EthicalIssuesinPublicHealthcare公共医疗的伦理课题.ppt

Ethical Issues in Public Healthcare公共醫療的倫理課題 Dr Derrick Au (區結成醫生) Head of Human Resources Hong Kong Hospital Authority Ethics in Public Health and Health Care Management (EDB 07.6.2012) Ethical principles for clinical cases臨床上的倫理原則 Commonly taught ethical principles: Respect of autonomy尊重自主原則 Beneficence 行善原則 Nonmaleficence 不傷害原則 Justice 公義原則 Clinical ethics in practice臨床倫理原則的應用 Patient rights 病人權利 Doctor-patient relationship醫患關係 Health care decision-making 醫療方案的決定 Clinical ethics in practice臨床倫理原則的應用範圍 Patient rights 病人權利 Doctor-patient relationship醫患關係 Health care decision-making 醫療方案的決定 Common clinical ethical issues 臨床倫理範圍的常見課題 (部分) Informed consent 知情同意 原則：autonomy，information on risk and benefit，duty of care Patient privacy 病人私隱 原則：autonomy，confidentiality Life-sustaining treatments 維持生命的治療抉擇 原則：autonomy， information on risk and benefit，patient’s best interests Clinical Ethics Clinical ethics: A structured approach to assist health care professionals in identifying, analyzing, and resolving ethical issues in clinical medicine. Some clinical issues of importance: Informed consent – autonomy vs. benevolence Truth telling – autonomy vs. nonmaleficence Confidentiality – autonomy and privacy End-of-life care – autonomy and risk-benefit Patient rights – autonomy vs. justice Risk-benefit – benevolence vs. nonmaleficence Four-Quadrant method of clinical ethics evaluation分析臨床倫理個案的四格分析方法 Clinical Indications 醫學上的指引 Patient Preference 病人的意願 Quality of Life 對生命質量的益處 Contextual Features 具體處境的因素 Source: Sliwa JA et al. Am J of PMR, Vol 81(9), Sep 2002, pp 708-717. A clinical case with ethical problem can be analyzed by considering four aspects of the case Patient’s Charter (病人約章) In year 2000, the Hong Kong Hospital Authority produced a Patient’s Charter to outline patient rights and responsibilities in public hospital Read more: .hk/tmh/patient_charter/index.html HA Patients’ Charter – Patients’ rights Right to Medical Treatment (醫治權) Right t