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Research on assessment of mental capacity for informed-consent and appointment system for substituted decision maker

替代决策者知情同意及任命制度心智能力评估研究

基本信息

批准号：
15591251
负责人：
SHIRAISHI Hiromi
金额：
$ 1.98万
依托单位：
Toyo University (2005)Tokyo Metropolitan Organization for Medical Research (2003-2004)
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2003
资助国家：
日本
起止时间：
2003 至 2005
项目状态：
已结题

项目摘要

According to the Doctrine of Informed Consent, a competent patient's decisions about accepting or rejecting proposed treatment are respected. And an appropriate substituted decision maker must decide for those patients who are incompetent to consent to treatment. Now there are few medical professionals who will ignore this Doctrine in many countries of the world. In Japan as well, the Doctrine is respected but there seems to be no well known tool such as MacCAT-T by Grisso and Appelbaum(1998) for assessing competence of the patient, nor the system for selecting a substituted decision maker when the patient is assessed as incompetentIn 2004, the authors conducted a survey by sending a questionnaire to Japanese internists, psychiatrists, neurologists and neurosurgeons in terms of assessing competence and selecting substituted decision maker in their clinical settings. The authors adopted 4 possible situations which corresponds to 4 different types of related abilities (expressing a choice, understanding, appreciation, and reasoning) and 4 different candidate for substituted decision maker (a family member, superintendent of the group-home, care-taker of the district, and a member of a ambulance personnel), respectively. Among the 295 respondents, there were 42 internists, 90 psychiatrists, 62 neurologists, and 81 neurosurgeons. Answers of medical professionals differed in questions to assess competence to consent to treatment, and to select an appropriate substituted decision maker. Many answered that there should be one or more authorized tool(s) for assessment and the necessity to establish a third party organization to decide when there is no appropriate substituted decision maker.The authors discuss it is high time to pay more attention for patients without competence to consent to treatment.

根据知情同意原则，有能力的患者接受或拒绝提议的治疗的决定是受到尊重的。而一位适当的替代决策者必须为那些没有能力同意治疗的患者做出决定。现在，在世界上许多国家，很少有医学专业人士会忽视这一学说。在日本，信条同样受到尊重，但似乎没有众所周知的工具，如Grisso和Appelbaum(1998)的MacCAT-T来评估患者的能力，也没有当患者被评估为不胜任时选择替代决策者的系统。2004年，作者通过向日本内科医生、精神病学家、神经病学家和神经外科医生发送问卷，对他们的临床环境中的能力评估和选择替代决策者进行了调查。作者采用了4种可能的情景，分别对应于4种不同类型的相关能力(表达选择、理解、欣赏和推理)和4种不同的替代决策者候选人(家庭成员、团体之家负责人、地区护理员和救护人员)。在295名受访者中，有42名内科医生、90名精神科医生、62名神经科医生和81名神经外科医生。在评估同意治疗的能力和选择适当的替代决策者的问题上，医学专业人员的回答各不相同。许多人回答说，应该有一个或多个授权的评估工具(S)，以及建立第三方组织的必要性，以决定何时没有合适的替代决策者。作者讨论了现在应该更多地关注没有能力同意治疗的患者。