変遷する医師の役割とインフォームド・コンセント : 歴史的観点からの考察(<特集>病とは何か・癒しとは何か インフォームド・コンセントとは何か)

抄録

In the history of medicine, some periods can be divided by the change in the physician's role concerning the course and prognosis of disease. In ancient times, the principal factor in determining the prognosis of a disease shifted from divine or supernatural forces to natural principles that were advocated by the authors of the Hippocratic corpus. During this period when both physician and patient maintained their relationship in account with natural principle, prognosis was so heavily dependent on natural forces that the physician's role was limited to a supplementary one. After a long medieval period, the physician's role underwent a change from advocacy to subjugation of natural principles. In the eighteenth century, as Foucault indicated, the old clinic was replaced by anatomically articulated medicine. With this change, the age of paternalism came, sustained by the clinical effectiveness of the physician's experience and skill. However, as biomedical knowledge was accumulated and enhanced, people's expectation and confidence moved from physician's skill to the corpus of biomedical knowledge, that actually controlled the outcome and prognosis of disease. The concept of informed consent, first introduced on October 22, 1957, not only signified the epochmaking addition of the patient's will to the decisive factors for outcome and prognosis of disease, but also reflected that the physician's role hand become that of a catalytic agent between the sum of medical knowledge and patient. The introduction of informed consent, on the one hand, eliminated the physician's image as representative of healing, and on the other hand, gave the contemporary physician a new task, the investigation of the patient's uniqueness and the formation of a comprehensive notion of the clinic in the context of the physician-patient relationship.