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Clinical Ethical Analysis of Informed Consent to Anesthesia in Patients with Mental Disorders
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摘要: 在临床实践中，麻醉技术的知情同意仍是麻醉学科的独特领域，但麻醉科医生轻视精神障碍患者的知情同意成为临床工作的薄弱环节。在人类原始道德本能的加持下，基于对精神障碍患者同情的道德关怀，代理同意被认为有利于患者，但现实中存在多种因素制约患者在麻醉知情同意上享有权利。在医患共同决策医学模式下，应尽可能让轻症精神障碍患者参与知情同意过程，其提供信息的深度和广度取决于患者的自知力。获取精神障碍患者麻醉知情同意的路径尚待优化，可通过多学科合作等多种方式，达到患者真正知情同意，保障精神障碍患者的合法权益。Abstract: In clinical practice, informed consent to anesthesia technology is still a unique field of anesthesiology. For patients with mental disorders, anesthesiologists' neglect of the process of informed consent has become a weak link in clinical work. With the primitive moral instinct of humans and based on sympathetic moral care for patients with mental disorders, proxy consent is considered to be beneficial to patients, but in reality, there are many factors that restrict their rights in anesthesia informed consent. In the medical model of doctor-patient joint decision-making, patients with mild mental disorders should be involved in the informed consent process as much as possible, and the depth and breadth of the information provided depend on the patient's insight. The path to truly obtaining informed consent for anesthesia from patients with mental disorders needs to be optimized. Through multi-disciplinary cooperation and other methods, we can achieve real informed consent and protect the rights of patients with mental disorders.作者贡献：黄明涛负责论文选题、设计及初稿撰写；刘永潇负责临床麻醉专业知识把控及论文审核；莫楠负责论文指导及修订。利益冲突：所有作者均声明不存在利益冲突
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[1] 汤姆·比彻姆, 詹姆士·邱卓思. 生命医学伦理原则(第5版)[M]. 李伦, 等译. 北京: 北京大学出版社, 2014, 8: 78. [2] 陈化. 知情同意的伦理阐释与法制建构[M]. 北京: 人民出版社, 2019: 123. [3] 陈圆方, 李小萍. 精神障碍患者知情同意权的研究[J]. 中国医学伦理学, 2016, 29: 690-693. doi: 10.12026/j.issn.1001-8565.2016.04.44 [4] 孙东东. 自知力缺损精神障碍患者知情同意权的法学理论与实务[J]. 中国心理卫生杂志, 2013, 27: 569-570. doi: 10.3969/j.issn.1000-6729.2013.08.002 [5] Van Camp LSC, Sabbe BGC, Oldenburg JFE. Cognitive insight: A systematic review [J]. Clin Psychol Rev, 2017, 55: 12-24. doi: 10.1016/j.cpr.2017.04.011 [6] Jørgensen R, Licht RW, Lysaker PH, et al. Effects on cognitive and clinical insight with the use of Guided Self-Determination in outpatients with schizophrenia: A randomized open trial [J]. Eur Psychiatry, 2015, 30: 655-663. [7] Potgieter HE. Authenticity of informed consent in anaes-thesia: ethical reflection on the dilemma of informed consent in anaesthesia[D]. Stellenbosch: Stellenbosch University, 2020: 87. [8] Bombardieri AM, Mathur S, Soares A, et al. Intraoperative Awareness With Recall: A Descriptive, Survey-Based, Cohort Study[J]. Anesth Analg, 2019, 129: 1291-1297. doi: 10.1213/ANE.0000000000004358 [9] 赵冰晓, 艾艳秋, 金峰, 等. 择期全麻手术患者术中知晓影响因素分析[J]. 临床麻醉学杂志, 2016, 32: 547-549. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ201606007.htm [10] 李丽君, 刘政, 王学军. 术中知晓的研究进展[J]. 中华麻醉学杂志, 2021, 41: 122-124. