終末期医療の問題 臨床死生学の視点から : 治療の差し控えと中止をめぐって(シンポジウム「生命倫理をめぐる法政上の諸問題-法整備における制度設計をめぐって-」)

抄録

In May 2007, the Japanese Ministry of Health, Labour and Welfare announced guidelines on the process of decision-making concerning the termination of medical treatment. The two basic principles are:・respect for the patient's right to make decisions (including provisions in the case of mental incapacity)・ensuring appropriate medical treatment through a medical team of relevant practitioners. However, unlike in the United Kingdom, the Ministry's guidelines concern only the process of decision-making and not medical practice. In October 2007, the Japanese Association for Acute Medicine (JAAM) also announced guidelines on terminal treatment. Again, they concerns only matters such as immediate life support in the case of emergencies and are therefore not a complete reference. Yet according to the media, medical treatment has already been withdrawn in the case of over fifty patients following the JAAM guidelines. The development of medicine has made it possible to prolong life indefinitely in the case of comatose patients. On the other hand, families often wish treatment to be withdrawn. In view of the lack of full guidelines based on social consensus, withdrawal of medical treatment is thus occurring in somewhat of a theoretical vacuum. This paper discusses the problem in comparison with the current situation in the USA and the UK, and proposes a possible solution.