Relational Autonomy, the Right to Reject Treatment, and Advance Directives in Japan.
Relational Autonomy, the Right to Reject Treatment, and Advance Directives in Japan.
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DOI：
10.1007/s41649-021-00191-1
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发表时间：
2022-01
影响因子：
2.9
通讯作者：
Asagumo A
中科院分区：
文献类型：
--
作者：
Asagumo A
虽然“以病人为中心的医学”和“知情同意”的概念所包含的病人决定自己想要什么的权利在日本得到了广泛的承认和强调，但在尊重死亡即将来临时不再有能力的人的意愿方面仍然存在严重的问题。一般认为，上述概念不包括在停止治疗不可避免地导致死亡的情况下拒绝治疗的权利，即使患者先前表示希望在有能力时行使这一权利。在本文中，我首先解释了目前日本的社会和法律的情况，在那里，法律的不明确的拒绝治疗的权利，往往导致医生采用的患者的话的解释，最不利于治疗退出。然后，我认为，拒绝治疗的权利应该得到认真对待，即使当病人不再有能力，或拒绝治疗将导致死亡。我认为，在一个个人自主被认为与社会价值观不相容的国家，关系自主的概念可能会有一些实际和有价值的影响。最后，我回答了可能的反对关系自治和解决社会上广泛关注的滑坡从允许拒绝治疗的权利到死亡的义务。
Although the patient’s right to decide what they want for themselves, which is encompassed in the notion of ‘patient-centred medicine’ and ‘informed consent’, is widely recognised and emphasised in Japan, there remain grave problems when it comes to respecting the wishes of the no-longer-competent when death is imminent. In general, it is believed that the concepts above do not include the right to refuse treatment when treatment withdrawal inevitably results in death, even when the patient previously expressed the wish to exercise this right when competent. In this paper, I first explain the current social and legal situation in Japan, where the lack of legal clarity regarding the right to reject treatment tends to result in doctors adopting the interpretation of patients’ words that is least conducive to treatment withdrawal. I then argue that the right to refuse treatment should be taken seriously, even when the patient is no longer competent, or the treatment refusal will result in death. I suggest that the concept of relational autonomy might have some practical and valuable implications in a country where individual autonomy is considered incompatible with societal values. Finally, I answer possible objections to relational autonomy and address the widespread societal concern about sliding down the slippery slope from allowing the right to refuse treatment to the obligation to die.
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