Research on the Actual Conditions of Informed Consent in Contemporary America

医学思想在美国社会70年代的S受到了革命性的巨变。人们质疑医生专断的家长式权力，坚持自决的权利，以及否定医生将病人作为操纵对象的观点。本研究的目的是分析当代美国医生和患者追求知情同意的实际情况，并弄清迈向21世纪的发展历程。世纪。为此，笔者对麻省总医院、乔治城大学医学院和旧金山州立大学医学院的医务人员和病人进行了参与式观察和访谈，并对收集到的大量研究报告进行了分析。(1)知情同意制度化，实事求是。(2)在美国的医院里，除了生物伦理学家、医学社会学家、医务社会工作者、心理学家等医生之外，还有许多其他职业。(3)人们认为知情同意不仅是医生的责任，也是所有医疗职业的责任，也是患者的责任。(4)即使患者是儿童或弱智人士，知情同意也是必要的，不仅对家庭成员，而且对患者本身也是如此。(5)为了达到这一目的，医务人员通过视频、图片、各种面板不规范地告知患者的医疗情况。(6)许多医院都有知情同意书，总体来说，医患关系发生了翻天覆地的变化，医生的家长式专制消失了，因为美国医学界经历了一场医学思想的革命。

The medical thought has received the great revolutionary change at the 70's of American society. People questioned the arbitrary paternalistic power of physicians and insisted the rights of self-determinations as well as repudiate doctors treat patients as the objects of manipulation. These situations I named 'the revolution of medical thoughts'.The aims of this research are to analyze the actual conditions on how physicians and patients are pursuing the informed consent in the contemporary United States, and to make clear the course of these development toward the 21st. century. For that sake I tried to do the participant observation and some interviews with medical people and patients at the Massachusetts General Hospital, Medical Hospital of Georgetown University, and Medical Hospital of San Francisco State University, as well as to analyze huge materials of study reports I have collected.As the results of these field researches I can confirm the following points. (1)The informed consent is institutionalized firmly and is conducted actually. (2)Many such professions other than physicians as bioethicists, medical sociologists, medical social workers, psychologists take part in at the hospitals of the United States. (3)People consider the informed consent is not the duties of only physicians also the duties of all medical professions as well as patients. (4)The informed consent is necessary even though patients are children or mentally handicapped persons, for not only family members but also patients themselves. (5)For the sake of that, medical people inform patient's medical situations to themselves undurstandablly by using videos, pictures, many kind of panels. (6)Many hospitals have manuals of informed consent.In general doctor-patient relationship was changed dramatically and doctor's paternalistic despotism was disappeared because American medical world has experienced 'the revolution of medical thoughts'.