精神障害者の身体合併症への非自発的治療の倫理性 : 精神科医療におけるインフォームド・コンセントの限界について

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Psychotic patients are different from demented people because they possess the ability for competence in principle. Therefore, medical treatment must be performed based on the concept of informed consent. But in reality, there can be discrepancies between their overt-will and covert-will, because they have pathological thought processes due to double orientation and ambivalence. So we must speculate on their true wishes, and act appropriately. If they express their true wishes covertly, performing medical treatment on them involuntarily is not paternalistic intervention. I consider this behavior one which is based on self-determination. In this situation, we must carry out treatment for somatic complications, and the range of the treatment we can do should be within the area of low invasive therapy, for example, medication or injection. We may not arrive at a consensus for surgical operations and more invasive therapies. I report on two schizophrenic cases in this paper, one with breast cancer and the other with diabetes. We could not carry out a surgical operation for the first case, but I am now using injection of insulin for the second case. In the field of clinical medicine, there is a tendency for informed consent to be considered part of the therapeutic contract. In this context, overt expression of agreement is necessary in order to set up the contract. Psychotic patients express their wishes for treatment unclearly or covertly, so they do not have the opportunity to receive treatment even though they want to. Expanding the bounds of informed consent for psychotic patients would place them at a disadvantage and deprive them of medical treatment. I worry about the emergence of a new form of discrimination against psychotic patients.
日本医学哲学・倫理学会の論文
1998-10-01

精神障害者の身体合併症への非自発的治療の倫理性 : 精神科医療におけるインフォームド・コンセントの限界について

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