医の倫理教育 : その過去、現在及び未来

抄録

From an experience of more than twenty years in undergaduate and postgraduate education of medical ethics and bioethics, the author discussed the following four problems. 1. Eduation of bioethics should be started as early as possible by parents and kindergarten teachers, and should be followed by primary and secondary school teachers prior to medical education. 2. During the past twenty years, almost every Japanese including medical students became very familiar with medicoethical and bioethical issues arising from new medical technology. However, education on citizens' everyday ethics and pupil / students' ethics are more important than medical ethics relating to modern topics such as euthanasia, in vitro fertilization, organ / tissue transplantation and so on. 3. When, by whom, where, in which stage of the curriculum, in which style, on what kind of topics, medical ethics education should be done, are all very difficult questions to answer, However, the author have reached the following answers. (1) The effect of lecture style education on medical ethics in a large lecture hall, especially in the preclinical course is very limited. (2) Small group discussion on everyday clinical practice is more important than a systematic lecture. (3) Everyday ethical and humanitarian behaviors of all practitioners to the patients and their families are more important than lectures by famous professors. 4. Why Japanese physicians show less concern about medicoethical and bioethical issues was discussed. Some of the reasons are : (1) It results largely from a cultural difference between Euro-American countries and Japan. (2) Japan is too legalistic country in which most behavior of the people is regulated by laws, most of them enacted in the 19th century, rather than by medical ethics and bioethics. (3) Medical practice in Japan is typical Managed Care controlled by government and National Health Insurance Laws. For most physicians it is rather rare to find an opportunity of ethical decision-making. (4) The Physician-Health Insurance Law relationship and patient-government relationship are very often more important as well as more powerful than the patient-physician relationship in Japan. (5) Medical education in Japan both in pre- and postgraduate courses is a typical School Medicine or University Medicine which places too much attention on medical science and modern high-technology, respecting less the humanity, human dignity and interests of the community.