【作者】 李蓓英；

【导师】 冯泽永； 潘佳铭； 彭自强；

【作者基本信息】 西南师范大学 ， 伦理学， 2003， 硕士

【摘要】 和谐的医患关系是获得良好医疗效果的基本保证，然而随着我国医学科学的发展和改革开放的不断深入，人们的物质、精神生活虽不断提高，医患关系却遇到了前所未有的挑战，其中，医患沟通障碍成为突出的现实问题和当前医学伦理学界关注和探讨的重点。 本文在借鉴、吸收学术界研究成果的基础上，以事实为依据，考查了我国医患关系的现状，从伦理层面分析了医患沟通障碍的原因，并对如何清除医患沟通障碍，营建和谐的医患关系提出了自己的见解。除“引言”外，全文共分三个部分。 第一部分：医患关系的现状。界定了本文将要论述的医患关系的涵义，指出了当前我国医患关系的状况是医疗纠纷逐年递增，医患矛盾愈演愈烈。调查表明，医患沟通不良是造成医患关系紧张、医疗纠纷居高不下的重要原因。为促进医患沟通、改善医患关系、切实保障医患双方的利益，社会各界倡导尊重患者的知情同意权，可是这一主张却遭到部分患者的异议，同时医方自我保护性医疗的问题也在医患关系中日益凸显出来。 第二部分：医患沟通障碍的原因分析。笔者认为，西方医学人文建构的“迟到”与中国医学人文传统的“失落”形成了医学中的人文空白。对科学的崇拜使唯科学主义的影响在医疗实践和医学教育中根深蒂固，造成医患关系物化；对金钱的崇拜消解着医患之间的关爱和信任，使医学进一步失人性化。医学从人与人的故事变为人与机器的故事，人与金钱的故事。人文空白使医学丧失了应有的人I 性温度，从而阻碍了医患沟通。D 第三部分：医患沟通的伦理清障。论文从医学模式和医患模式的转变切入， 提出将医患间的技术沟通与非技术沟通统一起来，重建人性的医学。目前的关键I 是立足本国国情和医患双方的利益，学习借鉴西方人文精神、批判继承中国传统D 医德，深刻理解知情同意原则的内涵和现实意义，认真处理好患者知情同意与代D 理人（亲属）同意的关系，以及患者知情同意权与医生的医疗干预权的关系等问Z 题，促进医患沟通，改善医患关系。更多还原

【Abstract】 Good effect of medical treatment must be predicated on harmonious doctor-patient relationships. With the development of medical sciences and reforms, both the material and spiritual life in China has become better. Doctor-patient relationships, however, confront new challenges. The major obstacle of communication in the relationships has become a serious social problem and a medical ethics issue.The thesis adopts the theoretical achievements in the area, analyses the current situation of doctor-patient relationships and reasons for obstacles in doctor-patient communication and discusses how to remove the obstacles and build harmonious doctor-patient relationships. This process can be seen in the following three parts.1. Current situation of doctor-patient relationshipsThe author defines "doctor-patient relationships" and then points out the current situation of doctor-patient relationships in China has deteriorated and the conflicts between doctors and patients are more fiercely fought. Studies have demonstrated that unhealthy doctor-patient communication is the major cause of medical malpractice. In order to improve doctor-patient communication and protect their bilateral interests,society as a whole has advocated to respect the patients’ right of informed consent. However, some patients doubt and object to this view; some, doctors prefer a wider range of tests and possible treatments to protect their medical reputation.2. Reasons for obstacles in doctor-patient communicationHumanism vacuum in medical sciences is a result of lack of western medical humanism and loss of Chinese traditional medical humanism. Scientism in medical education and practice has made the doctor-patient relationships materialistic. Money worship has eliminated the love and trust between doctors and patients. Medical sciences have become not stories between person and person, but between person and machine, between person and money. The humanism vacuum has resulted in unhealthy doctor-patient communication.3. Replace ethical obstacles in doctor-patient communicationThe author discusses both the medical model and the doctor-patient model and suggests uniting the technology communication and non-technology communication in order to rebuild the medical sciences with sufficient levels of humanity. The most important thing is to embrace our own culture in the interests of doctors and patients. We should critically assimilate western and Chinese medical humanism and fully understand the significance of informed consent. In order to promote communication and improve doctor-patient relationships, we must correctly handle two problems. One is that patients or their agents, especially families, should exercise the right of informed consent. The other is how to balance the need for informed consent and medical paternalism.更多还原