インフォームド・コンセントと道徳発達論
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概要
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In the discussion on informed consent, we find some doctors may think they should not give patients some information, even if the patients think it indispensable. And vice versa. This results from moral gaps. Therefore, informed consent needs to bridge moral gaps. L. Kohlberg points out gaps among developmental stages as well as among ideas about values. He suggests bridging the former by making the latter comprehensible to all concerned. However, doesn't the person on the higher moral stage think the lower inmoral? No, according to Kohlberg, because the higher moral stage includes the lower stages as reintegrated components. But K. Wilber criticizes Kohlberg saying that the higher moral stage doesn't include the lower, unlike the higher cognitive stage. Which is right? In order to answer this question, I investigated the relation among stages and sent out questionnaires. Theoretically speaking, the higher moral stage doesn't include the lower stages, because unlike cognitive stages, moral stages don't have only cognitive structures, but also content formed by the structures, namely, the meaning of roles as human relations. The higher moral stage includes the lower cognitive structures, but no lower social meanings. Thus the morally higher person won't discuss things on the lower stage. Therefore, to bridge these moral gaps is possible only by raising the lower people up to the higher stages. And the higher stage 5 is easy to reach for adults, because they have already reached the cognitive stage necessary to reach moral stage 5. Furthermore this stage itself enables moral development by promoting role-playing, another antecedent of moral development. And my questionnaires also show that stage 5 can bridge moral gaps. Thus the discussion for informed consent must be based on moral stage 5. Concretely speaking, hospitals should offer not only doctors but also patients as many chances to participate in their everyday decisions as possible.
- 日本医学哲学・倫理学会の論文
- 1992-10-23