代行判断者を立てるべきか否かを決定するための患者の判断能力の有無の判定基準たる判断能力の概念について  [in Japanese] The Concept of Competence as a Criterion to Assess the Patient's Ability to Determine Whether or Not to Designate a Representative Decision-Maker  [in Japanese]

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Author(s)

    • 粟屋 剛 AWAYA Tsuyoshi
    • 岡山大学大学院医歯薬学総合研究科法医生命倫理学講座生命倫理学分野 Department of Bioethics, Graduate School of Medicine, Dentistry & Pharmaceutical Sciences, Okayama University

Abstract

  医療行為の承諾の場面では, 患者の判断能力が要求される. 患者に判断能力があれば承諾は有効となり, なければ無効となる. そして後者の場合, 代行判断者を立てる必要が出てくる. この代行判断者を立てるべきか否かを決定するための患者の判断能力の有無の判定基準たる判断能力の概念は, 通常, 「自己の身体に対してなされる医療行為の内容・性質, 利益・不利益などを理解し, それに基づいてその医療行為を承諾するか否かを判断する能力」 などと理解されている. しかし, このように, 当該の具体的医療行為を基準にして判断能力の概念が定立されるならば, なされようとしている当該医療行為が高度な判断を要するものである場合, 通常程度の社会的な判断力を有する成人患者であってもそのような高度の判断能力を有していなければ 「判断能力なし」 , したがって 「承諾は無効」 , とされてしまう. こうした場合, 患者は通常は, 医師を信頼して, あるいは, いわゆるセカンド・オピニオンを求めたうえで当該医療行為を承諾するであろうが, そのような承諾を無効とはいえないであろう.<br>  このような矛盾を避けるために, そうした判断能力の概念は一般的, 抽象的な意味での 「医療行為」 の概念を基準にして定立されるべきである. すなわち, そのような判断能力とは, 「一般的, 抽象的な意味での医療行為の概念を理解し, 判断する能力」 である.

  Patients must have competence in order to grant consent for medical procedures. This consent is valid only when the patient is competent. If not, the consent is invalid, and in this case, the designation of a representative decision-maker will be required. It is commonly understood that the concept of competence as a criterion to assess the patient's ability to determine whether or not to designate a representative decision-maker is “the ability to understand the details, characteristics, and advantages and disadvantages of the medical procedure in his or her own body, and to determine whether or not to grant consent for the procedure on the basis of this understanding” .<br>  In this framework of understanding, the concept of competence is established on the basis of the relevant, specific medical procedure. However, with this in mind, if the relevant medical procedure is difficult for a patient to understand and decide on, it will require the patient to be highly competent, meaning an adult patient who is capable of making decisions regarding general social matters, but not the relevant, highly demanding medical procedure, may be regarded as “not competent” and his or her consent will be “invalid” . In such cases, the patient will usually rely on his or her physician's judgment or request a second opinion to grant consent regarding the relevant medical procedure. Consent given in this way cannot be called invalid, and herein lies the contradiction.<br>  To avoid this, the concept of competence as a criterion to assess the patient's ability to determine whether or not to designate a representative decision-maker shall be established on the basis of the concept of “medical practice” in general or abstract sense. That is to say, competence is “the ability to understand and make decisions regarding the concept of medical practice in general or abstract sense” .

Journal

  • THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA

    THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA 26(3), 309-314, 2006-05-15

    THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA

Cited by:  2

Codes

  • NII Article ID (NAID)
    10017494128
  • NII NACSIS-CAT ID (NCID)
    AN00330159
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    02854945
  • Data Source
    CJP  CJPref  J-STAGE 
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