由手術知情同意過程談華人社會文化對自主的意涵

The Meaning of Autonomy in Chinese Culture: Obtaining Informed Consent for Operation

知情同意基於倫理尊重自主的概念，是執行臨床醫療處置的基礎。以手術為例，在尊重自主概念之下，醫生說明醫療狀況的對象應以病人為主體；病情告知應於病人行使同意權之前。本文由倫理自主原則之重要性，論及華人社會不同於西方社會的自主權的意涵，由具自主能力病人，在手術前簽署同意書的過程之案例進行討論。臨床上病情解釋到完成簽署手術及麻醉同意書，參與的專業人員包括醫師與護理人員，雖然病情告知並非護理人員的責任，但執行同意書給予及回收簽署的護理人員，絕對有必要瞭解在華人文化社會之下，個人的自主權意涵。

The purpose of gaining the patient's informed consent is ethical, lying in respect for his or her autonomy, and such consent forms the foundation for the performance of clinical medical treatment. In order to respect the patient's autonomy, for example, during decisions about operations, doctors have the obligation to clearly explain that patient's medical condition to him/her. A thorough briefing should be given prior to the obtaining of the patients' consent. In fulfillment of their duties as medical professionals, both doctors and nurses should be involved in clinically informing patients as well as in obtaining their signature for operation and anesthesia. Although informing patients about their physical state is not the responsibility of nurses, it remains absolutely necessary for nurses to understand how people in Asian cultures understand autonomy. This paper begins with a discussion of autonomy in ethics, and then outlines the differences between the Eastern and Western concepts of autonomy, before discussing the obtaining of the signature of consent, a process performed by the nursing staff during clinical treatment, and resulting in the provision of such signatures by patients with the legal capacity to provide them.