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

I.信息披露是医疗关系中医生对患者应尽的一项基本法律的义务。这一义务是基于医生对病人和作为专业人员对社会的长期道德责任。医生在提供治疗前、治疗中和治疗后的信息时，必须以患者的最佳治疗利益为出发点，不得对患者造成伤害。无论病人是否同意接受治疗，这项义务都存在。未能确保充分的信息披露未能尊重患者的尊严和自主权，并剥夺了他们做出自主选择的机会;这最终可能导致患者受到伤害。这些失败在一些备受瞩目的scandels（Alder-Hey，Britol Inquiry）中得到了很好的证明，这些scandels动摇了人们对医学专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：信息披露作为医疗从业人员的主要职责之一，为伦理和法律的标准制定提供了一个极好的小插曲。这些标准在过失法中得到了体现，特别是在病人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，这项法律有可能使病人的信息过载，并鼓励医生采取防御性做法。该法律（Chester v Afshar [2004] UKHL 41）也改变了医疗关系，要求医生仅为知情同意而披露信息。我的博士学位追踪了过失法和道德规范在五个阶段的变化：从1950年到现在。我已经进行了详尽的审查披露的做法，病人的信息需求和沟通的社会学研究，建立在这五个时期的信息披露实践的深入了解。本论文确定了法律、决策过程和沟通结果之间的相关性。在这样做的时候，论文确定了一些总体概念问题与以前和目前的法律。专论：奖学金将使我能够写一本专著，阐述与信息披露有关的不同法律的和道德标准，以及这些标准如何影响实践中的决策。该专著将产生实质性的法律的和政策影响，因为它将确定过失法范围内各种披露标准的概念和实践问题。国内立法者和律师以及采用类似标准的普通法管辖区将对此感兴趣。该专著也将对寻求降低责任风险的医疗从业者、医疗监管机构和保险公司感兴趣;因为它将提供关于如何对材料信息做出决策的知情的现实指导。四.论文我将发表两篇论文从我的论文：1。一份伦理文件：这将讨论不同的概念化的合法和非法的控制模式自主知情同意。（目标：J Med Ethics）2.法律的分析：蒙哥马利案的判决打开了诉讼的闸门;在过去的7年里，有70起报告的案件。这些案件混淆了从业人员的法律的职责和标准。我的论文将产生第一个概念上连贯的概要审查判例法。四.研讨会我将在BMA、RCS和卡迪夫法学院举办三个研讨会，培训医生如何有效地披露信息。这将建立我的网络，为拟议的研究招募。

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.