2007，Maternal Li Liyun was sent to a hospital in Beijing for rescue due to dystocia。Suggestions from the patient's family disagreed with the doctor for cesarean section surgery，Refusing to sign on the Surgical Conference。Although rescued after a few hours，Pregnant women's death。In this case，Tragedy occurs.。Maternal family members mistakenly consider the consent of informedness as "life and death"，The signing of the surgery agrees as a legal liability that the hospital shirk due to medical accidents。Part of the case in this case The system of informedness in the inforation of the informed consent system in the medical risk notification。

In the Commonwealth State，Montgomery vs Lanarkshire Health Board [2015] Uksc 11 (Montgomery case) is a milestone judgment，The significance of the case is that patients in medical relations are no longer passive recipients of medical intervention under the principle of informed consent.，Instead, the main body of medical decision -making with the doctor with autonomy。In other words，Doctors and patients' relationships from the traditional "doctor's active decision，Patient model of patients passive acceptance "transformed into" doctors and patients participating together、Patients' common decision -making mode。The principles of "Awareness Agreement" in the UK began in 1957 "Bolam V Friern Hospital Management Committee" [1957] 1 WLR 582 (BOLAM Case)。John Hector Bolam at the FRIERN Hospital received "electrical spasm therapy" in 1954 to treat depression。When he was treated for treatment，convulsions and fell because the body accepts electric shocks，and cause hip joint dislocation and pelvic fracture。Afterwards，He sued the hospital，It is said that it has not fulfilled the care obligation to take care of the patient，Specifically reflected in: first，No muscle relaxation drugs were given before Bet365 app download treatment to reduce the risk of muscle twitching and reducing the risk of injury during the electric shock; the second，The doctor did not tell the patient's electric shock to treat potential risks。Discussion after the court，and extensively solicited the opinions of a professional physician of psychiatrics, learned，Under the medical conditions at the time，Greating muscle relaxation drugs before electric shock treatment is not a common consensus in the medical community，Common side effects such as respiratory suppression due to muscle relaxation drugs。Another point of view, think，Artificial fixation patients during treatment can reduce the probability of death，But at the same time increase the risk of fracture。The jury also learned that the medical practice at that time was that doctors usually do not inform patients with low probability of treatment.，Unless the patient actively asks。

In the case，The defendant has a care responsibility for the plaintiff，But caused the facts such as fractures，There is a causal relationship between the results of the damage and the medical behavior。But the operation of the court judgment FRIERN Hospital meets the medical industry standards，and established the BOLAM standard that has been used for many years since then。Under this standard，If the institution in the medical field consisting of skilled medical personnel confirms that the operation of the doctor involved in the case is appropriate，Even if it causes damage to the patient, it will not determine that it violates the obligation of attention to the patient，Other medical institutions have other opposite views, and they are not asking。Therefore, the establishment of this standard has caused the support of the court to support the obligation to violate the attention of medical services。In this case，Doctors are convinced that electric shock therapy is greater than disadvantages，The medical behavior adopted in line with the medical specifications at the time。The court believes that the diagnosis of the defendant is not wrong，bet365 live casino games If the doctor informed the patient's related sequelae，Patients will refuse to treat。In other words，The court recognized the doctor's free tailoring of medical behavior in medical specifications。

BOLAM standard defect is that the testimony of medical groups is overly dependent，It has caused the judgment of the case that is not objective enough。In this case，Determine whether the doctor violates the obligation to pay attention to the patient，Whether the doctor's informs meet the standard of a "rational doctor" that should be notified by the patient。But，Medicine is a strong professional discipline，The information of both doctors and patients is extremely asymmetric，Leading the consent mode of informedness is easily reduced to procedural notification，Patients become passive medical behavior recipients，The leading position of the doctor occupied decisions。Although the common purpose of the doctor and patients is to relieve the patient's illness，But the focus of the focus sometimes has obvious differences。So，Patient's values ​​and life goals should be respected during the medical decision -making process，Because the patient will make a decision that is contrary to pure medical suggestions under the action of his personal values。For example，A radiation therapy that may refuse to change its face -changing face -changing radiation therapy，thus pursue the last dignity of life; "Full Moon Face caused by fear of hormone therapy due to the immune system disease、Buffalo Back "and other side effects，and would rather choose a more conservative but general treatment method;，It is better to abandon life and refuse to treat foreign blood transfusion.。Although the patient's choice is on the surface, the purpose of relieving the pain from the doctor and patients，But if you try to respect the values ​​of the patient's personal pursuit and follow，It is not difficult to understand the medical decision of the patient's "inconsistent common sense"。

