美國看病常識(8)---病人的權利和責任

       
病人的權利和責任(Patient Rights & Responsibilities)

         網友問：“到ER看急診或住院時必須簽署那麽多的同意書（informed consent）才能得到治療或手術，感覺像是給自己簽下了生死狀任由宰割、不能自主了。醫院的醫護人員該不會強行把病人五花大綁在手術台上動刀吧？病人到底有哪些正當、合法的權利可以拒絕治療、自行出院而自我保護、不受傷害呢？”   這一篇就介紹病人的權利和責任（Patient Rights & Responsibilities）。

        每個州都有非常具體的法律條文來維護民眾的就醫權利。請訪問或致電各州的衛生署（Health Department）的網址或問訊處，取得最準確的當地條文。以下以紐約州為例。

PATIENTS' BILL OF RIGHTS（病人的人權法案）

As a patient in a hospital in New York State, you have the right, consistent with law, to:
（作為一個在紐約州醫院的病人，您有以下合法權利：）

1. Understand and use these rights. If for any reason you do not understand or you need help, the hospital must provide assistance, including an interpreter.
（理解和使用這些權利。如果您有任何原因不理解，或者您需要幫助，醫院必須提供援助，包括一名翻譯。）

2. Receive treatment without discrimination as to race, color, religion, sex, national origin, disability, sexual orientation, or source of payment.
（得到治療，不因種族，膚色，宗教，性別，國籍，殘疾，性取向，或付款來源而受歧視待遇。）

3.Receive considerate and respectful care in a clean and safe environment free of unnecessary restraints.
（在清潔和安全的環境並無不必要的管製下得到周到和尊重的照顧。）

4. Receive emergency care if you need it.
（得到緊急救護，如果您需要它。）

5. Be informed of the name and position of the doctor who will be in charge of your care in the hospital.
（被告知在醫院裏負責治療您的醫生的名字和身份/職務。）

6.Know the names, positions, and functions of any hospital staff involved in your care and refuse their treatment, examination or observation.
（知道您治療過程中所涉及的任何醫院工作人員的姓名、職務和職能，並有權拒絕他們的治療，檢查或觀察。）

7. A no smoking room.
（一間無吸煙病房。）

8. Receive complete information about your diagnosis, treatment and prognosis.
（得到有關您的診斷，治療及預後的完整資料。）

9. Receive all the information that you need to give informed consent for any proposed procedure or treatment. This informatiom shall include the possible risks and benefits of the procedure or treatment.
 （得到您需要的、任何建議的程序或治療的所有信息，使您能知情同意。這信息應包括可能的風險和好處。）

10. Receive all the information you need to give informed consent for an order not to resuscitate. You also have the right to designate an individual to give this consent for you if you are too ill to do so. If you would like additional information, please ask for a copy of the pamphlet " Do Not Resuscitate Orders - A Guide for Patients and Families."
（得到您需要的所有信息，知情同意而作出“不要壓胸複蘇”的指令。如果您的病情太過嚴重，您還有權指定一個人替你決定。如果您需要更多的信息，請詢問一份拷貝的小冊子“不要壓胸複蘇令---患者和家屬指南”。）

11. Refuse treatment and be told what effect this may have on your health.
（拒絕治療和被告知這可能對你的健康將有什麽影響。）

12. Refuse to take part in research. In deciding whether or not to participate, you have the right to a full explanation.
（拒絕參與研究（指新藥新療法的臨床試驗）。在決定是否參加前，有權得到一個充分的解釋。）

13. Privacy while in the hospital and confidentiality of all information and records regarding your care.
（住院期間的隱私和有關您的醫療的所有資料和記錄的保密。）

14. Participate in all decisions about your treatment and discharge from the hospital . The hospital must provide you with a written discharge plan and written description of how you can appeal your discharge.
（參與有關您的治療和出院的所有決定。醫院必須提供書麵的出院計劃和不同意出院的書麵上訴書。）

15. Receive your medical record without charge and obtain a copy of your medical record for which the hospital can charge a resonable fee.  You cannot be denied a copy solely because you cannot affored to pay.
（免費得到您的醫療記錄和醫院可能收取合理的費用提供您的醫療紀錄的拷貝副本。您的副本要求不會因支付不起而單純地被拒絕。）

16. Receive an itemized bill and explanation of all charges.
 （收到分項帳單和所有費用的解釋。）

17. Complain without fear of reprisals about the care and services you are receiving and to have the hospital respond to you and if you request it, a written response. If you are not satisfied with the hospital's response, you can complain to the New York State Health Department. The hospital must provide you with the Health Department telephone number.
（有權抱怨得到不周的照顧和服務而不必害怕報複，有權要求醫院答複並可以要求書麵答複。如果您不滿意醫院的答複，可以投訴到紐約州衛生署。醫院必須提供衛生署的電話號碼。）

18. Authorize those family members and other adults who will be given priority to visit consistent with your ability to receive visitors.
（符合您的接待能力，授權家庭成員和其他成年人的優先訪問次序。）

19. Make known your wishes in regard to anatomical gifts. You may document your wishes in your health care proxy or on a donor card, available from the hospital.
（公開您的器官捐贈意願。您可以在醫療授權書上表明意願或填寫醫院提供的捐贈卡。）

