看護倫理からみた生命倫理の諸問題 : 「説明に基づく同意」を手がかりに

抄録

The report deals with a theoretical connection between nursing ethics in the clinical setting and the bioethical ground underlying them. Special attention is given to the concept of "informed consent", which is often discussed in relation to bioethics. Clinical medicine today is now shifting its emphasis, previously placed on medical cure, to nursing care. One of the reasons for this change, in my opinion, is that advanced techniques in medical treatments having now reached a stage where many incurable diseases have actually proved curable, only truly incurable ones, such as chronic diseases of the aged, remain with us and they certainly require much more nursing care than medical cure. It is, therefore, undeniable that the importance of nursing care in clinical practice is now greater than ever. Achieving a higher level and quality of nursing service for patients is inseparable from both developing nursing skills and improving nursing ethics. In order to realize the latter purpose, nursing care ought to be designed to meet the needs of patients. Patients, on the other hand, decide themselves what they need: to help them have the power of "self-determination", they are entitled to obtain any information necessary for them to decide what they really need. The traditional idea of "patient-centered nursing", consequently, should be changed to the concept of "informed consent". So as to make this concept work efficiently in the clinic, relationships between patients and medical staff are expected to improve. This report is an attempt to elucidate these problems which arise at the crossroad of nursing ethics and bioethics under the following five sections: (1) Beginning of bioethics, (2) The concept of "informed consent", (3) A criticism of paternalism, (4) On the idea of "quality of life", (5) Establishing a back-up system in nursing.