不堪忍受疼痛的孕妇跳楼与无法承受骗婚的程序员跳楼(一)

从8.31西安绥德孕妇跳楼一尸两命,到9.8创业程序员跳楼。短短10天时间内,一男一女两起轻生事件,连续霸占互联网热点新闻,刷屏微博与微信朋友圈。这中间有诸多话题引发公众深思,牵动公众情绪。

今天先聚焦8.31孕妇事件,引发人们关注顺产与剖腹产,关注生育传统观念,涉及医患关系,现行诊疗过程中患者、家属以及医生的决策优先权。

基于目前医院与家属各执一词,且没有充分披露信息,官方也未定性情况下,个人只就上述相关话题做就事论事分析。

1、顺产和剖宫产

在一二线城市,基于顺产对产妇与婴儿有着明显益处的医学研究与实践,会更倾向于鼓励顺产。同时得益于医生基于产妇实际情况的生产方式建议,以及家属素质理解和支持,使得合理生产方式执行比较理想。

但是在三四线城市以及广大农村,剖宫产就很流行,通常是就诊医院也许是医生更倾向于剖宫产。可顺可剖的剖,甚至能顺的也剖,很难说没有创收或者利益关系。

基于上述现状以及早期的落后观念,目前我国剖宫产比例明显高于国际平均值,由此相关主管部门又基于执政传统和中国特色行事风格,制定了任务指标。每个月,只能有几个或者百分之几的剖宫产名额。僵硬的执行就可能导致纠正过枉,需要剖宫产的产妇在名额耗尽的情况下只能顺产。

上述说明暂时不能排除医院嫌疑。但同时,从剖腹产需要三年才可能生育二胎来看,似乎家属嫌疑也无法洗脱。关于具体是谁组织剖宫产,只能等待更详细资料和权威证据。但从目前披露的家属签字和产妇绝望跳楼(后面分析),家属嫌疑更大。

2、现行家属知情同意和授权委托操作

关于这点,有很多权威医学人士和法学专家都做过相关分析。基于手术过程中,可能出现的患者麻醉、意识模糊等情况,导致无法明确表达,需要家属知情同意,无可厚非。但是在患者清醒和医生清醒情况下,居然不能采取合理必要的诊疗措施,足以说明现行流程的问题。

这套制度推行与实施也许有医院规避风险的考量在里面,毕竟现在的医患关系那么紧张。

如果听医生的,好了皆大欢喜,出了问题家属肯定找医生和医院闹。由于现行法律与公安法院对医闹缺乏震慑性,导致了不管医院医生有没有责任,只要医闹,就是医院损失最大。所以医院医生不敢于做决策。

如果听患者的,关键时刻死无对证,家属翻脸不认账,还是医院倒霉。

权衡利弊,就听家属的,出了问题患者与家属协调。

3、患者与医生

通常情况,应该是医生、患者、家属的顺序,毕竟医生是专业的,会采取科学合理的应对措施。如单人手术过程中,如何用药与治疗等。只有无法取舍情况下才会征求患者与家属意见,如保大保小,流与不流,切与不切等。但这类要根据情况,如果与患者有厉害关系,只要患者清醒,就应该有先听患者的。

就像老梁说的绝症痛苦情况下自主放弃治疗等。

4、说一下对自杀的分析

哀莫大于心死。我很赞成老梁的分析,不是利他型自杀,更大可能是自我型自杀(参见老梁的知乎回答:https://www.zhihu.com/question/64916318/answer/227229224 )。如果是对医生医院的绝望,也许会寻求转院或者跟医院折腾。

 

最后,医院肯定有疏于看护的责任,如基于之前产妇多次请求剖腹产和胎儿过大都应增加关注,如备用手术室没有约束。而最新的中新网新闻“榆林绥德孕妇坠楼事件追踪:涉事医院2人被停职”(http://www.chinanews.com/m/sh/2017/09-11/8327646.shtml),也清楚认定了医院看护责任。个人认为,这个没有争议,对规范和改进医院产科和产房等管理都有积极意义。

但这不是所有人关注的焦点,对真相调查结果,还死者说法与公道是其一。改进家属知情同意授权制度,理清医生、患者、家属谁更有决策优先权是其二。

 

作者:杨永胜(豪迈haomaiyys)

写于2017年9月13日凌晨

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