臨床知情同意在中國的一些實踐及反思

Informed Consent in China: A Reflection from the Practitioner’s Perspective

Abstract

LANGUAGE NOTE | Document text in Chinese; abstract also in English.

“患者利益至上”知情同意是當代西方生命倫理學的一個核心概念，在規範臨床醫療實踐中的應用十分廣泛，相關的法規和指引更是層出不窮。隨著自由主義理論和權利觀念在全世界範圍內的流行，中國也開始注意到知情同意原則在臨床實踐中的重要意義，並逐步引入西方的相關規範。然而，大部分規範的制定缺乏對知情同意倫理基礎的考察，對臨床知情同意在中國的實踐也沒有足夠的關注。本文分析作為知情同意的道德基礎，並通過對一線醫務工作人員的訪談，了解臨床知情在中國實踐情況及限制，希望能為相關規範的制定提供一些思路。

Informed consent is considered to be one of the most important conceptual developments in contemporary bioethics, and is strongly implicated in the regulation of clinical practices in the West. Over the past decade, the growing prevalence of both liberal arguments supporting individual autonomy and rights-based debates focusing on equality has brought the concept of informed consent into the purview of Chinese legislation pertaining to healthcare and clinical practice. However, most of the laws and regulations are made by Chinese authorities in ignorance of the concept’s ethical groundings. In addition, lawmakers have not taken into account the empirical reality and specific situations of clinical practice in contemporary China. This essay contends that the history of informed consent legislation in China since 1994, exemplified by the recently adopted Article 55 of the Tort Law of the People’s Republic of China, reveals conflicting understandings of the ethical foundation of the notion of informed consent. The essay also presents extensive interviews conducted by the author with four frontline medical practitioners in first-tier cities that demonstrate how their experiences with informed consent are largely shaped by current institutional settings and influenced by traditional Confucian ethical norms, (e.g., an emphasis on interdependence among family members, which requires the doctor to consult with the family rather than the patient). The essay concludes that we must take into serious consideration the Chinese ethical tradition and its unique application in practice when cross-fertilizing the concept of informed consent.

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