응급진료에서 치료거부와 원칙으로서의 자율성

Abstract

People come to speak primarily of personal autonomy when mentioning autonomy. A reason that autonomy is valid as the main principle in decision making is because a person, who can make a decision, is a patient oneself in the aspect of own benefit considering diverse things. A patient has a right to make a decision. A doctor has obligation of maximally protecting a patient’s decision-making ability and of respecting a patient’s decision. If a patient comes to refuse treatment, a doctor ever considers intuitively that a patient’s treatment benefit against a doctor will need to be possibly given priority over a patient’s autonomous decision. However, a clinical benefit of which a doctor thinks may not be a big consideration as for a patient. If there is no special exception, ‘the principled autonomy’ needs to be applied to the treatment refusal of emergency in terms of ‘individual autonomy’ that regards an autonomous decision as the best. ‘The principled autonomy’ emphasizes a doctor’s obligation for autonomous decision as well as a patient’s right. This obligation is included what minimizes the influence that a doctor can exercise with considering a clinical benefit. That is because a doctor’s impacts on a patient can hinder the confidence formation in the patient-doctor relation. The confidential relationship is made through specific procedure on treatment refusal. This principled autonomy is applicable to emergency in pre-hospital and in-hospital phase. The treatment refusal is valid only given being premised the full understanding level. Hence, there is a need to grasp objective evaluation of a patient’s decision-making ability, communication ability, and an individual’s value.