病人權(quán)利與醫(yī)患關(guān)系（英文）課件

1、病人權(quán)利與醫(yī)患關(guān)係病人權(quán)利與醫(yī)患關(guān)系（英文）1The oldest code of medical ethics: Hippocratic Oath (4th Century BC)Several parts of the oath have been revised over the years, e.g. -“To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him”“N

2、or will I give a woman a pessary to procure abortion;”“I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in his art.”病人權(quán)利與醫(yī)患關(guān)系（英文）2Code of Professional Conduct (Hong Kong Medical Council)Medicine as

3、a profession is distinguished from other professions by a special moral duty of care to save lives and to relieve suffering. Medical Registration Ordinance (Cap. 161) confers upon the medical profession considerable freedom of self regulation, the profession is obliged to abide by a strict code of c

4、onduct which embodies high ethical values, protects patients interests, and upholds professional integrity.Trust is essential to the practice of medicine. There can be no medicine in the absence of trust. The patients trust imposes upon the doctor a corresponding duty to be trustworthy and accountab

5、le. http:/病人權(quán)利與醫(yī)患關(guān)系（英文）3Ethics: What is right?Moral (道德)- comes from Latin mos(mores); Ethics (倫理) - comes from Greek ethosBoth have meaning of customs (風(fēng)俗), or generally accepted social normBut What is right is not just a matter of social norm (e.g. slavery was a social norm at one time)Professiona

6、l norm is not always right, it does revise over timeWhat is legally permitted is not always right 病人權(quán)利與醫(yī)患關(guān)系（英文）4Ethical principlesCommonly quoted ethical principles: Autonomy 自主原則 Beneficence 行善原則 Justice 正義原則 Nonmaleficence 不傷害原則These are useful but by themselves are not adequate for ethical decisi

7、on making 病人權(quán)利與醫(yī)患關(guān)系（英文）5RightsThe great religions of the world have all sought to establish moral codes of conduct based on divine law.These are often concerned with the duties and obligations of man to his fellow human beings, to nature, to God and the whole of creation.Ancient Chinese moral philos

8、ophers like Confucius (孔子) and Mencius (孟子) are concerned with similar moral issue, though not as a part of divine law The idea of human rights is not universal - it is essentially the product of 17th and 18th century European thought. Such secular conception of rights emphasised duties and privileg

9、es that arose from peoples status or relationships, rather than abstract rights in the philosophical sense.Since1948, with the Universal Declaration of Human Rights, . Respect for human rights is becoming a universal principle of good government. http:/病人權(quán)利與醫(yī)患關(guān)系（英文）6Rights / ObligationsA paired conc

10、ept, for instance: People / Government Patient / Doctor Human being / fellow human beingsCommonly quoted universal human rights: right to life; right to freedom; right to own property (limiting where government may intrude); citizenship rights (voting, nationality and participation in public life);

11、rights to standards of good behaviour by governments (or protection of the rule of law);Other social, economic and cultural rights have become important during the 20th century, and raise important and still controversial issues about social justice and the distribution of wealth.http:/病人權(quán)利與醫(yī)患關(guān)系（英文）

12、7WHO: Patient rights understood as one aspect of basic human rightsWorld Health Organisation:Formalized in 1948, the Universal Declaration of Human Rights recognizes “the inherent dignity” and the “equal and unalienable rights of all members of the human family”. And it is on the basis of this conce

13、pt of the person, and the fundamental dignity and equality of all human beings, that the notion of patient rights was developed. In other words, what is owed to the patient as a human being, by physicians and by the state, took shape in large part thanks to this understanding of the basic rights of

14、the person. http:/病人權(quán)利與醫(yī)患關(guān)系（英文）8From the perspective of patients advocate (病人權(quán)益倡議者)社區(qū)組織協(xié)會:倡議病人權(quán)益是為了保障病人在強(qiáng)調(diào)專業(yè)知識的醫(yī)療制度中，人的自主性自主性及尊嚴(yán)尊嚴(yán)不被侵犯。 經(jīng)多年推動，病人權(quán)益普遍為市民認(rèn)識及認(rèn)同，但與先進(jìn)社會的標(biāo)準(zhǔn)大相逕庭。由於醫(yī)護(hù)人員與病人關(guān)係並不平等、加上醫(yī)醫(yī)相衛(wèi)的文化、政府及各醫(yī)療機(jī)構(gòu)輕視病人權(quán)益，令醫(yī)療體系偏離以病人為本的宗旨。市民的知情權(quán)、選擇權(quán)、私隱權(quán)及投訴權(quán)未獲充分保障。病人權(quán)利與醫(yī)患關(guān)系（英文）9WHO: Patient rights can vary in d

15、ifferent countriesWorld Health Organisation (WHO):Patients rights vary in different countries and in different jurisdictions, often depending upon prevailing cultural and social norms. Different models of the patient-physician relationshipwhich can also represent the citizen-state relationshiphave b

16、een developed, and these have informed the particular rights to which patients are entitled. http:/病人權(quán)利與醫(yī)患關(guān)系（英文）10Patients Charter (病人約章)In year 2000, the Hong Kong Hospital Authority produced a Patients Charter to outline patient rights and responsibilities in public hospital病人權(quán)利與醫(yī)患關(guān)系（英文）11HA Patie

