I. 結核の研究と診療における倫理

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The following topics were discussed in the lecture. 1. Structure of clinical medicine. 2. Physician scientist. 3. Science and ethics. A scientist must be responsible at least ethically for “uncertain consequence”of his research. Even medical science of today is a system of insufficient information and medical progress might result sometimes in unexpected outcome. In order to enhance welfare of human being and at the same time guard the society from “disease of medical progress”, a balance between unrestricted creative activity of investigators and severely critical evaluation by the fellow scientists and physicians is indespensable. In addition to it, scientists can not reject the assess ment of the society, for science is not the only value but one of values and medicine is science not only on but for human being. 4. Ethics for medical research. “Primum non nocere” is one of the most important instructions for clinical scientists but it is also true that medical progress depends largely on a brave doctor who dares to make entirely new trial on man. Easy extrapolation of animal data to bed side is unscientific and unethical because of insurmountable species difference. It is the greatest ethical dilemma in medical research that an investigator is obliged to run a risk to utilize a healthy or sick person as an experimental subject, if he wants to be ethical. Declaration of Helsinki and other ethical codes are for the purpose of dealing with the difficulties. 5. Ethics for medical care. Medical care is based on relationship between patients and physicians, not between myco bacteria and rifampicin. The operational way of thinking is essential especially for control of tuberculosis, but as a man is always extraordinary and “einmalig”, medical care must finally aim at individualization. In other words, individual morality should predominate statistical morality. It is not physicians exclusive duty to transmit information from laboratory to bed side. Feedback action from bed side is also essential for sound progress in clinical medicine. For instance, monitoring system covering practioners is the most important safeguard against adverse drug reactions. The purpose of medical care is not only to add hours to life but also to add life to hours and it is beyond question that recent advance in medical science has largely contributed to alleviate even untractable disease. But medicine of today is successful sometimes only in pro longing patients life without restoring independence in daily living and dignity of man. From technological point of view, medical care might have nothing to do with vegitable state, senile idioty, etc., but from ethical point of view, a physician can not disregard a hopeless case. Medical progress raised a very difficult problem of basic importance: what is life? what is a man? and what is medical care

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砂原茂一
国立療養所東京病院

I. 結核の研究と診療における倫理

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