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犹他州法律允许未成年人追溯撤销医疗同意“攻击美国医疗体系的基础”

《新英格兰医学杂志》（new England Journal of Medicine）的一项新观点认为，这项立法使临床医生在为未成年人提供合法同意的性别确认护理时面临诉讼风险，并可能导致医生在其他州拒绝为其他健康状况提供治疗。

在犹他州，未成年时同意接受“激素变性治疗”或“性别特征”手术的患者，如果他们后来后悔接受了治疗，可以撤销他们的知情同意。 Under the 医疗事故法案, 2023年更新, minors can recant their consent before age 25 if they develop a “permanent injury” from their treatment, with the argument that their doctor should have anticipated the patient’s health outcome and subsequent regret.

根据公共卫生学院和康奈尔大学法学院（CLS）新濠影汇线上赌场研究人员的一篇新观点文章，允许患者追溯撤回知情同意给临床医生带来了极大的负担，限制了获得性别确认护理的机会，并严重威胁到支持美国医疗保健的法律基础设施。

“It is unrealistic and unreasonable to expect clinicians to predict which patients may later reverse their consent to treatment,” write 金伯利纳尔逊, associate professor of community health sciences, and 克里斯蒂昂德希尔, associate dean for faculty research and professor of law at CLS, in the 新英格兰医学杂志. 他们写道，这一史无前例的立法可能会阻止谨慎的临床医生提供这种护理，而不是扩大未成年人的医疗保健选择。

知情同意是医疗保健的核心组成部分，它确保患者从临床医生那里获得有关医疗程序或治疗的风险和益处的适当信息，以便他们能够对自己的健康做出明智的决定。 这种同意促进了患者的自主权，医生的道德指导，以及医患之间持续的信任和沟通。

犹他州的立法给这一可信的过程蒙上了一层阴影，使得临床医生可能要对未经未成年患者或其新濠影汇网上赌场/监护人同意的治疗负责，甚至在他们提供治疗多年之后。

“Clinicians need to be able to rely on consent at the time of treatment,” says Nelson in a statement separate from the perspective. “Undermining this critical aspect of the clinician-patient relationship has the potential to greatly limit the treatments clinicians feel comfortable providing, which can have long-term implications for patients, clinicians, and medical care, more broadly.”

新法律使临床医生有可能因性别肯定护理之外的治疗而面临诉讼。 例如，医生可以为一个出生时被指定为男性的小病人提供缩胸手术，而不是因为性别不安，比如乳腺癌治疗。 这种对法律的宽泛解释可能会阻碍医生在提供性别确认护理的实践中进行手术，或者使他们在依赖未成年人同意进行其他治疗时更加犹豫。

作者警告说，虽然犹他州是目前唯一通过这项立法的州，但其他州可能会迅速效仿。

“As we have seen in other politically fraught areas of medical care, state laws tend to be tested out in one or two states, then applied more broadly by other states and used to target other medical treatments,” says Underhill. “As such, it is possible that laws targeting not only gender-affirming care, but other areas of politically contested care—such as 避孕, 怀孕, and 疫苗接种—may also start adding provisions that allow patients to revoke their consent retroactively. 这将使临床医生提供这种医疗服务在法律上更加不稳定。”

“It is important to note that minors and parents always have the right to decline or stop treatment,” Nelson says. “This change to the Utah Medical Malpractice Act does not impact that fundamental right. What it does is allow minors to retroactively withdraw their consent from treatment that has already been completed, which is likely to have the effect of making clinicians less willing to treat minors as they may not feel confident they can rely on their consent at the time of care.”

作者总结说，医生不应该猜测他们完全同意治疗的病人是否会在未来的某个时候改变主意。 “所有领域的临床医生都应该认识到，这些法律不仅是在攻击性别确认护理——它们是在攻击美国医疗体系的基础。”