In addition to the New York State rights listed above, each patient at ____Hospital has the right to understand and participate in decisions regarding the management of his or her pain.
（除了紐約州上麵列出的權利，每個在本院的病人有權了解和參與有關他或她的疼痛管理的決策。---這一條是我的醫院加的。疼痛已成為體溫、呼吸、脈搏、血壓四大生命體征之外的第五大體征（the Fifth Vital Sign）而倍受重視。）


PATIENT RESPONSIBILITIES（病人的責任）
A patient has the responsibility to:
（病人有責任：）

1. Provide, to the best of his/her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications and other matters relating to his/her health.
（提供最好的他/她所知的，準確和完整的信息包括當前的不適，過去的病史，住院史，藥物和其它有關他/她的健康事項。）
 
2. Report changes in their condition to the responsible practitioner.
（向負責的醫生報告病情的變化。）

3. Make it known if they clearly understand a contemplated course of action and what is expected of them, to ask any questions they may have, and to follow the treatment plan recommended by the practitioner primarily responsible for their care. This may include following the instructions of nurses and allied health personnel as they carry out the coordinated plan of care and implement the responsible practitioner's orders; and as they enforce the applicable hospital rules and regulations.
 （有責任表明他們是否清楚地理解一個擬定的治療方案和對他們的期望，和可以提任何問題並遵照主治醫師建議的治療計劃進行。這可能還包括遵照護士和相關醫療人員的指示，因他們負責實施治療計劃和醫生的命令及適當的醫院的規章製度。）

4. Keep appointments and, when unable to do so for any reason, notify the practitioner or the hospital.
（保持預約時間，若您因任何理由不能這樣做時，請通知醫生或醫院。）

5. Accept the results of his/her own actions if he/she refuses treatment or dose not follow the practitioner's instructions. （接受他/她拒絕治療或不按照醫生指示的自我行為的結果。）

6. Assure that the financial obligations of their health care are fulfilled as promptly as possible.
 （保證盡快履行為他們的健康服務的付款義務。）

7. Follow hospital rules and regulations affecting patient care and conduct.
（遵守醫院為病人的治療和行為製定的規章製度。）

8. Be considerate of the rights of other patients and hospital personnel, and assist  in the control of noise, smoking, and the number of visitors.
（體諒其他病人和醫院工作人員的權利，並協助控製噪音，吸煙和探病人數。）

9. Be respectful of the property of other persons and of the hospital.
（尊重他人和醫院的財產。）

10. Keep all personal property in appropriate containers, as the hospital is not responsible for your personal things.
（適當保管好個人的所有財物，因為醫院不負責個人財物的保管。）



簡單地說，神誌清醒的病人有權拒絕服藥、手術等治療措施；有權要求換主治醫生（Attending Physician)；有權要求提前出院(leave against medical advice)或延後出院(discharge appeals)。但您必須簽署相關文件，為自我行為和可能的後果負責。下麵是一份文件的格式：

INFORMED REFUSAL OF TREATMENT / RELEASE OF RESPONSIBILITY
I understand that ____Hospital has offered:

O  to examine me (the patient) to determine whether I am suffering from an emergency medical condition;
O  to provide necessary treatment to care for and stabilize my condition;
O  to provide medically appropriate transfer to another facility capable and/or willing to provide care that is not available at this facility;
O  to arrange for transfer by ambulance or aircraft;
O  to perform/provide the following therapies/procedures deemed appropriate for my condition:

__________________________________________________________________________________________

__________________________________________________________________________________________

The physician(s) and /or licensed healthcare professional(s) have informed me that the benefits that might reasonably be expected from the offered services are:
__________________________________________________________________________________________

__________________________________________________________________________________________

I understand that my refusal may result in a worsening of my known condition and any conditons currently unknown, and could pose a threat to my life, my health, and my medical safety including death or permanent disability. I hereby:

O  refuse the offered services      O  acknowledge my decision to leave against medical advice.

I have read this document in its entirety, and I fully understand it. I release ____ Hospital , the attending physician and all____hospital healthcare providers and employees from all responsibility and resultant ill effects.

_________________________                         _________________________
Patient                                                                 Date

Administrative - check all that apply:

Patient:
O  Refused informed discussion          O  Left against madical advice            O  Left without signing form

_________________________                         ________________________
Witness (Physicion/Healthcare Provider)              Date
  
When a patient is a minor or lacks capacity to give
consent, signature of person authorized to give
consent for treatment:

_________________________                         _________________________
Name of Authorized Representative                     Relationship to Patient






但有例外：那些有可能傷害社會和他人的病人，比如某些傳染病和精神病人等不得出院，除非出具法庭（court）的最終允許決定。





祝各位多學習、多了解自己的權利範圍，保障自己的權益，免受傷害、自我負責！
（若中文翻譯有誤，敬請指正。也歡迎轉載。敬請注明出處，謝謝！）




相關鏈接：

1. 有關美國醫療法律糾紛方麵的一些個人看法---by老道

2. 美國看病常識(7)---疼痛及各種表達法(中英對照)

3. 美國看病常識(4)---Advance Directives(預先指示)

4. 美國看病常識(3)---有哪些同意書和文件要簽?






**今天（09/30/2010）補加一個《中國醫學院畢業並在美行醫的醫生名錄》鏈接，方便查找美國各州行醫的各科中國醫生，請點擊： http://physician.cmgforum.net/

[蘋果和梨]

謝謝!