An ethical analysis of the disclosure of surgeons' performance data to patients within the informed consent process

十多年来，美国纽约州的医院一直在收集有关进行冠状动脉旁路移植术的外科医生死亡率的信息，并将这些信息提供给患者。联合王国将从2004年开始提供这些和其他关于外科医生能力的绩效指标（“报告卡”）。有充分的理由认为，在不久的将来，澳大利亚可能会引入类似的制度。患者在决定是否同意某一外科医生对其进行手术时，可以使用报告卡中包含的信息。当代生物伦理学家强调医学中适当的知情同意程序的重要性。这是一个过程，在病人同意手术之前，医生向病人提供相关信息，并确保病人理解这些信息。目前，美国的报告卡是在互联网上公开发布的，但没有系统地尝试将报告卡中的信息纳入知情同意过程。我们不知道病人是否理解他们得到的信息，或者他们是否适当地将这些信息纳入他们的决策程序。在我们的研究中，我们将考虑如何在知情同意过程中最好地使用报告卡中包含的信息。我们将牢记帮助患者在知情的情况下做出同意手术的决定的重要性，尊重外科医生的职业操守的重要性，以及为患者提供尽可能高的护理标准的重要性。我们的研究结果将是一个经过修订的知情同意过程模型，该模型将以道德上可接受的方式纳入报告卡。

For over a decade, hospitals in the American state of New York have been collecting information about the mortality rates of surgeons conducting Coronary Artery Bypass Grafts, and making this information available to patients. The United Kingdom is set to make these and other performance indicators on the ability of surgeons ('report cards') available from 2004. There are good reasons to think a similar system may be introduced in Australia in the near future. Patients can use the information contained in report cards when deciding whether or not to consent to have a particular surgeon conduct an operation on them. Contemporary bioethicists stress the importance of a proper informed consent process in medicine. This is a process in which a doctor advises a patient of relevant information and ensures that the patient comprehends that information, before the patient consents to an operation. Currently report cards in America are publicly disseminated on the internet, however there is no systematic attempt to incorporate the information contained in report cards into the informed consent process. We do not know if patients understand the information they are given, or if they incorporate it into their decision making procedures appropriately. In our study we will consider how information that is contained in report cards could best be used in the informed consent process. We will keep in mind the importance of helping patients to make their own informed decisions to consent to operations, the importance of respecting the professional integrity of surgeons and the importance of providing the best possible standard of care for patients. The result of our study will be a revised model of the informed consent process that incorporates report cards in an ethically acceptable way.