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ202004027.htm [11] Rimbert S, Riff P, Gayraud N, et al. Median Nerve Stimulation Based BCI: A New Approach to Detect Intraoperative Awareness During General Anesthesia[J]. Front Neurosci, 2019, 13: 622. doi: 10.3389/fnins.2019.00622 [12] Tasbihgou SR, Vogels MF, Absalom AR. Accidental awareness during general anaesthesia-a narrative review[J]. Anaesthesia, 2018, 73: 112-122. doi: 10.1111/anae.14124 [13] 周友军, 杨垠红, 译. 奥地利普通民法典[M]. 北京: 清华大学出版社, 2013: 44. [14] 吴宝铮. 青少年情绪障碍患者性格特征及社会心理学影响[J]. 中国公共卫生管理, 2017, 33: 557-559. https://www.cnki.com.cn/Article/CJFDTOTAL-GGWS201704035.htm [15] 罗光强. 精神分裂症临床干预过程中知情同意问题的伦理研究[D]. 长沙: 中南大学, 2010: 101. [16] Choudry S. Best Interests in the MGA2005: What Can Health Care Law Learn from Family Law?[J]. Health Care Anal, 2008, 16: 240-251. doi: 10.1007/s10728-008-0084-x [17] Zemła AJ, Nowicka-Sauer K, Jarmoszewicz K, et al. Measures of preoperative anxiety[J]. Anaesthesiol Intensive Ther, 2019, 51: 64-69. doi: 10.5603/AIT.2019.0013 [18] Zaleski KL, Waisel DB. Withholding information from an anxiety-prone patient?[J]. AMA J Ethics, 2015, 17: 209-214. doi: 10.1001/journalofethics.2015.17.3.ecas2-1503 [19] Burkle CM, Pasternak JJ, Armstrong MH, et al. Patient perspectives on informed consent for anaesthesia and surgery: American attitudes[J]. Acta Anaesthesiol Scand, 2013, 57: 342-349. doi: 10.1111/aas.12037 [20] 国家卫生健康委员会. 国家卫生健康委员会2022年6月17日新闻发布会文字实录[EB/OL].(2022-06-17)[2022-08-02]. http://www.nhc.gov.cn/xcs/s3574/202206/ffb0385b3c0949ee84b7cdcc86a78fca.shtml .[21] Huang Y, Wang Y, Wang H, et al. Prevalence of mental disorders in China: a cross-sectional epidemiological study[J]. Lancet Psychiatry, 2019, 6: 211-224. doi: 10.1016/S2215-0366(18)30511-X [22] Grisso T, Appelbaum PS, Hill-Fotouhi C. The MacCAT-T: a clinical tool to assess patients' capacities to make treatment decisions[J]. Psychiatr Serv, 1997, 48: 1415-1419. doi: 10.1176/ps.48.11.1415 [23] Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician[J]. J Psychiatr Res, 1975, 12: 189-198. doi: 10.1016/0022-3956(75)90026-6 [24] Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment[J]. J Am Geriatr Soc, 2005, 53: 695-699. doi: 10.1111/j.1532-5415.2005.53221.x [25] Yu J, Li J, Huang X. The Beijing version of the Montreal Cognitive Assessment as a brief screening tool for mild cognitive impairment: a community-based study[J]. BMC Psychiatry, 2012, 12: 156. doi: 10.1186/1471-244X-12-156 [26] Tait AR, Voepel-Lewis T, Zikmund-Fisher BJ, et al. The effect of format on parents' understanding of the risks and benefits of clinical research: a comparison between text, tables, and graphics[J]. J Health Commun, 2010, 15: 487-501. doi: 10.1080/10810730.2010.492560 [27] 胡文, 喻是霖, 张梅, 等. 麻醉知情同意面临的问题及优化策略[J]. 中国病案, 2021, 22: 19-22. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGBN202112009.htm -
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