浅论防御性医疗行为的特殊表现形式.doc

浅论防御性医疗行为的特殊表现形式------医疗同意书 韦嫚 沈春明① 摘 要 近几年来，医疗纠纷诉讼增多，医患冲突加剧，诚信原则缺失。在临床实践中，贯穿整个医疗过程中的医疗同意书成为医务人员保护自身的重要措施，成为合法保护下的防御性医疗行为的一种表现形式。本文对防御性医疗行为进行界定，并将医疗同意书的法律形式固定及医疗同意书产生的不利影响进一步阐述。从而得出医疗同意书是法律固定且合理存在的积极防御性医疗行为的一种表现形式。希望通过对医疗同意书的正确认识和运用，减少医疗裁量权和病人自我决定权以及医师说明义务的冲突，规范医疗行为。 关键词 医疗同意书 防御性医疗行为 医疗裁量权 Discusses defensive medicine shallowly the special manifestation------Medical letter of consent/WEI Man，SHEN Chun-ming // Management,?: Abstract In the last few years, the medical dispute lawsuit increases, the medical trouble conflict intensifies, good faith principle flaw. In the clinical practice, in the penetration entire medical procedures medical letter of consent becomes the medical personnel to protect own important measure, becomes under the legitimate protection the defensive medical behavior one kind of manifestation. This article carries on the limits to the defensive medical behavior, and the adverse effect which the medical letter of consents legal fixed form, the reasonable existence reason and the medical letter of consent has further elaborated. Thus obtains the medical letter of consent is the legal form fixed under reasonable existence positive defensive medical behavior one kind of manifestation. The hope through to the medical letter of consents correct understanding and the utilization, reduces the therapeutic privilege and the patient self-decision-making power as well as doctor shows the voluntary the conflict, standard medical behavior. key words medical letter of consent，defensive medicine，therapeutic privilege First-author’s address Medicine and social development Research center , Management institute of Chongqing Medical University, Chongqing, 400016, China 1医疗同意书成为防御性医疗行为的表现形式 现今，在医疗过程中，医师常展现其医学专业知识上之知的权威（Sapientiaol Authotrity），及伦理权威。在医疗技术主义及官僚化的体制下，病患的情绪不满、不安，影响以及医疗纠纷逐年增加。[1]医师也开始较多地采用防御性医疗行为，其表现形式日趋多样化。其中，医疗同意书便成为这种多样化的表现形式之一。 目前，对防御性医疗行为的表现形式及其分类标准各有见解。以什么为标准分类，如何分类？笔者认为：因防御性医疗行为已经带来了一定事实上的医疗损害、法律问题及责任后果承担问题，根据它在医疗过程中产生临床表现形式可以分为两类