治療の選択をめぐって : エホバの証人の輸血拒否(法学者の立場から,シンポジウム 日本の医療とリベラリズム-患者の位置づけから共通基準の形成まで-)

抄録

The issues of "informed consent" and "the patient's right to self-determination" have been discussed in the philosophical, ethical, and legal areas in medicine. In particular, the refusal of blood transfusions by Jehovah's Witnesses is regarded as a typical case of the discussions on the validity and limitation of the patient's right to self-determination. It is well-known that Jehovah's Witnesses refuse allogeneic blood transfusions on the basis of Biblical statements, such as "you must never eat flesh with its life still in it, that is the blood" (Genesis 9:4) or "you are to abstain… from blood" (Acts 15:29). What is the standard medical practice where a patient absolutely refuses blood transfusions? Is there the limitation of the patient's right to self-determination? How far is it possible to approve the choice of medical treatments by patients? In this paper, such problems are discussed from the following three standpoints. 1. The concrete contents of the refusal of blood transfusions by Jehovah's Witnesses. 2. The contents of the guidelines of ethics committees in the university hospitals of Japan. 3. The controversial points of these contents (1. and 2.) and the Japanese legal system. My conclusion is as follows : 1) If a Jehovah's Witness patient has his own judgement, whether he is an adult or a minor, and is not in a state of emergency, his will to refuse blood transfusions must be respected. 2) If he is an unconscious adult in an emergency and has an advance directive, his will must be respected. 3) If he is an unconscious minor in an emergency and medical doctors have no alternative choice, it will not be against the law that they give blood transfusions to him, because there has been no judicial precedent for such a case in Japan as yet.