XIE Jing, LI Shu, ZHU Ling, ZHANG Shuyang. Autonomy of Patients and Informed Consent in Clinical Practice[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(1): 147-151. DOI: 10.12290/xhyxzz.2021-0007
Citation: XIE Jing, LI Shu, ZHU Ling, ZHANG Shuyang. Autonomy of Patients and Informed Consent in Clinical Practice[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(1): 147-151. DOI: 10.12290/xhyxzz.2021-0007

Autonomy of Patients and Informed Consent in Clinical Practice

More Information
  • Corresponding author:

    ZHANG Shuyang, E-mail: shuyangzhang103@163.com

  • Received Date: January 03, 2021
  • Accepted Date: January 28, 2021
  • Available Online: October 31, 2021
  • Issue Publish Date: January 29, 2022
  • This article addresses the ethical issues of respect for autonomy and informed consent, focusing on how clinicians should deal with these concepts in clinical practice. We first clarify the concept of respect for autonomy and its practical application, as well as informed consent. We then track the origin and development of informed consent both in western countries and in China. Followed by describing several challenges that limit the practice of informed consent, we make our suggestions so as to help clinicians handle the informed consent in daily practice.
  • [1]
    Department of Health, Education, and Welfare; National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report. Ethical principles and guidelines for the protection of human subjects of research[J]. J Am Coll Dent, 2014, 81: 4-13.
    [2]
    Grady C. Enduring and emerging challenges of informed consent[J]. N Engl J Med, 2015, 372: 855-862. DOI: 10.1056/NEJMra1411250
    [3]
    Jonsen AR, Siegler M, Winslade WJ. Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine[M]. 8 Ed. New York: McGraw-Hill Education, 2015: 49.
    [4]
    Fan R. Self-determination vs. family-determination: two incommensurable principles of autonomy: a report from East Asia[J]. Bioethics, 1997, 11: 309-322. DOI: 10.1111/1467-8519.00070
    [5]
    全国人民代表大会. 《中华人民共和国基本医疗卫生与健康促进法》[EB/OL]. (2019-12-29)[2020-12-29]. http://www.gov.cn/xinwen/2019-12/29/content_5464861.htm.
    [6]
    马晓. 中国国情与知情同意之思[J]. 中国医学伦理学, 2018, 31: 962-965, 1001. https://www.cnki.com.cn/Article/CJFDTOTAL-XNLX201808003.htm

    Ma X. Reflection on China's National Conditions and Informed Consent[J]. Zhongguo Yixue Lunlixue, 2018, 31: 962-965, 1001. https://www.cnki.com.cn/Article/CJFDTOTAL-XNLX201808003.htm
    [7]
    张渊. 患者偏好与医患共同决策[J]. 协和医学杂志, 2019, 10: 679-684. DOI: 10.3969/j.issn.1674-9081.2019.06.022

    Zhang Y. Patient Preference and Shared Decision Making[J]. Xiehe Yixue Zazhi, 2019, 10: 679-684. DOI: 10.3969/j.issn.1674-9081.2019.06.022
    [8]
    强美英. 医疗知情同意的法伦理思考[J]. 医学与哲学, 2020, 31: 14-16. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZX201005010.htm

    Qiang MY. The Legal Ethical Thought of Medical Informed Consent[J]. Yixue Yu Zhexue, 2020, 31: 14-16. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZX201005010.htm
    [9]
    Siegler M, Collins ME, Cronin DC. Special challenges to the informed consent doctrine in the United States[J]. J Clin Ethics, 2004, 15: 38-47.
    [10]
    Annas GJ. Doctors, Patients, and Lawyers-Two Centuries of Health Law[J]. N Engl J Med, 2012, 367: 445-450. DOI: 10.1056/NEJMra1108646
    [11]
    夏媛媛. 从知情同意的发展史正确认识知情同意权[J]. 医学与社会, 2007, 20: 44-46. https://www.cnki.com.cn/Article/CJFDTOTAL-YXSH200702018.htm
    [12]
    Chervenak J, McCullough LB, Chervenak FA. Surgery without consent or miscommunication? A new look at a landmark legal case[J]. Am J Obstet Gynecol, 2015, 212: 586-590. DOI: 10.1016/j.ajog.2014.06.062
    [13]
    Nuremberg Military Tribunal. The Nuremberg Code[J]. JAMA, 1996, 276: 1691. DOI: 10.1001/jama.1996.03540200077043
    [14]
    Declaration of Helsinki. Recommendations guiding doctors in clinical research. Adopted by the 18th World Medical Assembly, Helsinki, Finland, June 1964[EB/OL]. [2020-12-31]. https://www.wma.net/what-we-do/medical-ethics/declaration-of-helsinki/doh-jun1964/.
    [15]
    World Medical Association Declaration of Lisbon on the Rights of the Patient. Adopted by the 34th World Medical Assembly, Lisbon, Portugal, September/ October 1981[EB/OL]. [2020-12-31]. https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/.
    [16]
    全国人民代表大会. 《中华人民共和国执业医师法》[EB/OL]. (2005-08-01)[2020-12-31]. http://www.gov.cn/banshi/2005-08/01/content_18970.htm.
    [17]
    中华人民共和国国务院. 《医疗事故处理条例》[EB/OL]. (2005-08-02)[2020-12-31]. http://www.gov.cn/banshi/2005-08/02/content_19167.htm.
    [18]
    全国人民代表大会. 《中华人民共和国民法典》(2020-06-01)[2020-12-31]. https://www.chinacourt.org/law/detail/2020/06/id/150163.shtml.
    [19]
    Cocanour CS. Informed consent-It's more than a signature on a piece of paper[J]. Am J Surg, 2017, 214: 993-997. DOI: 10.1016/j.amjsurg.2017.09.015
    [20]
    Perni S, Rooney MK, Horowitz DP, et al. Assessment of Use, Specificity, and Readability of Written Clinical Informed Consent Forms for Patients With Cancer Undergoing Radiotherapy[J]. JAMA Oncol, 2019, 5: e190260. DOI: 10.1001/jamaoncol.2019.0260
    [21]
    Tait AR, Hutchinson RJ. Informed Consent Training in Pediatrics-Are We Doing Enough?[J]. JAMA Pediatr, 2018, 172: 211-212. DOI: 10.1001/jamapediatrics.2017.4088
    [22]
    Koller SE, Moore RF, Goldberg MB, et al. An Informed Consent Program Enhances Surgery Resident Education[J]. J Surg Educ, 2017, 74: 906-913. DOI: 10.1016/j.jsurg.2017.02.002
    [23]
    Lee SC, Nguyen V, Nguyen A, et al. Teaching Anesthesiology Residents How to Obtain Informed Consent[J]. J Educ Perioper Med, 2019, 21: E632.
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