17、nts Charter Patients rightsRight to Medical Treatment (醫(yī)治權(quán)醫(yī)治權(quán))Right to Information (知悉權(quán)知悉權(quán); 知情知情權(quán)權(quán))Right to Choices (決定權(quán)決定權(quán) )Right to Privacy (私隱權(quán)私隱權(quán) )Right to Complaint (申訴權(quán)申訴權(quán)) 病人權(quán)利與醫(yī)患關(guān)系（英文）12HA PatientsCharter Patients ResponsibilitiesGive your heath care providers as much information as you can

18、about your present health, past illnesses, any allergiesFollow the prescribed and agreed treatment plan, and conscientiously comply with the instructions given.Show consideration for the rights of other patients and health care providers, by following the hospital rules concerning patient conduct.Ke

19、ep any appointments that you make, or notify the hospital or clinic as earlyl as possible.Should not ask health care providers to provide incorrect information, receipts or certificates.Should not waste medical resources unnecessarily.http:/病人權(quán)利與醫(yī)患關(guān)系（英文）13Hong Kong Medical Associations Patients Righ

20、ts and Responsibilities Responsibilities:To play an active and responsible role in the healthcare process, you should be frank to your doctors in revealing your medical conditions. endeavor to co-operate with any agreed form of management. be well informed by your insurers of the detailed scope of c

21、overage of your medical insurance policies. not request doctors to issue incorrect receipts, certificates or document, or to make incorrect entry into the medical records. be responsible to meet the required fees and charges for the medical services provided to you. http:/病人權(quán)利與醫(yī)患關(guān)系（英文）14HKMA Patient

22、s rightsRight of information.- Charges- Drugs.Right of refusalRight of confidentialityMedical Reports- Public medical institutions.- Private hospitals and practitionersComplaints- Public medical institutions.- Private hospitals and practitionersOperations- Public and Private Medical Institutions病人權(quán)利

23、與醫(yī)患關(guān)系（英文）15HKMA: Right of InformationA patient should have a reasonable and balanced understanding of the sickness he is suffering from. You may enquire about what disease you have, if you need any further examination, and how to cure the disease. You should also know what treatment you will receive

24、, whether with drugs or operation, any side effects after treatment, and the chances of recurrence. In other words, in order to know more relevant facts about your sickness, you should consult your attending doctor. 病人權(quán)利與醫(yī)患關(guān)系（英文）16In the U.S.DefinitionPatient rights encompass legal and ethical issue

25、s in the provider-patient relationship, including a persons right to privacy, the right to quality medical care without prejudice, the right to make informed decisions about care and treatment options, and the right to refuse treatment.Many issues comprise the rights of patients in the medical syste

26、m, including a persons ability to sue a health plan provider; access to emergency and specialty care, diagnostic testing, and prescription medication without prejudice; confidentiality and protection of patient medical information; and continuity of care.http:/topic/patient-rights病人權(quán)利與醫(yī)患關(guān)系（英文）17The

27、U.S. Patients Bill of RightsHealth care reform led to an emergence of health maintenance organizations (HMOs) and other managed health care plans. The rapid change in medical care moved health care decision making from medical professionals to business entities, a move many consider to be detrimenta

28、l to the health care industry in general. Establishing a patients bill of rights has been the response to this concern. The Bipartisan Patient Protection Act of 2001 has been debated and passed by the U.S. Senate and the U.S. House of Representatives and signed into law.病人權(quán)利與醫(yī)患關(guān)系（英文）18In the U.S. Bi

29、ll of RightsThese basic rights include the right to: participate in the development and implementation in the plan of care be treated with respect and dignity be informed about condition, treatment options, and the possible results and side effects of treatment refuse treatment in accordance with th

30、e law, and receive information about the consequences of refusal quality health care without discrimination because of race, creed, gender, religion, national origin, or source of payment privacy and confidentiality, which includes access to medical records upon request personal safety know the iden

31、tity of the person treating the patient, as well as any relationship between professionals and agencies involved in the treatment informed consent for all procedures information, including the medical records by the patient or by the patients legally authorized representative and hospital charges, e

32、xcept for Medicaid and general assistance consultation and communication complain or compliment without the fear of retaliation or compromise of access or quality of care病人權(quán)利與醫(yī)患關(guān)系（英文）19What is happening to the doctor-patient relationship?Some doctors are worried that the physician-patient relationsh

33、ip, a special humanism motivated by tradition and governed by the ethics of medicine, may be fouled up by the fiscal and economic constraints likely to occur in the health care system - Alvan Feinstein, MD, professor of medicine, Yale University School of Medicine, New Haven, Conn.Marwick, Charles.

