A tájékozott beleegyezés jogi és etikai problémái

Abstract

INTRODUCTION: The previously accepted paternalistic relationship between patients and doctors has changed in last century. The expectation for patients to be involved in medical decisions is growing, but this involvement cannot be imagined without informed consent, hence it became one of the most important elements of a physician's responsibilities. Although informed consent is broadly regulated legally in Hungary, experiences show that practical realization is insufficient. This is also represented in the large number of lawsuits in connection with the inadequate or wrong use of informed consent. The aim of this study was to survey for the first time in Hungary the state of informed consent by the analysis of written consents to anaesthesia. METHODS: The authors collected and studied written consents to anesthesia from 36 hospitals and clinics in Budapest. They studied among others the presence of the following formal elements: individual consent forms for anesthesia, signatures on forms etc. They also examined whether the consents contained all of the conventional elements of informed consent. RESULTS: 61% of hospitals had individual forms for consent to anesthesia. Every consent form required a signature by the patient and almost every form (except two) by the doctor as well. 39% of forms describe the medical treatment in detail and only 25% mention its advantages and disadvantages. 28% of them specify definite risks, but only 19% mention their probability. 67% of the documents refer to the possible need to extend intervention. Patients have to declare whether they permit urgent blood transfusion in 25 institutions (69%). In only two hospitals are patients informed of their rights to revoke consent or to resign from being informed of medical treatment. CONCLUSION: Although all institutions have written consent forms that adhere to legal regulations, in terms of their format and matter they leave much to be desired. It is especially conspicuous that possible risks are named in less than a fourth of all forms, thus they have to be mentioned verbally and this obviously is a source of later arguments. The authors believe that all invasive medical procedures require templates for consent forms put together by professional panels. These forms could then be adapted to all specific medical procedures of the hospital in question.