Reflection on family consent: based on a pregnant death in a Beijing hospital.
The 'family consent' process has been placed at the centre of Chinese clinical practice. Although there has been critical analysis of how the process functions in relation to the autonomy and rights of patients, there has been little examination of the perceptions and attitude of patients and their families and the medical professionals, in relation to moral dilemmas that arise in real cases in the bioethical discourse. When faced with a consent form in an emergency situation, the family member's capacity to act is reduced, as he/she becomes enmeshed in the hospital structure of tacit, socially-imposed rules. In a questionnaires based on a real death case in 2008, 70.9% of the surveyed medical professionals (n = 3,665) disagreed with performing surgery without the consent of the family even if the patient's life was in danger, while 36.6% of the surveyed patients (n = 1,198) hold the same position. This work demonstrates the weakness of the family consent process as a safeguard of patient's autonomy. Finally, I argue that saving the patient's life should be the overriding obligation rather than the respect for the surrogate's autonomous choice at such a decisive moment.
Center for Bioethics, Peking Union Medical College, Beijing, China. zxqclx@yahoo.com
Xinqing
X
Zhang
D000328:Adult; D002681:China; D002755:Choice Behavior / Q000941:ethics*; D032903:Confucianism; D003643:Death; D003657:Decision Making / Q000941:ethics; D004630:Emergencies; D005190:Family; D005260:Female; D006801:Humans; D026684:Personal Autonomy; D010817:Physician-Patient Relations / Q000941:ethics; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000941:ethics* / Q000592:standards; D011795:Surveys and Questionnaires; D020458:Third-Party Consent / Q000941:ethics*; D035502:Trust