美国看病常识(8)---病人的权利和责任

       
病人的权利和责任(Patient Rights & Responsibilities)

         网友问：“到ER看急诊或住院时必须签署那么多的同意书（informed consent）才能得到治疗或手术，感觉像是给自己签下了生死状任由宰割、不能自主了。医院的医护人员该不会强行把病人五花大绑在手术台上动刀吧？病人到底有哪些正当、合法的权利可以拒绝治疗、自行出院而自我保护、不受伤害呢？”   这一篇就介绍病人的权利和责任（Patient Rights & Responsibilities）。

        每个州都有非常具体的法律条文来维护民众的就医权利。请访问或致电各州的卫生署（Health Department）的网址或问讯处，取得最准确的当地条文。以下以纽约州为例。

PATIENTS' BILL OF RIGHTS（病人的人权法案）

As a patient in a hospital in New York State, you have the right, consistent with law, to:
（作为一个在纽约州医院的病人，您有以下合法权利：）

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.
（理解和使用这些权利。如果您有任何原因不理解，或者您需要帮助，医院必须提供援助，包括一名翻译。）

2. Receive treatment without discrimination as to race, color, religion, sex, national origin, disability, sexual orientation, or source of payment.
（得到治疗，不因种族，肤色，宗教，性别，国籍，残疾，性取向，或付款来源而受歧视待遇。）

3.Receive considerate and respectful care in a clean and safe environment free of unnecessary restraints.
（在清洁和安全的环境并无不必要的管制下得到周到和尊重的照顾。）

4. Receive emergency care if you need it.
（得到紧急救护，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.
（被告知在医院里负责治疗您的医生的名字和身份/职务。）

6.Know the names, positions, and functions of any hospital staff involved in your care and refuse their treatment, examination or observation.
（知道您治疗过程中所涉及的任何医院工作人员的姓名、职务和职能，并有权拒绝他们的治疗，检查或观察。）

7. A no smoking room.
（一间无吸烟病房。）

8. Receive complete information about your diagnosis, treatment and prognosis.
（得到有关您的诊断，治疗及预后的完整资料。）

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、任何建议的程序或治疗的所有信息，使您能知情同意。这信息应包括可能的风险和好处。）

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“不要压胸复苏”的指令。如果您的病情太过严重，您还有权指定一个人替你决定。如果您需要更多的信息，请询问一份拷贝的小册子“不要压胸复苏令---患者和家属指南”。）

11. Refuse treatment and be told what effect this may have on your health.
（拒绝治疗和被告知这可能对你的健康将有什么影响。）

12. Refuse to take part in research. In deciding whether or not to participate, you have the right to a full explanation.
（拒绝参与研究（指新药新疗法的临床试验）。在决定是否参加前，有权得到一个充分的解释。）

13. Privacy while in the hospital and confidentiality of all information and records regarding your care.
（住院期间的隐私和有关您的医疗的所有资料和记录的保密。）

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.
（参与有关您的治疗和出院的所有决定。医院必须提供书面的出院计划和不同意出院的书面上诉书。）

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.
（免费得到您的医疗记录和医院可能收取合理的费用提供您的医疗纪录的拷贝副本。您的副本要求不会因支付不起而单纯地被拒绝。）

16. Receive an itemized bill and explanation of all charges.
 （收到分项帐单和所有费用的解释。）

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.
（有权抱怨得到不周的照顾和服务而不必害怕报复，有权要求医院答复并可以要求书面答复。如果您不满意医院的答复，可以投诉到纽约州卫生署。医院必须提供卫生署的电话号码。）

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，授权家庭成员和其他成年人的优先访问次序。）

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.
（公开您的器官捐赠意愿。您可以在医疗授权书上表明意愿或填写医院提供的捐赠卡。）

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.
（除了纽约州上面列出的权利，每个在本院的病人有权了解和参与有关他或她的疼痛管理的决策。---这一条是我的医院加的。疼痛已成为体温、呼吸、脉搏、血压四大生命体征之外的第五大体征（the Fifth Vital Sign）而倍受重视。）


PATIENT RESPONSIBILITIES（病人的责任）
A patient has the responsibility to:
（病人有责任：）

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，准确和完整的信息包括当前的不适，过去的病史，住院史，药物和其它有关他/她的健康事项。）
 
2. Report changes in their condition to the responsible practitioner.
（向负责的医生报告病情的变化。）

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.
 （有责任表明他们是否清楚地理解一个拟定的治疗方案和对他们的期望，和可以提任何问题并遵照主治医师建议的治疗计划进行。这可能还包括遵照护士和相关医疗人员的指示，因他们负责实施治疗计划和医生的命令及适当的医院的规章制度。）

4. Keep appointments and, when unable to do so for any reason, notify the practitioner or the hospital.
（保持预约时间，若您因任何理由不能这样做时，请通知医生或医院。）

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/她拒绝治疗或不按照医生指示的自我行为的结果。）

6. Assure that the financial obligations of their health care are fulfilled as promptly as possible.
 （保证尽快履行为他们的健康服务的付款义务。）

7. Follow hospital rules and regulations affecting patient care and conduct.
（遵守医院为病人的治疗和行为制定的规章制度。）

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.
（体谅其他病人和医院工作人员的权利，并协助控制噪音，吸烟和探病人数。）

9. Be respectful of the property of other persons and of the hospital.
（尊重他人和医院的财产。）

10. Keep all personal property in appropriate containers, as the hospital is not responsible for your personal things.
（适当保管好个人的所有财物，因为医院不负责个人财物的保管。）



简单地说，神志清醒的病人有权拒绝服药、手术等治疗措施；有权要求换主治医生（Attending Physician)；有权要求提前出院(leave against medical advice)或延后出院(discharge appeals)。但您必须签署相关文件，为自我行为和可能的后果负责。下面是一份文件的格式：

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：那些有可能伤害社会和他人的病人，比如某些传染病和精神病人等不得出院，除非出具法庭（court）的最终允许决定。





祝各位多学习、多了解自己的权利范围，保障自己的权益，免受伤害、自我负责！
（若中文翻译有误，敬请指正。也欢迎转载。敬请注明出处，谢谢！）




相关链接：

1. 有关美国医疗法律纠纷方面的一些个人看法---by老道

2. 美国看病常识(7)---疼痛及各种表达法(中英对照)

3. 美国看病常识(4)---Advance Directives(预先指示)

4. 美国看病常识(3)---有哪些同意书和文件要签?






**今天（09/30/2010）补加一个《中国医学院毕业并在美行医的医生名录》链接，方便查找美国各州行医的各科中国医生，请点击： http://physician.cmgforum.net/

[苹果和梨]

谢谢!