患者本人に対する告知の理論と実践 : カトリック生命倫理学の原理と実際

抄録

The purpose of. this paper is to reconsider the ethics of truth-telling through analyzing the theory of Catholic bioethics and its practice in the in-home palliative care provided by the Association Romanini in Rome. Catholic bioethical theory obliges doctors to tell the truth only to the extent that their patients demonstrate the willingness and ability to accept it. Following Catholic ethics, medical staff of the Association Romanini first tell the truth to their patients' families, and then in discussion with these families decide whether or not it is preferable to tell the patients. In practice, however, they tend to refrain from telling the truth to their patients. This is primarily because they wish to avoid negative effects, such as the patient's 'loss of hope', and secondarily because establishing a relationship of trust between the medical staff, family, and patient is considered more important than the act of truth-telling itself. Family participation in decision-making is common in Japan as well. It has sometimes been criticized as a result of Japan's socio-cultural tendencies to emphasize group decision-making. Indeed, family decision-making may infringe paternalistically on the patient's autonomy. However, the case of the Association Romanini illustrates the importance of human relationships of trust - not only between the medical staff and their patients but also including their families - that cannot be reduced simply to contractual, clinical or 'provider-consumer' relationships.