Abstract
In recent years, the term of'informed consent'has become popular in Japan and the respect of patient's autonomy in daily medical decision making has been increasingly stressed. We, Japanese doctors'may have been too paternalistic against patients, and I personally feel we should appreciate and promote the informed consent principle. But the application of the doctrine of informed conset as a vehicle in law suit decision seen in US is a different matter. In recent years, the number of court-decisions using this doctrine are increasing in Japanese society. In the field of neurosurgery, among 7 reported cases concerning the operation of intracranial aneurysm or arteriovenous malformation, 5 cases are about the breach of disclosure. Under the informed consent doctrine, once the court acknowledges doctor's betrayal of patient's autonomy, doctor is forced to compensate not only the consolation money but also the bodily damage itself which is essentially the result of the statistical risk of the operation, even though there exists no technical negligience at all. Consiquently doctors are forced to let his patient make his own decision which is sometimes too burdensome for the patient. According to the questionaire study of a comission of the ministry of welfare 1989,more than half doctors considers that doctor had better make decision for his patient considering patient's opinion, whereas only 20% doctors cosider patient should have priority in decision-making. Though there are a few exceptions, patients are not so self-established or strong enough to make a decision about his bodily operation which may result in death-selection. Under such circumstances I personally believe the introduction of informed consent doctrine in Japanese medical law suit is not preferable. It may sometimes be more harmful than beneficial for the patient-doctor relationship or for the patient's human right.
