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精神障碍患者麻醉知情同意的临床伦理分析

黄明涛,  刘永潇,  莫楠

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黄明涛, 刘永潇, 莫楠. 精神障碍患者麻醉知情同意的临床伦理分析[J]. 协和医学杂志. doi: 10.12290/xhyxzz.2022-0196
引用本文: 黄明涛, 刘永潇, 莫楠. 精神障碍患者麻醉知情同意的临床伦理分析[J]. 协和医学杂志. doi: 10.12290/xhyxzz.2022-0196
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HUANG Mingtao, LIU Yongxiao, MO Nan. Clinical Ethical Analysis of Informed Consent to Anesthesia in Patients with Mental Disorders[J]. Medical Journal of Peking Union Medical College Hospital. doi: 10.12290/xhyxzz.2022-0196
Citation: HUANG Mingtao, LIU Yongxiao, MO Nan. Clinical Ethical Analysis of Informed Consent to Anesthesia in Patients with Mental Disorders[J]. Medical Journal of Peking Union Medical College Hospital. doi: 10.12290/xhyxzz.2022-0196
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精神障碍患者麻醉知情同意的临床伦理分析

doi: 10.12290/xhyxzz.2022-0196

  • 1 福建医科大学健康学院;

  • 2 福建医科大学医学人文研究中心;

  • 3 宁德师范学院附属宁德市医院麻醉科;

  • 4 福建医科大学附属第一医院麻醉科;

  • 5 福建医科大学马克思主义学院

基金项目: 

福建省教育科学“十四五”规划课题"医学生医学人文教育中情元素的培育研究"（FJJKBK21-107）；福建省社会科学规划一般项目“公共卫生信息活动中的道德冲突与伦理风险研究”（FJ2018B164）

详细信息
    通讯作者:

    莫楠，E-mail：gmn841002@163.com

  • 中图分类号: R749;R-052

Clinical Ethical Analysis of Informed Consent to Anesthesia in Patients with Mental Disorders

  • 1 The School of Health, Fujian Medical University;

  • 2 Medical Humanities Research Center, Fujian Medical University;

  • 3 Department of Anesthesiology, Ningde Municipal Hospital of Ningde Normal University;

  • 4 Department of Anesthesiology, The First Affiliated Hospital of Fujian Medical University;

  • 5 The School of Marxism, Fujian Medical University

Funds: 

“ The 14th five year plan” of Fujian Educational Science “ Research on the cultivation of emotional elements in medical humanities education for medical students”（ FJJKBK21-107）； General project of social science planning of FujianProvince“ Research on moral conflict and ethical risk in public health information activities”（FJ2018B164）

    摘要
  • 摘要: 在临床诊疗中，对麻醉技术的知情同意仍然是麻醉医生的独特领域，而在精神障碍患者中，医生重视麻醉知情同意书的签字，而轻视患者知情同意的过程成为工作中的薄弱环节。在人类原始道德本能的加持下，基于对精神障碍患者的一种同情的道德关怀，代理同意被认为有利于患者。但是现实中各种因素使得精神障碍患者在麻醉知情同意上受到不同程度的制约。另一方面，面对精神障碍患者，考虑到术中配合及麻醉安全性的问题，麻醉方式的选择尤为关键。在医患共同决策的医学模式下，不能忽视患者的知情同意权，应该尽一切可能让轻症精神障碍患者参与知情同意过程，提供的信息深度和广度将取决于患者自知力。真实获取精神障碍患者麻醉知情同意的路径尚待优化，通过多学科合作、采用知情同意能力评估工具、改进麻醉术前访视等方法，以期做到真正的知情同意，保护精神障碍患者的权利。
    Abstract: In clinical diagnosis and treatment, informed consent to anesthesia is still the unique field of anesthesiologists. In patients with mental disorders, doctors attach importance to the signing of informed consent to anesthesia, while ignoring the process of informed consent of patients has become a weak link in their work. With the support of human primitive moral instinct and based on a kind of sympathetic moral care for patients with mental disorders, surrogate consent is considered to be beneficial to patients. However, various factors in reality restrict the informed consent of patients with mental disorders to different degrees. On the other hand, in the face of patients with mental disorders, considering the problems of intraoperative cooperation and anesthesia safety, the choice of anesthesia mode is particularly critical. The doctor led medical model can not ignore the right of informed consent of patients. It should do everything possible to let patients with mild mental disorders participate in the informed consent process. The depth and breadth of information provided will depend on the patient's self-knowledge. The path to truly obtain the informed consent of patients with mental disorders needs to be optimized. Through multi-disciplinary cooperation, the use of informed consent ability assessment tools, and the improvement of preoperative visits, we hope to achieve real informed consent and protect the rights of patients with mental disorders.
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    • 参考文献(29)
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出版历程
  • 收稿日期:  2022-04-10
  • 录用日期:  2022-07-07
  • 网络出版日期:  2022-08-30

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