2007，Mother Li Liyun was sent to a hospital in Beijing for rescue due to dystocia。Because the patient’s family disagrees with the doctor’s recommendation for cesarean section，Refuse to sign the surgery consent form。After several hours of rescue，Pregnant woman died。In this case，The root cause of the tragedy lies in the incorrect use of the right to informed consent by the patient’s family as agents。Family members of pregnant women mistakenly regard informed consent as a “life and death condition”，Considering signing a surgical consent is an act by the hospital to shirk its legal responsibility for bet365 sign up bonus code malpractice。This case partially exposed the flaws of the current informed consent system in bet365 sign up bonus code risk notification。

In Commonwealth countries，Montgomery vs Lanarkshire Health Board [2015] UKSC 11 (Montgomery case) is a landmark judgment，The significance of this case is that in the bet365 sign up bonus code relationship, patients are no longer passive recipients of bet365 sign up bonus code intervention under the principle of informed consent，But a subject with autonomy to make bet365 sign up bonus code decisions together with doctors。In other words，The doctor-patient relationship has changed from the traditional "doctor's active decision-making，The parental model of passive acceptance by patients has been transformed into one of joint participation of doctors and patients、Shared decision-making model in which patients fully present their preferences。The British "informed consent" principle began in 1957 with "Bolam v Friern Hospital Management Committee" [1957] 1 WLR 582 (Bolam case)。Mr. John Hector Bolam went to Friern Hospital in 1954 to receive "electroconvulsive therapy" to treat depression。While he was undergoing treatment，Twitched and fell down due to electric shock to the body，And causing hip dislocation and pelvic fracture。Afterwards，He sued the hospital，It said it failed to fulfill its duty of care to patients，Specifically reflected in: first，No muscle relaxants were given before treatment to reduce muscle twitching during electric shock and reduce the risk of falls；Second，The doctor did not inform the patient of the potential risks of electroshock therapy。After discussion in court，After extensive solicitation of opinions from psychiatric professionals，Under the bet365 sign up bonus code conditions at the time，It is not a general consensus in the bet365 sign up bonus code community to give muscle relaxants before electroshock treatment，Because muscle relaxants have common side effects such as respiratory depression。Another school of thought，Manually immobilizing patients during treatment can reduce the probability of death，But it also increases the risk of fractures。The jury also heard that it was bet365 sign up bonus code practice at the time for doctors not to inform patients of the less likely risks of treatment，Unless the patient actively asks。

In this case，The defendant doctor had a duty of care to the plaintiff，But it caused injuries such as fractures，And there is a causal relationship between the damage result and the bet365 sign up bonus code behavior。However, the court ruled that Friern Hospital’s operations complied with bet365 sign up bonus code industry standards，And established the Bolam standard that has been used for many years since then。Under this standard，If an institution in the bet365 sign up bonus code field consisting of skilled bet365 sign up bonus code personnel confirms that the actions of the doctor involved were appropriate，Then even if it causes harm to the patient, it will not be deemed to have violated the duty of care to the patient，It doesn’t matter if other bet365 sign up bonus code institutions have other opposing views。Therefore, the establishment of this standard makes it difficult for claims arising from breach of duty of care in bet365 sign up bonus code services to be supported by the court。In this case，The doctor is convinced that the benefits of electroshock therapy outweigh the risks，And the bet365 sign up bonus code actions taken complied with the bet365 sign up bonus code standards at the time。The court held that the defendant doctor’s diagnosis was not wrong，If the doctor informs the patient of the relevant sequelae，Patient will refuse treatment。In other words，The court recognized doctors’ discretion in bet365 sign up bonus code conduct within bet365 sign up bonus code regulations。

The flaw of the Bolam standard is its overreliance on the testimony of the bet365 sign up bonus code community，This leads to an insufficiently objective judgment of the facts of the case。In this case，Determine whether the doctor violated his duty of care to the patient，Whether the doctor’s notification behavior meets the standards that a “rational doctor” should inform patients。However，Medicine is a highly professional subject，The information between doctors and patients is extremely asymmetric，Leading the informed consent model into procedural notification，Patients become passive recipients of bet365 sign up bonus code actions，Doctors occupy the dominant position in decision-making。Although the common purpose of doctors and patients is to relieve the patient’s pain，But the focus is sometimes significantly different。Therefore，The patient’s values ​​and life goals should be respected in the bet365 sign up bonus code decision-making process，Because patients, influenced by their personal values, may make decisions that are contrary to purely bet365 sign up bonus code advice。For example，Cancer patients may refuse radiation therapy that could drastically alter their appearance，Thus pursuing the final dignity of life；Patients with immune system diseases suffer from “moon face” caused by fear hormone treatment、Buffalo back” and other side effects，I would rather choose a more conservative but generally effective treatment；Another example is religious belief，I would rather give up my life than refuse allogeneic blood transfusion treatment。Although the patient's choice seems to deviate from the common purpose of relieving pain between doctors and patients，But if you try to respect the patient’s personal pursuits and values，It is not difficult to understand the patient’s “unreasonable” bet365 sign up bonus code decision-making。

