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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。
PrintConsent
In general, under the laws of Hong Kong, a medical practitioner is not allowed to perform any medical treatment or procedure on a patient who does not consent to it.
The consent given must be for the actual procedure or treatment performed.
Any medical treatment or procedure involving physical contact with the patient’s body is a prima facie (which means there is evidence on the face of it) case of trespass or battery on the person, unless the patient has expressly or implicitly consented to that contact, even if the doctor believes that it is in the best interest of the patient, and even if it is in fact in the best interest of the patient.
The Medical Council of Hong Kong has devised a Code of Professional Conduct (“the Code”) for all registered medical practitioners in Hong Kong.
Section 2 of the Code (revised section 2 of the Code of Professional Conduct promulgated in Issue No. 22 of the newsletter of the Medical Council in December 2015) deals with consent:
“2.3 Consent may be either implied or express. In respect of minor and non-invasive treatments (*), consent can usually be implied from a patient’s conduct in consulting the doctor for his illness (but not in a situation where the consultation was only for the purpose of seeking an opinion).
* “invasive treatments” refer generally to treatments involving puncture of the skin or insertion of an instrument or foreign material into the body.
2.4 Oral consent is acceptable for minor invasive procedures. Documenting oral consent in the patient’s medical record offers protection to doctors, in case of subsequent dispute as to whether consent has been given.
2.5 Express and specific consent is required for major treatments, invasive procedures, and any treatment which may have significant risks. Specifically:- (a) Consent for surgical procedures involving general/regional anaesthesia and parenteral sedation must be given in writing. (b) For written consent, a reasonably clear and succinct record of the explanation given should be made in the consent form. The patient, the doctor and the witness (if any) should sign the consent form at the same time. Each signatory must specify his name and the date of signing next to his signature.
2.6 Where there are statutory requirements that consent in specified circumstances be given in prescribed forms, those requirements must be complied with. (e.g, removal of parts of body or specifice parts after death for theraputic purposes or for proposes of medical education or research: Section 2 and 3 of the Medical (Therapy, Education and Research) Ordinance, Cap.278)
Section 2.7 of the Code provides that consent is valid only if:
“(i) it is given voluntarily;
(ii) the doctor has provided proper explanation of the nature, effect and risks of the proposed treatment and other treatment options (including the option of no treatment); and
(iii) the patient properly understands the nature and implications of the proposed treatment.”
2.10.1 Explanation should be given in clear, simple and consistent language. Explanation should be given in terms which the patient can understand. It is the doctor’s duty to ensure that the patient truly understands the explanation by being careful and patient.
2.10.2 The explanation should be balanced and sufficient to enable the patient to make an informed decision. The extent of explanation required will vary, depending on individual circumstances of the patient and complexity of the case.
2.10.3 The explanation should cover not only significant risks, but also risks of serious consequence even though the probability is low (i.e. low probability serious consequence risks).
A valid consent in this sense will be an “informed consent”.