34、Preservation of Physician-Patient Relationship Seen as Integral to Health Care System ReformJAMA The Journal of the American Medical Association. Volume 271(12), 23 March 1994, pp 892-893病人權(quán)利與醫(yī)患關(guān)系（英文）20William C. Hsiao: William C. Hsiao, PhD, Department of Health Policy and Management, Harvard Schoo

35、l of Public Health, Boston, Mass. We have promoted the diffusion of some technologies that may not be cost-effective and encouraged their overuse Furthermore, we undercompensate primary care physicians, discouraging them from rendering their services, and likewise (fail to encourage) the young medic

36、al school graduates to pursue a career in family care. Instead of trying to align the economic incentives to improve cost-effectiveness, we are creating an administrative organization that will intrude on this very personal relationship between doctor and patients, between the caring physician with

37、the technical expertise and the patient, Is that the best we can do to preserve this unique relationship?Marwick, Charles. Preservation of Physician-Patient Relationship Seen as Integral to Health Care System ReformJAMA The Journal of the American Medical Association. Volume 271(12), 23 March 1994,

38、pp 892-893病人權(quán)利與醫(yī)患關(guān)系（英文）21Models of Doctor-Patient RelationshipThere are three different kinds of models:1. PATERNALISTIC (家長式關(guān)係)2. CONTRACTUAL (合約關(guān)係)3. FIDUCIARY (受託關(guān)係; Fiduciary duty:受託責(zé)任)病人權(quán)利與醫(yī)患關(guān)系（英文）22Fiduciary relationship in peril?Over the ages the doctor-patient relationship has been defined,

39、through rules of ethics and rules of law, as a fiduciary one, as a relationship founded in trust. When a patient seeks a physicians help and the physician agrees to give that help, a special covenant is made. The patient agrees to take the physician into her confidence, to reveal to him even the mos

40、t secret and intimate information related to her health. The physician, in turn, agrees to honor that trust, and to become the patients advocate in all matters related to her health, placing her interests above all others - including his own personal or financial concerns.The loss of this doctor-pat

41、ient relationship has obvious consequences for patients. Patients, when they are sick and thus least able to fend for themselves, are left without a true, dedicated advocate as they try to navigate the hostile halls of the healthcare system, whose chief concern is to find ways of not spending money

42、on them. Loss of the traditional doctor-patient compact leaves patients marginalized and floundering within that system at the time they are most vulnerable.- Blog of DrRichThe Importance of the Doctor-Patient Relationship, and Why We Cant Have It AnymorePosted on January 23, 2009病人權(quán)利與醫(yī)患關(guān)系（英文）23Pate

43、rnalistic model:Strengths and WeaknessesPaternalistic model: The doctor is the professional. He/she gives the order, the patient obeys.Strengths: Emphasizes the expertise and knowledge of the doctorWeaknesses: Ignores the autonomy of the patient Ignores non-health related but morally legitimate valu

44、es of the patient病人權(quán)利與醫(yī)患關(guān)系（英文）24Contractual model:Strengths and WeaknessesContractual model: The doctor and patient contract for each others mutual benefit; the patient determines or agrees to the doctors decisions.Strengths: Highlights the autonomy of both patient and physician Acknowledges coopera

45、tive/shared aspects of medical decision-making Weaknesses: No contracts developed or signed in real doctor/ patient relationships Model doesnt allow for at trusting relationship 病人權(quán)利與醫(yī)患關(guān)系（英文）25 Fiduciary model:Strengths and Questions Fiduciary model: The patient confidently entrusts his/her health c

46、are to the doctor, who takes on the obligation of working for the benefit of the patient (Fiduciary: relates to a holding of something in trust for another)Strengths: Preserves the freedom and autonomy of both patient and physician The legitimate role of physician knowledge The important role of tru

47、st in the doctor/patient relationship Questions raised by skeptics:1. Patient trust may be manipulated for further economic gain.2. Patient trust may undermines consumers awareness of need for self-protection3. Serious illness and fear of death diminish patient autonomy and power to contract any rel

48、ationship.病人權(quán)利與醫(yī)患關(guān)系（英文）26What about Chinese Culture?Traditional Chinese medical ethics emphasizes 醫(yī)德, based on virtues and morality, rather than relationship between two autonomous individualsPatients as children (醫(yī)者父母心) is related to the ideal image of a benevolent ruler (愛民如子)It may be analogous t

49、o the concept of guardianship (監(jiān)護(hù)) in Western culture 病人權(quán)利與醫(yī)患關(guān)系（英文）27A few cases for thought病人權(quán)利與醫(yī)患關(guān)系（英文）28Case 1: Refusal of treatmentChest physiotherapy is prescribed for an elderly cancer patient by the attending doctor, but he refuses. Must the physiotherapist insist on carrying out the treatmen

50、t plan?Is it unethical to go against the patients wish (to refuse)?病人權(quán)利與醫(yī)患關(guān)系（英文）29Case 2: Autonomy and family memberA patients son insisted that the doctor should not tell his mother that she has been diagnosed with chronic leukemia, otherwise he will take her home against medical advice.The mother seems to be generally passive and submissive to the sons decisions related to her health careHow should the patients right be addressed?病人權(quán)利與醫(yī)患關(guān)系（英文）30Case 3: Demand of Alternative Medicine (另類療法)A 20 year old patient with severe head injury from traffic accident did not improve with rehabilitation