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法学 2024年第4期12卷 2341-2347页

作者：黄润鑫华东理工大学法学院，上海

本文以法院案例研究为基础，探讨了在预先医疗决定范畴下患者自主权与医师自由裁量权之间的关系与解决权利冲突的价值指引和路径构想。解决冲突的价值指引包括立法原则需优先保护高位权利、明确权利边界、重视患者利益至上、规范权利行... 详细信息

本文以法院案例研究为基础，探讨了在预先医疗决定范畴下患者自主权与医师自由裁量权之间的关系与解决权利冲突的价值指引和路径构想。解决冲突的价值指引包括立法原则需优先保护高位权利、明确权利边界、重视患者利益至上、规范权利行使；路径强调医疗决策应真实反映患者意愿、明确患者自主权与家属替代决定的边界。法院在调解冲突中扮演重要角色，需要多方合作解决。以期此文对医患关系进行更为全面和深入的法律分析，更好地适应我国老龄化社会需求，促进医疗服务的公平、公正和高效。

关键词：预先医疗决定患者自主权医师自由裁量权 Advance Care Decisions patient autonomy Physician Discretion

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Double balloon enteroscopy examinations in general anesthesia

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World Journal of Gastroenterology 2010年第27期16卷 3418-3422页

作者： Laszlo Zubek Lena Szabo Peter Laszlo Lakatos Janos Papp Janos Gal Gabor Elo Department of Anaesthesiology and Intensive Therapy Semmelweis University 2nd Department of Pediatrics Semmelweis University 1st Department of Medicine Semmelweis University

AIM:To demonstrate that the double balloon enteroscopy(DBE) can be safely performed in general anesthesia with intubation.METHODS:We performed a retrospective examination between August 2005 and November 2008 amongpatients receiving intubation narcosis due to DBE examination.The patients were grouped based on sex,age and physical status.Anesthesia records includedduration of anesthesia,quantity of medication usedand anesthesia-related complications.We determinedthe frequency of complications in the different groupsand their relation with the quantity of medication usedand the duration of anesthesia.RESULTS:We compiled data for 108 cases of general anesthesia with intubation.We did not observeany permanent anesthesia-related complications;themost frequent side effects of anesthesia were hypo-tension(30.55%),desaturation(21.29%),and apnea(17.59%).These complications were significantly more frequent among patients with multiple additional diseases [hypotension(23.1% vs 76.9%,P = 0.005),desaturation(12.3% vs 69.2%,P patients with multiple additional diseases.

关键词： Double balloon enteroscopy General anesthesia Intubation Sedation patient autonomy

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Ethical Decision-Making in Clinical Nutritional Practice

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Food and Nutrition Sciences 2011年第6期2卷 641-646页

作者： Francois P.R.de Villiers Department of Paediatrics and Child Health School of MedicineMEDUNSA CampusUniversity of LimpopoPretoriaSouth Africa

Ethics requires a critical evaluation of assumptions and arguments about norms and values;what should be done and what should not. Practitioners should practice ethically, and the professions should be at the forefront of applied ethics. There are four principles, patient autonomy, beneficence, non-maleficence and justice, which are guides to ethical day-to-day practice. patient autonomy: autonomy means self-rule by persons of their thoughts and actions. patient autonomy requires the practitioner to realise that patients have the right to be involved in decision-making on their own behalf. Beneficence refers to the duty of the practitioner to do the best for the patient. The benefits of breast-feeding are many, and the eventual outcome on health enormous. Nevertheless, health-care workers are diffident in promoting breast-feeding, and readily accept excuses for not breast-feeding, contrary to the principle of beneficence. Non-maleficence refers to the duty of the practitioner not to do harm;it requires the practitioner to withhold harmful therapies;Vitamin E, for example, has been proven to be ineffective as an antioxidant in humans, and large doses have been proven to increase mortality. Yet these are the doses available in supermarkets and “Health shops”. Nutritionists should actively advise against harmful “dietary supplementation”. Distributive justice requires every patient to have an equal opportunity to obtain appropriate therapy. There are relatively few nutritionists and dieticians in South Africa, and indeed in the entire African continent, but proportionately even fewer in the areas of greatest need. A case illustrates the application of these ethical principles to show how they can be applied to our daily practice. Using these four principles is a practical approach to solving ethical dilemmas.

关键词： Ethics patient autonomy Beneficence Non-maleficence Justic

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