설명동의의 신경윤리(Neuroethics)*

Informed consent has problems with readability, length, complexity, and so on. On the one hand, rigid requirements related to informed consent discourage subjects to participate experiment. On the other hand, it distracts from more serious ethical problems in clinical research such as decision-making capacity. Recently, there is increasing evidence that some proportion of the population has difficulties with decision-making capacity. Therefore, the neuropsychological tests associated with decision making are needed before giving valid informed consent. The decision making related to informed consent can be described by the interplay between emotional and cognitive functions. How can we investigate this empirically? An appropriate scale measuring neuropsychological function in informed consent should include both cognitive and emotional abilities. Nowadays, the MacArthur Competence Assessment Tool(MacCAT) was widely used. But it relies predominantly on cognitive abilities such as understanding, appreciation, reasoning, and expression of choice. Considering recent empirical studies, the inclusion of emotional abilities in relation to decision-making seems to be essential. Iowa Gambling Task (IGT) requires emotional function as well as cognitive function to perform proper decision-making. Thus, it would be necessary to administer both the MacCAT and the IGT in people who have deficits in decision making and in giving valid or invalid informed consent.