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又來到「長者法網智多聲」的時間了，這一節我們會跟大家說一下，在醫療程序中，醫生要怎樣徵求病人的同意，病人又是否可以拒絕治療。
醫生在醫治病人或展開醫療程序之前，要先得到病人的同意。香港醫務委員會制訂了《香港註冊醫生專業守則》，裡面解釋了甚麼是「徵求同意」。
守則提到，醫生要視乎治療的嚴重程度來徵求病人同意，例如最輕微的治療，可以根據病人看醫生時的表現，理解他是否同意接受治療；而涉及重大手術、入侵性程序或高風險的治療，就必須得到病人清晰而且明確的同意。更重要的手術，就更加要以書面方式表達同意。
那是否只要病人說好就是同意呢？不是的。守則寫明，醫生要向病人正確解釋建議治療的性質、成效和風險，並且為病人提供其他治療選擇。病人要正確地理解治療的性質和影響，然後自願表示同意。如果醫生給予的意見不全面，或病人和家屬聽完醫生解釋之後，沒有足夠合理的時間考慮就要做決定，那麼即使病人同意，都會變成無效。
當然，病人要有能力理解醫生提供的資料，以及有能力做決定，才可以在知情之下同意。如果病人是精神上無行為能力的，例如他患有精神病、痴呆或弱智，就可能要由監護人代為同意。
一旦病人沒有清晰表示同意，或沒有完全同意在治療過程中，讓醫生接觸他的身體，任何涉及接觸病人身體的治療或療程，都可以被視為侵權或襲擊的表面證據。即使病人同意接受治療，但如果他獲得的建議不夠全面或不符合要求，他都可以控告醫生侵權，要求賠償。
除了同意之外，病人亦有權拒絕治療。任何拒絕治療的指示，必須要清晰而明確，而且病人是自願作出這個決定。其中一種拒絕治療的方式，就是預設醫療指示了，如果想知道更多，可以到長者社區法網看看。
無論病人同意或是拒絕接受治療，如果醫生在治療期間疏忽犯錯，導致病人受傷害，他就要因為疏忽而負上法律責任。長者社區法網亦有詳細介紹甚麼是醫療疏忽。另外，受害的病人亦可以向醫務委員會投訴，醫委會可以展開調查和聆訊，並且判罰專業失當的註冊醫生。不過，醫委會不可以賠償給受害病人，所以，如果病人要求有金錢上的補償，就要向法院提出申索了。這一節就講到這裡，多謝大家收聽。
PrintCapacity to consent
In Hong Kong, an adult patient (one who has attained the age of 18 and is not “mentally incapacitated”) is able to give his/her consent that is valid under the law.
A person who is “mentally incapacitated” may still be able to give his/her consent if he or she can understand the general nature and effect of the treatment.
Mentally incapacitated patients (“MIP”)
MIP are persons who are incapable, by reason of mental incapacity, of managing and administering their property and affairs; or persons suffering from mental illness or psychopathic disorders or having significant impaired intelligence.
Detailed definitions can be be found in Section 2(1) of the Mental Health Ordinance, Chapter 136, Laws of Hong Kong (“MHO”).
Part IVC of MHO governs consent to treatment in relation to an MIP who has attained the age of 18 and is incapable of giving consent.
A MIP is incapable of giving such consent if that person is incapable of understanding the general nature and effect of the treatment (Section 59ZB(2) of the MHO).
So if a MIP can understand the general nature and effect of the treatment, he or she is able to give consent.
For MIP who is incapable of understanding the general nature and effect of the treatment, consent may be given by the guardian of the patient under Part IIIA or IVB of the MHO in respect of whom a guardianship order has conferred the power to consent under Sections 44B(1)(d) or 59R(3)(d).
Where consent cannot be obtained from guardians, according to section 59ZF(1) of the MHO, a registered medical practitioner or registered dentist can carry out or supervise a treatment if it is a matter of urgency and that treatment is necessary and is in the best interests of the MIP.
The exceptions are sterilization and removal of organs for transplantation, even if the treatment is a matter of urgency and is necessary and is in the MIP’s best interests (Sections 59ZA, 59ZC, 59ZG and 59ZBA of the MHO).
In such circumstances, consent may be given by the Court upon application by any person (including a medical superintendent, registered medical practitioner or registered dentist).
Under section 59ZB(3), when considering whether or not to give consent, the Court shall observe and apply the following principles, namely to:
- ensure that the mentally incapacitated person is not deprived of the treatment merely because he lacks the capacity to consent to the carrying out of that treatment; and
- ensure that any treatment that is proposed to be carried out in respect of the mentally incapacitated person is carried out in the best interests of that person.
“In the best interests” , according to section 59ZA of the MHO, means in the best interests of the MIP in order to:
- save the life of the MIP;
- prevent damage or deterioration to the physical or mental health and well-being of that person; or
- bring about an improvement in the physical or mental health and well-being of that person.
If the Court is satisfied that the treatment should be carried out “in the best interests” of the MIP, the Court may consent to the carrying out of the treatment and make an order to the applicant to that effect.