第三者行為の届出と倫理的ジレンマ:2症例報告  [in Japanese] Notification of third-party infringement and ethical dilemma : a report of two cases  [in Japanese]

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Abstract

<p> 本邦の健康保険制度は,第三者行為により生じた傷病に対して代替的給付を行う仕組みを有している.患者がこの給付を受けるには第三者行為の届出が必要条件となるが,この届出は後に補償問題を惹起するため,患者と医師の意見が一致せず,倫理的ジレンマが生じる可能性がある.しかし,本邦ではこれまで,第三者行為の届出やこの代替的給付の仕組みと関連して医師の倫理的問題は研究されていなかった.</p><p> 我々は,第三者行為の届出と関連して倫理的ジレンマを生じた2症例を経験した.2症例とも,療養の給付事由に対する第三者行為の関与が絶対的なものではなかった.1例では医師の説得により届出が行われ,もう1例では届出が行われなかった.症例の経験を通して,この代替的給付の仕組みに関する幾つかの問題を指摘した.今後,第三者行為が部分的に関与した傷病の医療費請求のあり方について,さらなる議論を通じ,将来何らかの指針などが示されるべきであろう.</p>

<p>  The health insurance systems in Japan include a substitutional mechanism of payment to a victim on behalf of an individual at fault. The patient must submit a notification of third-party infringement if he/she wants to use this optional mechanism. As this notification plays the role of a trigger for a claim for compensation, patients and physicians'opinions regarding this notification may often be in disagreement. In particular, an ethical dilemma may arise if a victim was negative toward the claim for compensation and demanded the usual Medical Treatment Benefits from the physician instead. Ethical matters concerning physicians have not been studied in Japan in relation to this substitutional payment mechanism or notification of third-party infringement.</p><p>  Herein, we report two cases in which an ethical dilemma arose concerning this notification. In these cases, the contribution of third-party infringement to the hospitalization was not conclusive. The one submitted the notification affected by physicians'persuasion, but the other did not. Problems on the substitutional payment mechanism are also discussed using the cases. Management of treatment expense claims in cases whose sickness or injury is partially attributed to third-party infringement should be discussed further and better organized in the future.</p>

Journal

  • Journal of Clinical Ethics

    Journal of Clinical Ethics 5(0), 38-44, 2017

    Japan Association for Clinial Ethics

Codes

  • NII Article ID (NAID)
    130008064483
  • Text Lang
    JPN
  • ISSN
    2187-6134
  • Data Source
    J-STAGE 
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