チーム医療における不確実なリスクに対する集団的意思決定

抄録

Serious accidents can be caused by inadvertent action. In particular, there are various unexpected but hazardous risks connected with medical treatment. In fact, some medical treatments have resulted in grave consequences. One typical example of this is the HIV crisis that occurred in the Japanese blood supply system. The government, doctors, nurses, other healthcare professionals and especially patients and their families were confronted with difficult decision-making against uncertain risks. The question is how to deal with unexpected and uncertain risks. The "precautionary principle" was introduced to cope with such difficulties. However, the precautionary principle is considered to be imprecise and vague when we try to apply it to real-life cases. Decision-making models are required. Healthcare professionals must work in collaboration with other healthcare professionals in multidisciplinary care teams. They must discuss cases with each other and make cooperative decisions. In the past, the doctor has often been assumed to be the most appropriate person to make the decisions. This is not so widely accepted today. Therefore we need a new model for collaborative decision-making. The aim of this article is to provide multidisciplinary care teams with a practical model for collaborative decision-making against uncertain and unexpected risks. The focus is on the process of decision-making. A paradigm case -HIV case- is presented to show how to apply the model to real-life cases. The question of the case is what kind of decision-making is possible for doctors, nurses, other healthcare professionals and hemophiliacs and their families to avoid HIV infection when the cause of the AIDS is unknown.