薬を要求する患者 : 欧米における向精神薬処方の現状とそれに伴う倫理的問題

抄録

Psychoactive drugs - e.g., antipsychotics, antidepressants, antimanics, anxiolytic sedatives - are now widely prescribed in industrialized countries. However the misuse and frequent over-use of these drugs, especially the tranquilizers, has often been discussed in the extant literature. While the public's understanding of the negative aspect of taking psychoactive agents has become more widespread, physicians (not only psychiatrists) often remark that there is a tendency on the part of patients to demand and acquire these drugs by exerting great pressure on physicians for whom it is often difficult not to comply. J. D. Wallace, M. D., has dubbed this the "tranquilizer on demand" syndrome. However, the patient's demand should not in itself be simply rejected by the physician, rather his or her demand should be taken into account. We need to consider the basis for the demand. The literature suggests that patients' knowledge concerning their own mental health and its appropriate treatment (e. g., psychoactive drugs) is typically limited and not based on an adequate understanding of medicine. Therefore physicians should consider very carefully (within the context of the physician-patient relationship) each patient's autonomy and unique response to the treatment modality. If the patient's demand for psychoactive medication is not warranted on the basis of sound medical judgement, then the quality of the demand itself should be analyzed. Only then can the physician transform the "demand" into the most beneficial treatment plan. The necessary conditions for this transformation are : (1) that the doctor has sufficient knowledge concerning the natural history of the presumed psychiatric disorder, (2) that the patient is fully informed and understands the appropriateness of his or her original demand, and (3) that the patient is prepared to accept the authority (though perhaps only limited) of the physician.