Bolam standard is adopted more than half a century later，In 2015, he was challenged by the judgment Bet365 app download of the Montgomery case.。Specific mother Montgomery Nadine ladies are petite in shape，and suffer from insulin -dependent diabetes (type I diabetes)。Pregnant women with type I diabetes are prone to fetal weight too much，Coupled with the petite body of pregnant women，Vaginal delivery has high risk，If it is difficult to produce。In this case，McLellan, a obstetrician who is responsible for Ms. Montgomery, admits that the probability of a dystrophy of the pregnant woman is about 10%。But based on the doctor's experience，Most of the most shoulder -length difficulty can avoid serious consequences through timely medical intervention。The risk of cerebral palsy caused by hypoxia due to difficulty in shoulders is 0.1%。Bolam case with the above，Unless the patient is specially inquiring，Otherwise, according to the practice，Doctors will not inform the risk of extremely low probability。Due to Montgomery's abdomen, the fetus weight is too large，It is difficult to enter the birth canal during childbirth，Therefore, it will be difficult to take vaginal delivery。Doctors face two options: one is to try to make the fetal shoulders no longer block the birth canal; the other is to let the fetus return to the uterus，and perform emergency cesarean section surgery。The doctor only informed Montgomery Ms. Ms. Ms. Ms. Ms. Ms. Montgomery was larger than normal.。Although Montgomery told the doctor about her worry about fetal weight，But the doctor did not inform him of the risk of dystocia for shoulder -length。When Montgomery has vaginal delivery，A shoulder -length dystocia appears，It takes 12 minutes from the baby's head to the completion of delivery，To the baby due to hypoxic cerebral palsy，Damage to the ability of limbs。Subsequent，Montgomery filed a lawsuit with the court，Request compensation。But the doctor argued that it would generally not discuss the problem of shoulder -to -shoulder production with pregnant women，Because she believes that if she tells the risk of the shoulder difficulty，Pregnant women will choose Bet365 app download cesarean section，and the cesarean section will cause greater damage to pregnant women。Dr. McLellan emphasized that it has always been thinking about the benefit of the maternal，I did not tell the risk of the shoulder -length dystocia。

Montgomery's appeal in the first instance and the appeal court ended in a failure，The reason is that the court followed the BOLAM standard，I respect the doctor’s free tailoring right。After consulting medical experts in the court，I believe that Dr. McLellan's behavior meets industry standards，Never constitutes a negligence。But in the judgment of the British Supreme Court，Montgomery got support from the court，The court believes that doctors have the obligation to inform patients with "major risks" related to medical care，Let the patient decide autonomously。The court further explained the so -called "major risk"，refers to a risk that a rational patient usually pays attention to，and this risk has nothing to do with its incidence。So，Even in this case, even if the risk of cerebral palsy is only 0.1%，But the major illness that is difficult for patients and their families to bear cerebral palsy belongs to "major risk"。So far，BOLAM standards are no longer used in the communication and informed consent of doctors and patients，The British Supreme Court believes whether a doctor should inform the patient's judgment standard for the medical information，Standards for the medical industry should not be adopted，Instead, the patient's human rights standard。Do the doctor should inform the patients about the risks caused by treatment or other alternative treatment plans are not just medical problems，Patients have the right to decide to bear risk for their own health status。In other words，Montgomery case transforms the "rational doctor" standard established in the BOLAM case into the "rational patient" standard，In terms of information notification，The "Agreement Agreement" standard is raised into the "common decision" standard for doctors and patients，It requires doctors to fully communicate with Bet365 app download patients，Let patients understand risks，and make the final choice according to your own situation，instead of simply relying on professional medical knowledge to make medical decisions。

Current，Chinese doctor -patient communication and medical decision -making still consent with knowledge、Inform decision -making as the main。Common decision -making mode compared to informed consent mode，Effective communication between doctors and patients is needed，Fully respect patient autonomy。Asymmetric information between doctors and patients also put forward additional requirements for medical workers，If you avoid using too many professional terms、Fully consider the personal needs of patients。One aspect，Under a common decision -making mode，Patient's compliance with the doctor's advice will be significantly increased，to improve the level of self -management; on the other hand，Common decision -making can effectively reduce the dispute between doctors and patients，Reduce violent injuries and other adverse events。As the British requires in practice，If a diagnosis and treatment behavior has huge potential risks，Regardless of the size of the occurrence of probability，Doctors should inform patients，Common decision -making with patients。

Respect patient autonomy，This combines the patient's value preference with the doctor's professional diagnosis and treatment opinion，It is also particularly important in the process of improving the level of chronic disease diagnosis and treatment。For example，Diabetes commonly existed among the people、The efficacy of diseases such as hypertension，Except drug intervention，It has a close relationship with the self -management of the patient and the self -management of the patient's lifestyle。The problem of aging in my country is becoming more serious，Patients in the common decision -making mode of doctors and patients can integrate non -medical related factors into clinical decisions，If you have a diet habit、Work intensity, etc.，Make diagnosis and treatment decisions is bet365 live casino games more likely to be accepted and executed by patients，to improve the daily self -management level of chronic diseases。At present, the communication between doctors and patients in the Commonwealth national country has gradually changed from BOLAM standard to Montgomery standard，Ask doctors to understand the condition through communication with patients，and the personal needs of patients into clinical decisions，Analysis of the advantages and disadvantages of the treatment plan，Therefore, medical decision -making that conforms to the value orientation of patients。Perfect information inform the rules，Establish information based on the premise of respect for the autonomy of patients，It is one of the important factors to improve the efficiency of medical work。

　Bet365 lotto review