【文章內容簡介】 re the grammatical words are put back in, ., ?Notes: ‘Gillick standard’ (mature enough to give consent) making the implied meanings clear, ., ?Notes: None (acc. speaker) One example of a patient unable to give consent is someone under the influence of drugs. The ‘Gillick Standard’ is whereby minors are considered mature enough to give consent, despite their age. According to the speaker, there are no examples. Listening C Listen to Part 2 of the lecture and make notes. Take notes as possible as you can. See Notes section of the table in Answers to Exercise E. 請將本單元的音頻和此 PPT放在一個單獨的文件夾內，點擊小喇叭即可播放音頻。（下同） Listening D Using your notes, answer the questions on the handout on the right. Listening D Using your notes, answer the questions on the handout on the right. 1 What topic did the lecture cover first? The background to the current ethicolegal framework in which doctors have to operate. 2 What assumption does the lecturer contradict? That the principles underpinning the Hippocratic Oath have simply been refined over time by the legal and medical professions to give us our current ethical framework. 3 What was the importance of the Nuremberg Code, according to the lecturer? It provided the starting point for current ethical standards in medicine. 4 What was at the centre of the code? The need for the voluntary consent of the human subject to any procedures they would undergo. 5 What was the consequence of the Declaration of Helsinki for doctors? For the first time it was recognized that there was a need to obtain informed consent from patients. Listening D Using your notes, answer the questions on the handout on the right. 6 What is the lecturer’s attitude to the belief by some doctors that patients do not have enough medical knowledge and expertise to properly evaluate the risks and benefits of a procedure? He disagrees with it on the grounds that it is legally and ethically necessary to obtain informed consent from patients. 7 What example of a specific barrier to informed patient consent does he discuss? The research by Sudore et al. which shows the limitation of the consent form as a means of providing the patient with information on which to base informed consent. 8 What does he conclude from the research? Doctors cannot assume patients understand the medical consent information we provide them with and they should check that the patient has understood. 9 What is the most important consideration the lecturer suggests needs to be taken into account when gaining patient consent? To ensure that the patient is legally entitled to give their consent. Listening E Refer to the model Cornell notes on page 107. Review Notes What is the background of medical ethics? What is the Nuremberg Code? Background to current ethicolegal framework ? X NOT linked to 4th C Hippocratic Oath starting point for development medicolegal ethics today: Nuremberg Code 1945 ? experiments → WW prisoners (ice water to test survival) ? code clarifies what is acceptable in experiments with humans ? principle of voluntary subject consent (no guidance on patient–doctor relationship) 1 Check your answers with the model. 2 Complete the Review and Summary sections of the Cornell notes. Listening What is the Declaration of Helsinki? Declaration of Helsinki 1964 (WMA) ? addresses doctor–patient relationship ? participation voluntary AND informed → need for informed consent from all patients ? basis for current medicolegal ethics How do doctors view consent in practice? Consent in practice – differences ? some doctors view consent as strictly legal → avoid legal action for assault ? some think only doctors can make informed decision. Not agree. Legal and ethical reasons (patient autonomy) E Refer to the model Cornell notes on page 107. Listening How does example of consent form illustrate issue of patient consent? What practical issues need to be considered? Consent form ? Sudore et al. (2020) – 28% patients fully understand form 1st time – need to check patient understanding ? ! CANNOT assume patient understanding → important issue for legislators Practical issues ? check patient can legally give consent – adults OK if reason not impaired (unable to give consent ., drink/drugs/mental illness) children – not poss in US, OK in UK/Can/Oz if pass ‘Gillick standard’ (mature enough to give consent) E Refer to the model Cornell notes on page 107. Listening F The lecturer talks about the consent form. Listen again to part of the lecture. What words tell us whether the information is fact or opinion? Some doctors may believe that by signing the consent form … The evidence shows that this is not the case. A very useful article by Sudore et al. (2020) in the Journal of General Internal Medicine … .. in fact only 28% … In my view this very strongly supports ... This phrase can be used to give both a speaker’s own opinion as well as an opposing view. By stating that it is not the case, without any tentative language, the lecturer is indicating how strongly he feels about this. It may be that the evidence is not conclusive. Whether something is ‘useful’ is a matter of opinion, but it indicates that the lecturer considers it worthwhile. By using the words ‘in fact’ the lecturer is contrasting what has been found with other contradicting opinions. By stating that this is his view, the lecturer accepts that there may be other opinions. Listening G Study the phrases in the box. Which type of information below follows each phrase? Listen to some sentences from the lecture. ? restatement ? definite point ? summary of a source ? examp