Law, Ethics and Medical Decision-Making for Information Disclosure: A Moral Diagnosis

信息披露的法律、伦理与医疗决策：道德诊断

• 批准号: ES/X006697/1
• 负责人: Matthew Watkins
• 金额: $ 11.89万
• 依托单位: CARDIFF UNIVERSITY
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2022
• 资助国家: 英国
• 起止时间: 2022 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=ES%2FX006697%2F1
• 关键词: Law; Ethics; Medical; Decision; Making

i. ContextAlongside diagnosis and treatment, information disclosure is a fundamental legal duty owed to the doctor to the patient in the medical relationship. This duty is based on a long-standing moral responsibility that a doctor owes to the patient, and as a professional to society. The doctor must act within the patient's best therapeutic interests, and not cause them harm, when providing information before, during, and after treatment. This duty exists irrespective of whether the patient is consenting to a treatment. Failure to ensure adequate information disclosure fails to respect the dignity and autonomy of a a patient, and denies them the opportunity to make autonomous choices; which can ultimately lead to patient harm. These failures have been only too well evidence in a number of high profile scandels (Alder-Hey, Britol Inquiry) which has shaken trust in the moral and technical expertise of the medical profession, and has subsequently let to political and academic calls for strong ethical regulation.ii. My Thesis: Information disclosure, as one of the primary duties of medical practitioners, offers an excellent vignette of forms of ethical and legal standard-setting. These standards have manifested within the law of negligence, and particularly, in relation to the information that patient's need to make an informed consent to treatment. The current law (Montgomery v Lanarkshire Health Board [2015] UKSC 11) requires doctors to disclose an objective content of so patients can understand the risks and benefits of treatment, as well as information patients may want to know. Currently, the law has the potential to overload patient's with information, and encourage doctors to adopt defensive practices. The law (Chester v Afshar [2004] UKHL 41) has also altered the medical relationship requiring doctors to disclose information exclusively for informed consent. My PhD tracks changes in the law of negligence and ethical gudiance in five stages: between 1950 to present. I have undertaken an exhaustive review of sociological studies on disclosure practices, patient information need, and communication, to build a in-depth picture of information disclosure practices during these five periods. The thesis identifies correlation between law, decision-making processes and communication outcomes. In doing so, the thesis identifies several overarching conceptual problems with previous and current law.iii. Monograph: The fellowship will allow me to write a Monograph which sets out how the different legal and ethical standards relating to information disclosure and how these have affected decision-making in practice. The Monograph will have substantive legal and policy impact; as it will identify the conceptual and practice problems with various standards of disclosure within the law of negligence. This will be of interest to domestic legislators and lawyers as well as common-law jurisdictions who had adopted similar standards. The Monograph will also be of interest to medical practitioners, medical regulators and insurers, who are seeking to reduce the risk of liability; as it will provide informed real-world guidance on how to make decision's about material information. iv. PapersI will publish two papers from my thesis:1. An ethical paper: which will discuss the different conceptualisation of legitimate and illegitimate control within models of autonomy for informed consent. (Target: J Med Ethics)2. A Legal Analysis: The Montgomery judgement has opened the litigation floodgates; in the last 7 years there have been 70 reported cases. These cases have muddled the legal duties and standards of practitioners. My paper will produce the first conceptually coherent synoptic review of case-law. iv. WorkshopsI will host three workshops at the BMA, RCS and Cardiff Law School, to train doctors how to effectively disclose information. This will build my network to recruit for the proposed study.

我。背景信息披露与诊断、治疗一样，是医疗关系中医生对患者承担的一项基本法律义务。这项义务是基于医生对患者以及作为专业人员对社会负有的长期道德责任。医生在治疗前、治疗期间和治疗后提供信息时，必须按照患者的最佳治疗利益行事，不得对患者造成伤害。无论患者是否同意治疗，这项义务都存在。未能确保充分的信息披露就不能尊重患者的尊严和自主权，并剥夺他们做出自主选择的机会；这最终可能导致患者受到伤害。这些失败在许多备受瞩目的丑闻（Alder-Hey、Britol Inquiry）中得到了充分的证明，这些丑闻动摇了人们对医疗行业道德和技术专业知识的信任，并随后引发了政治和学术界对强有力的道德监管的呼吁。我的论文：信息披露作为医生的主要职责之一，提供了道德和法律标准制定形式的精彩片段。这些标准已在过失法中得到体现，特别是与患者需要对治疗知情同意的信息有关。现行法律（Montgomery v Lanarkshire Health Board [2015] UKSC 11）要求医生披露客观内容，以便患者能够了解治疗的风险和益处，以及患者可能想知道的信息。目前，该法律有可能使患者的信息过多，并鼓励医生采取防御性做法。该法律（Chester v Afshar [2004] UKHL 41）还改变了医疗关系，要求医生仅在知情同意的情况下披露信息。我的博士学位跟踪了过失法和道德指导的五个阶段的变化：1950 年至今。我对有关披露实践、患者信息需求和沟通的社会学研究进行了详尽的回顾，以深入了解这五个时期的信息披露实践。该论文确定了法律、决策过程和沟通结果之间的相关性。在此过程中，本文确定了先前和现行法律的几个总体概念问题。专着：该奖学金将使我能够写一篇专着，阐述与信息披露相关的不同法律和道德标准以及这些标准如何影响实践中的决策。该专着将产生实质性的法律和政策影响；因为它将确定过失法中各种披露标准的概念和实践问题。这将引起国内立法者和律师以及采用类似标准的普通法司法管辖区的兴趣。寻求降低责任风险的医生、医疗监管机构和保险公司也会对本专着感兴趣；因为它将为如何做出有关重大信息的决策提供明智的现实指导。四.论文我将发表我的论文中的两篇论文：1．一篇道德论文：将讨论知情同意自主模型中合法和非法控制的不同概念。 （目标：J Med Ethics）2。法律分析：蒙哥马利案的判决打开了诉讼的闸门；在过去7年里，已报告了70起案件。这些案件混淆了从业人员的法律义务和标准。我的论文将对判例法进行第一个概念上连贯的概要审查。四.研讨会我将在 BMA、RCS 和卡迪夫法学院举办三场研讨会，培训医生如何有效地披露信息。这将建立我的网络来招募拟议研究的人员。

项目成果

Journal Paper

期刊论文

• 期刊: Applied Surface Science
• 影响因子: 6.7
• 作者: French. P. W

Law, Ethics and Medical Decision-making about information disclosure: a moral diagnosis

关于信息披露的法律、伦理和医疗决策：道德诊断

• 作者: Matthew Watkins