Research on the Actual Conditions of Informed Consent in Contemporary America

医学思想在70年代的美国社会发生了巨大的革命性变化。人们质疑医生武断的家长式权力，坚持自决的权利，并否认医生将病人视为操纵的对象。我把这些情况称为“医学思想的革命”。本研究的目的是分析当代美国医生和患者如何追求知情同意的实际情况，并明确这些发展走向21世纪的进程。世纪。为此，我尝试在麻省总医院、乔治城大学医学院和旧金山州立大学医学院进行参与性观察和对医务人员和患者的一些访谈，并分析我收集的大量研究报告材料。作为这些实地研究的结果，我可以确认以下几点。(1)知情同意制度牢固，落实到位。在美国的医院里，除了医生之外，还有许多其他职业，如生物伦理学家、医学社会学家、医学社会工作者、心理学家等。(3)人们认为知情同意不仅是医生的责任，也是所有医疗行业和患者的责任。(4)即使患者是儿童或智障人士，无论是家属，还是患者本人，都需要知情同意。(5)为此，医务人员通过视频、图片、各种面板，让自己明白地了解病人的医疗情况。(6)许多医院都有知情同意手册。总的来说，医患关系发生了巨大的变化，医生的家长式专制也消失了，因为美国医学界经历了“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'.