周一清晨

Episode 1:

1.Medical devices pay for Dr.Tierney ‘s heart and ambulatory wing, revealed some interest relationships between device corporations and doctors.

2.Dr.Martin didn’t do a full physical examination for Mary when he first saw her, even no X-rays, no blood work, made a cursory conclusion——prescribed extra strength Tylenol for her according to the retrospect, regardless of the possibility of bone cancer, just allowed metastatic cancer to run amok for four months. Dr.Martin was good at separating the conjoined twins, rebuilding the shattered faces ,but had at least killed three people. He was known as 007 among peers and colleagues cause license to kill.Actually, some doctors prefer complicated surgeries and make light of normal symptoms, leading to some misdiagnoses, at the same time, patients always complain about expensive examining cost, misunderstanding their doctors in charge.

3.Dr.Wilson failed to save the little boy Quinn McDaniels’ life due to uncontrollable bleeder. Quinn’s CT scan releaved a massive temporal-lobe tumor, which appeared malignant, so Dr.Wilson decided to operate immediately but he didn’t discuss it with his colleagues. The boy had never met his father but unfortunately his father has Von Willebrand’s disease. The doctor’s arrogance, unwillingness to seek a consult, neglecting to get a full and thorough history are responsible for the boy’s death though Dr.Wilson is not only one of the best surgeons in the world but also a committed and compassionate doctor who treated the little boy as if he were his son.What a tragedy, I had to admit that arrogance is fatal to each doctor as well as to people of all fields…

Episode two:

1.Dr. Park used Deep brain stimulation to treat a patient who was troubled by intention tremor, but DBS maybe the last resort. The operation was successful at that time, but later, the patient, Beth, prosecuted Dr. Park for she was left with an overactive libido. Dr. Park blamed her and the lawyer very strictly, in fact Beth begged Park to stop her tremor and was willing to receive the dangerous operation herself, but now she comes with lawyer, asking for money. Dr. Park’s words stimulated Beth, she dismissed the lawsuit and gave him a portraiture, she was a painter before. Beth conveyed her profound apology and sincere gratitude, this really touched me, brain is so mysterious that we cannot foresee what will happen after DBS. Such is human nature that people sometimes bite the hand that feeds one.

2.Dr. Tierney breached in protocol towards his donor, one of the patient donors Mr. Jasper wasn’t deceased but Dr. Tierney determined incorrectly that he was brain dead though he asked the neuro resident to examine Jasper and Jasper even reflect to the doctor’s commands. The transplant stuff is exciting, Dr. Tierney was called predator, a vulture trolling around the ICU, scavenging to harvest organs, not to be annoyed with annoying little things. Buck has been done his job well for 20 years, he has run a transport service that has made Chelsea one of the highest-volume centers in the country and keep the success high at the same time. This time he saved four lives, but neglected humanity and discriminated black people.

3.Dr. Ridgeway allowed Dr. Robidaux, a doctor-in-training, to operate on Miss Cash’s brain cause she thought Robidaux was perfectly capable of handling a Meningioma and that what a teaching hospital is. But because of Robidaux’s lack of experience, Cash’s olfactory nerve was damaged and unfortunately she was a chief. I have to say Ridgeway didn’t do any wrong but she is indisputably blame for this accident though the risk is permitted by the patients before the operation. No practice, no progress, no one hatches from an egg as a polished surgeon, but this is so unfair to the patient. The only way to avoid such tragedy is to perfect medico’s skill, hu…I guess Dr. Robidaux was so sorry.

（to be continued... the passage is originally written by me , no reprints without permission)

在《周一清晨》中有着许许多多医疗事件中事件，它们都充满着矛盾，十分复杂，但在生活中又常有发生。纵观全剧，其中一个情节最令我印象深刻。

这个事件大致是一个未成年女孩被马踢到了胸部，诊断为心包淤血，急需实施心包穿刺抽出淤血及积液。随后女孩的父母来到医院，宣称他们和他们的女儿都是基督教科学派信徒。这是一个认为物质是虚幻的，疾病只能靠调整精神来治疗的教派，所以他们要求把女儿接走，放弃治疗。此时医生Dr. Villanueva当机立断以简单包扎为由秘密进行了手术，救了小女孩一命，也机智地瞒天过海躲过了诉讼。