More than half a century after the adoption of the Bolam standard，Challenged by the Montgomery case decision in 2015。Mom-to-be Ms. Montgomery Nadine is petite，And suffers from insulin-dependent diabetes (type I diabetes)。Pregnant women with type I diabetes are prone to excessive fetal weight，In addition, pregnant women have petite bodies，Vaginal birth carries higher risks，Russian shoulder dystocia。In this case，McLellan, the obstetrician in charge of Ms. Montgomery, admitted that the probability of shoulder dystocia in the pregnant woman was about 10%。But based on doctor’s experience，The vast majority of shoulder dystocia can avoid serious consequences through timely bet365 sign up bonus code intervention。The risk of fetal cerebral palsy due to shoulder dystocia and hypoxia is only 0.1%。Same as Bolam case above，Unless the patient specifically asks，Otherwise follow convention，Doctors will not tell you about extremely low-probability risks。Because the fetus in Ms. Montgomery’s belly is too heavy，It can make it difficult for the fetus to enter the birth canal during delivery，Vaginal delivery will therefore be difficult。Doctors face two choices: One is to try to prevent the fetal shoulders from blocking the birth canal；The second is to return the fetus to the womb，And perform emergency cesarean section。The doctor only told Ms. Montgomery that her fetus was larger than normal。Although Montgomery expressed her concerns to the doctor about the weight of the fetus，But the doctor did not inform her about the risk of shoulder dystocia。When Ms. Montgomery gave birth vaginally，Shoulder dystocia occurred，It takes 12 minutes from the time the baby’s head is delivered to the completion of delivery，Causing cerebral palsy in infants due to hypoxia，With impaired mobility of limbs。Afterwards，Ms. Montgomery filed a lawsuit in court，Request for compensation。But the doctor argued that he generally would not discuss shoulder dystocia with pregnant women，Because she believes that if the risk of shoulder dystocia is informed，Pregnant women will choose cesarean section，Caesarean section will cause greater harm to pregnant women。Dr. McLellan emphasized that he always has the interests of mothers in mind，Not informed of the risk of shoulder dystocia。

Ms. Montgomery lost both her appeals at first instance and the Court of Appeal，The reason is that the court followed the Bolam standard，That is, respecting the doctor’s discretion。After the court consulted with bet365 sign up bonus code experts，Considers that Dr. McLellan’s behavior complied with industry standards，No dereliction of duty。But in the judgment of the UK Supreme Court，Ms. Montgomery gets court support，Court holds that doctors have a duty to inform patients of “significant risks” related to bet365 sign up bonus code treatment，And let patients make their own decisions。The court further elaborates on the so-called "significant risk"，Refers to risks that a rational patient would normally take seriously，And this risk has nothing to do with its incidence。Therefore，Even though the risk of cerebral palsy in this case is only 0.1%，However, cerebral palsy, as a serious disease that patients and their families cannot bear, is a "significant risk"。To this point，Bolam standards are no longer used in doctor-patient communication and informed consent，The British Supreme Court held that the standard for judging whether doctors should disclose bet365 sign up bonus code information to patients，bet365 sign up bonus code industry standards should not be used，Instead, adopt the patient’s human rights standards。Whether doctors should inform patients about the risks of treatment or alternative treatment options is not just a bet365 sign up bonus code issue，Patients have the right to decide to take risks for their own health。In other words，The Montgomery case transformed the "rational doctor" standard established in the Bolam case into the "rational patient" standard，In terms of information notification，Raise the standard of “informed consent” to the standard of “joint decision-making” between doctors and patients，It requires doctors to fully communicate with patients，Make patients understand the risks，And make the final decision based on your own situation，Instead of solely relying on professional bet365 sign up bonus code knowledge to make bet365 sign up bonus code decisions。

Currently，my country’s doctor-patient communication and bet365 sign up bonus code decision-making are still based on informed consent、Information is the main priority。Shared decision-making model compared to informed consent model，Need for effective communication between doctors and patients，Full respect for patient autonomy。The information asymmetry between doctors and patients has put additional requirements on bet365 sign up bonus code workers，How to avoid using too many technical terms、Fully consider the individual needs of patients, etc.。On the one hand，In joint decision-making mode，Patients’ compliance with bet365 sign up bonus code instructions will be significantly improved，Thus improving the level of self-management；On the other hand，Joint decision-making can effectively reduce doctor-patient disputes，Reduce adverse events such as violence and injuries to doctors。As required in practice in the UK，If a certain diagnosis and treatment behavior has huge potential risks，Regardless of the probability of occurrence，Doctors should inform patients，Shared decision-making with patients。

Respect patient autonomy，Thus combining the patient’s value preferences with the doctor’s professional diagnosis and treatment opinions，It is also particularly important in the process of improving the diagnosis and treatment of chronic diseases。For example，Prevalent diabetes among the people、Therapeutic effect of high blood pressure and other diseases，In addition to pharmaceutical intervention，Closely related to physician compliance and patient lifestyle self-management。my country’s aging problem is becoming increasingly serious，In the doctor-patient joint decision-making model, patients can integrate their own non-bet365 sign up bonus code related factors into clinical decision-making，Such as eating and living habits、Work intensity, etc.，Making diagnosis and treatment decisions easier for patients to accept and implement，Thus improving the daily self-management level of chronic diseases。Currently, doctor-patient communication in the Commonwealth countries is gradually changing from the Bolam standard to the Montgomery standard，Require doctors to understand the patient’s condition through communication，And integrate patients’ individual needs into clinical decision-making，Analyze the pros and cons of treatment options，To make bet365 sign up bonus code decisions that are consistent with the patient’s value orientation。Improving information notification rules，Establish information disclosure rules based on respecting patient autonomy，Is one of the important factors to improve the efficiency of bet365 sign up bonus code work。

　(Author’s unit: Capital Normal University bet365 sign up bonus code Political Science)