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孕妇跳楼,我的生命谁做主

2017-09-07 03:21:48   中国青年网

战胜病魔、守护生命,需要医生、患者以及患者家属相互信任、共同努力,如果彼此猜忌、各怀目的,再完美的制度设计,也依然会让人觉得漏洞百出

□ 叶 泉

陕西榆林一产妇在待产时,因疼痛难忍,从医院5楼坠下身亡引发关注。针对这一事件,院方和家属的说法大相径庭。院方说,已经多次建议家属剖腹产,但都被拒绝,孕妇为此两次向家属下跪,最后才跳楼的。家属则说,已经同意了剖腹产,但院方拒绝手术,而且孕妇也没有下跪而是下蹲。

事实真相到底怎样,外人不得而知,好在警方已介入调查,相信不久后会有权威结论发布。但是这个案子让笔者不由想起了十年前发生在北京的一个类似案件。当时一对来自湖南的打工“夫妻”(两人没办结婚手续)来到医院。“妻子”肺部大面积感染且怀有9个多月身孕,医生建议剖腹产,“丈夫”坚决反对,最后产妇和孩子死亡。这个事情当时闹得很大,医院的领导请示到了政府的卫生部门,卫生部门的答复是,没有家属签字不能手术。后来“妻子”的家人把医院告上了法庭。官司打了三年,经过法院两审,最终医院也没有承担责任。

这个结果其实一点都不意外,医院没有责任是因为医院严格遵守了国家的法律规定。根据国务院颁布的医疗机构管理条例,手术要征得患者同意和家属签字。

10年前北京的那起类似案件与此案的相同之处在于两者都卡在了家属签字这个关键点上,不同之处在于北京那起案子“妻子”已经昏迷,无法表达自己的真实意愿,而陕西这个案子患者很清醒,她希望做手术。

从法律上讲,生命权、健康权都是属于个人的权利,个人可以处置。既然生命权、健康权是属于个人的,那么患者当然有权决定自己要不要做手术。从理论上讲,在患者的意见与家属的意见发生冲突时,应该以患者的意见为主,但是这位跳楼的孕妇为什么不能决定自己要不要手术呢?院方的说法是孕妇在生产前签署了一份授权书,所以即使孕妇自己要求手术也要经过家属同意。

在手术决定权这个问题上,国家法律、部门规章、医院规定设计了很多程序,但是这些程序都指向了一个有些哲学意味的命题,那就是孕妇的生命谁做主。刚才已经说过了,从法律上讲,应该是病人的生命病人做主。但是当一个病人无法清醒地对自己的病情和身体作出判断时,也就派生出了家属的权利,这个权利实际是决定别人生死的权利。就像北京那起孕妇死亡的案子,“丈夫”不签字直接导致了孕妇的死亡。

当然,在这场生死之争中,还有一方当事人也很重要,那就是医生。事实上,医生比患者本人和家属更了解病情,从技术层面讲,他们似乎也更有权利决定是否要手术。其实,在北京孕妇死亡案之后,就有人提出,在紧急情况下,医生应有权不经过家属同意实施手术。但是时隔这么多年,医疗管理机构条例也正在修改之中,却并没有要修改这一条的意思。原因大概有两点:一是医生是否愿意承担责任,在当前医患关系紧张的情况下,让医生承担这种责任无疑压力巨大。二是生命是一个伦理命题,而不是简单的技术命题,如果家属无权决定患者的生死,那么,医生也同样面临着合理性的拷问。

在手术决定权问题上,我们当前的法律制度要求医生建议、患者同意、家属签字,这无疑划清了守护生命的各方责任。这种划分,虽然不是最好的,但应该说是最不坏的。

最后要说的是,战胜病魔、守护生命,需要医生、患者以及患者家属相互信任、共同努力,如果彼此猜忌、各怀目的,再完美的制度设计,也依然会让人觉得漏洞百出。

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