「知情放棄」與「空白同意」合乎自主原則嗎？論病人自主之性質   全文下載

Are “Informed Waiver” and “Blanket Consent” Acceptable Exceptions to the Principle of Autonomy? On the Nature of Patient Autonomy

本文藉著研究告知後同意的兩種例外「知情放棄」與「空白同意」來探討一個在病人自主理論上非常根本的問題：自主是權利還是義務？「知情放棄」乃指病人在知道其有決定權的情況下主動放棄其決定權之行使，而將一切決定交由醫師；空白同意則是指在相關資訊並不充分，甚至不具備的情況下就預先同意，作了決定。這二者都偏離了正統的自主原則──在充分的資訊下自主作決定，是否在倫理上可以接受？本文分析自主義務的可能論述，主張即便肯認病人有道德上的「自主」義務，但這只是一個「對己」義務，而非「對他義務」，因此可以依照病人的自由意願不履行。在臨床治療的醫病關係中，病人的「知情放棄」並不違背自主原則；另外從法社會學的「中間幹部理論」來主張關於人體檢體之再利用，必須允許某種形式的「空白同意」，才能真正落實尊重自主原則。

The ethical and legal doctrine of informed consent has a very strong metaphor that information is power. Therefore， it is believed (or at least claimed) that the power imbalance between doctor and patient caused by information asymmetry can be adjusted by empowering patients with physicians’ duty to disclose. Nonetheless， clinical experiences often show that information does not necessarily bring about knowledge， and knowledge does not necessarily bring about right choices. While informed consent forms become ever lengthier， more and more people doubt such information-dumping really promotes patient autonomy. This paper asks a basic question: can a competent patient waive his/her right to autonomy? Is patient not only entitled but also obliged to autonomy? In more specific， can a patient/subject decline his/her right to know or/and right to make a choice and delegate it to the physician/researcher? Is autonomy in nature a right or a duty? This paper tries to answer these questions by exploring two scenarios: patients’ informed waiver in a clinical setting and human subjects’ blanket consent in a research setting. The author anatomizes the bioethical concept of autonomy into two identifiable rights: right to know and right to make a decision， both， I argued， under certain condition are waivable.