这件事情本身而言，医生的做法是违法的。《医疗机构管理条例》第 33条规定，医疗机构施行手术、特殊检查或特殊治疗时，必须经得患者同意，此时医生本应和小女孩父母签订知情同意书才可实施手术；但另一方面，看着本可以治疗好的患者放弃治疗，这与医生天生的职业宗旨产生了极大的冲突。可以说，放弃治疗这一问题，在道德和法律之间，都有着极大的矛盾点和复杂点。

2015年11月2日，在四川眉山市人民医院重症监护室，男子郑某等家属在探视时将母亲朱某的呼吸管拔掉，后朱某死亡。呼吸机报警后护理人员要去接呼吸机，遭到家属阻止。随后郑某表示因经济原因无法继续治疗，但他也因此被起诉故意杀人罪。

没有签协议书私自拔管，这个荒谬的事件体现了我国现阶段公民法制观念的缺失。放弃治疗并不是一个简单的概念，是需要法律和道德约束的一个复杂的问题。

放大点说，放弃治疗有很多情况。从放弃治疗的发起者来讲，分为患者本人和患者家属两种，而医疗机构本身不能做出放弃治疗决策。从放弃治疗的原因来讲，大致可分为医学上的、经济上的和道德精神层面的。

在我国，生命权作为公民一项基本权利受到宪法的保护。《民法通则》规定公民享有生命健康权，执业医师法》第 25 条规定，对急危患者医师应当采取紧急措施进行诊治，不得拒绝急救处置，这体现了公民的生命权不可侵犯，所以医疗机构不具有放弃治疗的权力。通常情况下，放弃治疗要由患者本人决定，但有一些情况如患者为无法履行民事责任的未成年人、处于昏迷状态下的患者、有精神疾病的患者等，此时要由患者监护人或家属替患者进行决策。

家属决策是争论最多的话题，一般认为需要观察患者为限制民事行为能力人还是无行为能力人。《中华人民共和国民法通则》第十二条规定:十周岁以上的未成年人是限制民事行为能力人，不满十周岁的未成年人是无民事行为能力人，第十三条规定不能辨认自己行为的精神病人是无民事行为能力人。对于限制行为能力人，可根据患者理解医疗决策的能力和程度来判断是由患者自行决定,还是由代理人全权决定；对于无能力患者时,曾经有过行为能力,但没有留下任何明确表示，应当由代理人代为执行。伦理学将代理人代替被代理人做决定的形式称为"替代判断"，应尽量符合被代理人的喜好、价值观，并维护其最高利益。但这种决策还是免不了过于主观。

美国率先提出的生存意愿书我认为是值得现阶段推广的法律条文，生存意愿书又叫做生前预嘱，它是由某人做出的一份声明,内容是当他将来没有能力同意或拒绝某项医疗手段时，应用或不应采用哪些医学手段。生前预嘱只有患者失去行为能力时才可生效，有行为能力时可随时更改。在美剧《周一清晨》中也有提到生前预嘱的问题。第三集中朴医生为年老的男病人做手术，之后病人脑死亡，身体脏器却依旧活着，他没有遵从病人的生前预嘱让他死亡，而是用了呼吸机维持生命。然后，医生问病人年迈的妻子“你打算怎么办？”，老太太最终不得不选择遵从先生生前愿望让他死亡。主任为此批评了朴医生，因为他认为生前预嘱存在的一个价值就是减少家属在决策时的痛苦，让家属选择放弃治疗等于是内心的一次煎熬。从这个层面上讲，生前预嘱恰恰体现了医疗人文下的对患者和生命的尊重。

现阶段我国的医疗环境不断恶化，医患矛盾不断。一方面是社会法制观念太弱，患者没有通过法律维权的意识，一些法律规定的医疗问题得不到规范的管理；另一方面，患者的知情权和自主权在医疗过程中常常被剥夺，尊重患者自主性将很快成为中国未来人文医学发展的重要内容。只有做到完善立法、加强医疗人员相关内容的提醒，才能在放弃治疗等重大的医疗问题上少出错、少纠纷。

这剧太过于贴近真实的临床（当然错误还是不少的，但相对来说少很多了），被砍不稀奇，也间接的显示了大众对于医疗真实的态度。 只能说，这十集是给医疗工作者弥足的财富，其中剧情的跌宕，大概也只有医生们能发自内心里理解并感受。 说剧情不跌宕起伏的，只能说，狗血肥皂剧更适合你。 作为一名已经改行的曾经的医生，从这剧的被砍，以及在医疗圈中的风靡，不知道该说什么好。