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

在医疗关系中，信息披露与诊疗一样，是医生对患者应尽的一项基本法律义务。这项义务是建立在医生对病人和作为专业人员对社会的长期道德责任的基础上的。在治疗前、治疗中、治疗后提供信息时，医生的行为必须符合患者的最佳治疗利益，而不是对患者造成伤害。无论病人是否同意治疗，这项义务都存在。未能确保充分的信息披露，未能尊重病人的尊严和自主权，并剥夺他们自主选择的机会；这最终会对病人造成伤害。这些失败在一些引人注目的丑闻（阿尔德-嘿，布里托尔调查）中得到了很好的证明，这些丑闻动摇了人们对医疗专业的道德和技术专长的信任，随后引起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，作为医疗从业者的主要职责之一，提供了一个很好的形式的道德和法律标准制定的小插曲。这些标准在过失法中得到了体现，特别是在患者需要对治疗作出知情同意的信息方面。现行法律（蒙哥马利诉拉纳克郡卫生委员会[2015]UKSC 11）要求医生披露客观内容，以便患者了解治疗的风险和益处，以及患者可能想知道的信息。目前，这项法律有可能给病人带来过多的信息，并鼓励医生采取防御措施。该法律（Chester v Afshar [2004] UKHL 41）也改变了医疗关系，要求医生仅在知情同意的情况下披露信息。我的博士研究了过失法和道德指导的五个阶段的变化：从1950年至今。我对披露实践、患者信息需求和沟通的社会学研究进行了详尽的回顾，以建立这五个时期信息披露实践的深入图景。本文确定了法律、决策过程和沟通结果之间的相关性。在此过程中，本文确定了以前和现行法律的几个总体概念问题。专论：该奖学金将允许我写一篇专论，阐述与信息披露有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。《专著》将产生实质性的法律和政策影响；因为它将确定概念和实践问题与各种披露标准的过失法。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将对此感兴趣。该专论也将感兴趣的医生，医疗监管机构和保险公司，谁正在寻求减少责任的风险；因为它将为如何对重要信息做出决策提供知情的现实指导。我将从我的论文中发表两篇论文：一篇伦理论文：将讨论知情同意自治模型中合法和非法控制的不同概念。（目标：医学伦理学）法律分析：蒙哥马利案打开了诉讼的闸门；在过去7年中，报告了70例病例。这些案件混淆了从业者的法律责任和标准。我的论文将产生第一个概念上连贯的对判例法的概括性评论。讲习班将在BMA， RCS和卡迪夫法学院举办三个讲习班，培训医生如何有效地披露信息。这将为我的研究建立人脉。

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.