충분한 설명에 근거한 동의에서 환자의 의사결정능력 판단의 기준

In current medical area, it has become a common process that physicians obtain patients' clear consent after transfer of information on treatment to patients prior to start treatment, and there seems to be no problem in appearance. However, if the process to obtain patient consent is observed, it can easily be found that the process is merely a conventional process and, if the pattern obtaining the consents is more deeply reviewed, it can be found that requirements to be importantly treated in the process of obtaining consents are omitted. In the world of our medical society, the process that patients agree in treatment is hearing the information from physicians and signing on consent forms where such information is described in detail, at all. They believe that they have done their duties because patients read and signed and, therefore, requirements to be deeply considered in practice are not reviewed in the process to obtain consents.

The author reviewed the requirements for patients' decision-making competence among the requirements for patient consent. Despite patients' decision-making competence is the precondition of consent, procedure or standard to measure competence is not yet established. If medical information is disclosed and signature on consent forms is asked with no confirmation whether patients have the competence to make decisions, such an action cannot be considered to fulfill the liability to respect for patient's autonomy that is the original purpose.

Therefore, the author intend to introduce what are used as the standards for assessment of patients' decision-making competence in the Western and intends to review what kind of limits such standards have in assessment of patients' decision-making competence by reviewing the characteristics of patient's decision-making in practical medicine. While, one of the questions made by current medical area is that Western standards on decision-making are settled with exceedingly individual-centered decision-making, thus, there cannot be no limit in application in our medical area; this will also be reviewed together. Through the review of such limits, it will be reviewed how the physicians' standards on patients' decision-making competence should be settled, when physicians obtain patients' consent, for appropriate use in clinical practice and what requirements should be considered in assessment of patients' decision-making competence.