患者自我决定权的行使阻碍及其完善对策

Exercise Obstacles and Improvement Measures of Patients’ Self-Determination

摘要: 患者自我决定权的保障不足和行使受阻是近年来医疗纠纷发生的重要原因。虽然自我决定权的保护有坚实的宪法及法律支撑，但实践中由于知情同意主体意见矛盾、患者缺乏足够的医学知识、特殊患者的同意能力被过度限缩、紧急情况下难以探知患者真意等原因，患者自我决定权无法得到充分实现。为减少由此引发的医疗纠纷，首先，必须明确患者自主的优先地位；其次，要严格医方告知说明义务的履行和责任追究；最后，应探索建立预立医疗决定相关制度，从最大程度上保障患者的自主能够得到尊重。

Abstract: In recent years, the important reasons for the occurrence of medical disputes are the lack of protection and the obstruction of the exercise of patients’ self-determination. Although the protection of self-determination is supported by the solid constitution and laws, in practice, the self- determination of patients cannot be fully realized due to conflicting opinions of the subject of informed consent, the lack of sufficient medical knowledge of patients, the excessive limitation of consent ability of special patients, and the difficulty of knowing the true intention of patients in emergency situations. In order to reduce the resulting medical disputes, first of all, the priority of patient autonomy must be clearly defined; Secondly, the medical prescription should strictly fulfill the obligation to inform and explain and bear the responsibility for its performance; Finally, we should explore the establishment of a system related to advance medical decisions to ensure that patients’ autonomy is respected to the greatest extent possible.