目標：醫病關係中，病人是醫療之主體，而醫師說明義務之對象是病人，也「僅限於」病人。本研究藉急診病患侵入性檢查或治療同意書簽署人之研究，瞭解同意書簽署由誰來簽具，希望促使醫師致力於向病人本身做「告知後同意」的說明義務，以符醫學倫理訴求。方法：利用某醫院急診就診病患之病歷，回溯病歷之侵入性檢查或治療同意書簽署人，進行T-test與MANOVA統計分析，瞭解同意書簽署由誰來簽具。結果：依原始分析樣本252事件(234位病人)，由本人簽署僅81例(32.14%)。依檢傷級數狀態分析簽署同意人，檢傷級數一級者皆非本人簽署，達統計顯著差異(F＝16.101；p＝0.000)，各檢傷級數組間內的病人意識清醒狀態不影響統計結果；依年齡級數(＜20、20.65、＞65)分析，小於20歲者主要由父母簽署、大於65歲者主要由子女簽署，達統計顯著差異(F＝9.938；p＝0.000)，各組間內的病人意識清醒狀態不影響統計結果；依男女性別分析達統計顯著差異(F＝5.077；p＝0.025)；用檢查與治療類別分析也達統計顯著差異(F＝4.806；p＝0.029)。若將性命危急與意識不清的病人抽離後再次分析，分析意識完全清醒的病人樣本209事件(198位病人)，由本人簽署僅81例(38.76%)。依年齡級數(＜20、20.65、＞65)分析，小於20歲者主要由父母簽署、大於65歲者主要由子女簽署，達統計顯著差異(F＝17.181；p＝0.000)。結論：同意書的當事人是由病人本人簽署，當病人意識清醒時，侵入性檢查或治療的說明應向病人為之，而且也必須由病人本人行使同意權；如果病人為未成年人，則應該有法定代理人的同意。醫師應更致力於向病人本身做「告知後同意」的說明義務。

Objectives: Informed consent is intended to insure that a patient fully understands the procedures, benefits, and risks involved in a procedure or treatment. Informed consent is necessary not only for ethical and legal reasons, but also to help improve the quality of care and prevent
errors. Unfortunately, little is known about who gives informed consent on behalf of patients before a procedure or treatment in an emergency department. This study investigated the signing of informed consent forms by patients or their relatives in such a setting. Methods: We conducted
a review of medical records from 252 cases (234 patients) from January to February 2008 in a general hospital’s emergency department in Northern Taiwan in order to determine who signed the consent forms for patients about to receive invasive examinations or treatment. Data were
analyzed using T-test and MANOVA. Results: In only 81 cases (32.14%) was the consent form signed by the patient. All of the cases who were assigned triage category-I had the consent forms signed by their parents or other legal guardians. Patient under age 20 had the consent forms
signed by their parents, while patient over 65 had consent by proxy. Male patients frequently signed the consent forms themselves, while female patients had consent by proxy. Before invasive procedures, patients frequently signed the consent forms themselves. Conclusions: Patients have
the right to participate fully in decisions regarding their treatment in order to make decisions that correlate with their personal values. Frequently, this does not happen. Physicians should seek informed consent from patients unless they are incompetent or unconscious.