Does informed consent exempt Japanese doctors from reporting therapeutic deaths?
Does informed consent exempt Japanese doctors from reporting therapeutic deaths?
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知情同意是否可以免除日本医生报告治疗性死亡的情况？
DOI：
10.1136/jme.2004.009480
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发表时间：
2006
影响因子：
4.1
通讯作者：
K. Yoshida
中科院分区：
文献类型：
--
作者：
H. Ikegaya;K. Kawai;Y. Kikuchi;K. Yoshida
《日本医疗法》第21条规定，医生必须向警方报告非正常死亡，尽管法律没有定义“非正常死亡”一词。然而，许多医生不愿意报告潜在的治疗性死亡（PTDs）。日本法医学协会已经提交了包括PTD在内的非自然死亡指南。这些将PTD定义为意外死亡，其原因不明，但可能与医疗实践有关。在英国，这样的死亡是要“报告”给验尸官的。在这项研究中，我们探讨了医生是否会报告八种假设的ptsd。尽管临床学会（日本内科学会和日本外科学会）宣布医生必须报告因重大过失造成的死亡，但60%的参与者表示，在获得知情同意或在死亡发生后提供解释的情况下，他们不会报告涉及过量用药的重大过失。这可能是由于参与者错误地认为获得知情同意可以免除日本医生报告PTDs的责任。日本医生的态度是由死亡调查制度造成的。死亡调查制度的目的是发现是否发生了犯罪，而不是关注死亡原因。因此，日本政府决定委托一个独立组织进行一项试点研究，由医学专家对创伤后应激障碍进行调查，以防止因重大疏忽造成死亡。
The Japanese Medical Act section 21 states that doctors must report unnatural deaths to the police, even though the term “unnatural death” is not defined by law. However, many doctors are reluctant to report potential therapeutic deaths (PTDs). The Japanese Society of Legal Medicine has submitted guidelines for unnatural death, including PTD. These define a PTD as an unexpected death, the cause of which is unknown, but which is potentially related to medical practice. Such deaths are “reportable” to the coroner in the UK. In this study, we addressed the question of whether physicians would report each of eight hypothetical PTDs. Although the clinical societies (the Japan Society of Internal Medicine and the Japan Surgical Society) declare that doctors must report deaths due to gross negligence, 60% of the participants said that they would not report gross negligence involving an overdose in cases where they had obtained informed consent or had provided an explanation after the death occurred. This can be accounted for by the mistaken belief on the part of the participants that obtaining informed consent exempts Japanese physicians from the duty of reporting PTDs. The attitude of Japanese physicians is caused by the death investigation system, which is designed to discover whether a crime has been committed rather than focusing on the cause of death. Accordingly, the Japanese Government has decided to commission a pilot study from an independent organisation in which medical specialists will investigate PTDs in order to prevent deaths occurring as a result of gross negligence.