93%。各種預(yù)設(shè)下:三類群體選擇的差異均有統(tǒng)計學(xué)意義(各P0.05);而三個地區(qū)選擇的差異均無統(tǒng)計學(xué)意義(各P0.05)。按“尊重(/等待)患者(/家屬)意見”或“尊重醫(yī)師意見”合并數(shù)據(jù)分析提示:當(dāng)患者拒絕搶救而家屬同意搶救或患者無意思表達能力的幾種合并情況(家屬拒絕搶救、數(shù)個家屬意見分歧、家屬拒絕簽字或無家屬)下,被調(diào)查人群總體中多數(shù)選擇“尊重醫(yī)師意見”(選擇人數(shù)百分比分別為:65.47%、58.68%、72.81%、82.11%、93.20%)�；颊邿o意思表達能力時,家屬拒絕搶救或家屬意見分歧,選擇尊重醫(yī)師意見的被調(diào)查者傾向于通過第三方機構(gòu)參與決策。結(jié)論:除患者及家屬均拒絕搶救情況外,不同社會群體認同:當(dāng)患者病情急危且無法取得其有效知情同意時,其知情同意權(quán)應(yīng)被適當(dāng)限制、生命健康權(quán)應(yīng)優(yōu)先受到重視而視情況接受緊急救治。相關(guān)現(xiàn)行法律有待完善:(一)明確“患者病情急危時,近親屬意見明顯違反醫(yī)學(xué)科學(xué)或醫(yī)學(xué)倫理者”應(yīng)視為符合《侵權(quán)責(zé)任法》第56條規(guī)定之情形;(二)將緊急救治列入法定免責(zé)事由,對因此造成的損害予以適度減輕責(zé)任;(三)以完全民事行為能力標(biāo)準(zhǔn)判斷患者意思表達能力;(四)建立醫(yī)療機構(gòu)緊急救治行為的監(jiān)督機制,避免權(quán)利濫用。
[Abstract]:Objective: the provisions of previous laws on the effective exercise of informed consent of patients at risk have not yet been specified. Article 56 of the Tort liability Law, which came into force in 2010, further refines some of the contents. But it only states that "the patient or his close relatives cannot be consulted" and fails to cover cases where informed consent has been obtained and the decision is manifestly contrary to medical science. This subject intends to investigate the different groups of patients who do not properly exercise the right to informed consent, doctors' treatment of the identification of choice, and compare the social cognitive status and the current law deviation, The purpose is to provide empirical evidence for the possibility and necessity of perfecting the relevant provisions of Tort liability Law. Methods: using literature review, relevant case analysis, questionnaire design and empirical research methods, stratified random sampling of doctors and legal persons in Chongqing, Luzhou and Zunyi, including Chongqing, Luzhou and Zunyi, was carried out. Three different groups, such as the general public (patients or family members), are based on the existing Tort liability Act, In the event of an emergency in which a patient needs immediate medical treatment in order to save his life or to preserve the functions of his or her limbs or vital organs as a result of his or her critical condition, When the patient fails to exercise the right of informed consent properly, the identification of the physician's disposal mode is investigated. The survey indexes mainly include the identification and selection of the six presupposition treatments, and compare the differences among different groups, regions and different choices. The sample size was calculated by pre-survey, and the statistical analysis was carried out by using the row 脳 list 蠂 2 test or the Fisher exact probability method of two-way disordered R 脳 C table. The difference was statistically significant (P0.05). The total rate was calculated by sample rate and the 95% confidence interval was estimated by using 0.05 bilateral test level. Combined with the investigation results and legal theory analysis, further put forward the specific treatment suggestions and procedures. Results: the estimated minimum sample size was 406 cases, the questionnaire 600 cases, the effective recovery 559 cases, the recovery rate 93%. All kinds of presupposition: the differences of the three groups were statistically significant (P0.05), while the differences of the three regions were not statistically significant (P0.05). According to "respect (/ wait) patient (/ family) opinion" or "respect doctor's opinion" combined data analysis suggested that: when the patient refused to rescue and the family agreed to rescue or the patient had no ability to express the meaning of the combination (family refused to rescue, The majority of the people surveyed chose to "respect the doctor's opinion" (the percentage of the selected people was: 65.47%, 58.68% and 72.81%), and 82.11% of the respondents chose to "respect the opinion of the doctor". 93.20%) When the patient has no ability to express his will, the family refuses to rescue or the family members disagree with each other, and the respondents who choose to respect the doctor's opinion tend to participate in the decision through the third party organization. Conclusion: except for the patients and their families who refuse to rescue, different social groups agree that the right to informed consent should be restricted when the patient is in a critical condition and cannot obtain effective informed consent. The right to life and health should be given priority and emergency treatment as appropriate. Relevant existing laws need to be improved: (1) to make clear that "close relatives' opinions obviously violate medical science or medical ethics when the patient is in critical condition" should be regarded as conforming to the provisions of Article 56 of the Tort liability Law; (2) to include emergency medical treatment as a statutory reason for exemption, and to reduce the liability for the damage caused by it moderately; (3) to judge the patient's ability to express his will according to the standard of complete civil capacity; (4) establish supervision mechanism of emergency treatment in medical institutions to avoid abuse of rights.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：D923;R-051

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