Kitamura T
Department of Sociocultural Environmental Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Ichikawa, Chiba, Japan.
Psychiatry Clin Neurosci. 2000 Oct;54(5):515-22. doi: 10.1046/j.1440-1819.2000.00746.x.
Amendment of the Mental Health and Welfare Law in Japan will limit admission for medical care and protection only for those individuals who are incapable of giving consent to admission. This is a first in the history of the Japanese mental health legislation. By reviewing the law and psychiatric literature, it is argued that: (i) informed consent is a legal transaction that embodies the idea of an individual's right to autonomous decision-making in medical settings; (ii) health professionals have a duty to protect those individuals who cannot decide medical matters because of lack of capacity to do so; (iii) some patients are marginally incompetent so assessment of their competency is essential in protecting patients' civil rights; (iv) in order for a competency assessment to be reliable (and hence fair) the method should be psychometrically sound; (v) at the same time, in order for a competency assessment to be valid, the structure of a competency assessment should match the patient's psychological, cultural, and social background; and (vi) because informed consent is a process rather than a cross-sectional event, a competency assessment should be performed in everyday practice. The use of a brief and semistructured interview to assess patients' competency to give informed consent may meet all of the requirements described.
日本《精神健康与福利法》的修订将把医疗护理和保护的收治对象限制为那些无法同意入院的个人。这在日本精神健康立法史上尚属首次。通过审视该法律及精神病学文献，本文认为：（i）知情同意是一种法律行为，体现了个体在医疗环境中自主决策的权利理念；（ii）健康专业人员有责任保护那些因缺乏能力而无法决定医疗事务的个体；（iii）一些患者在能力上处于边缘状态，因此对其能力的评估对于保护患者的公民权利至关重要；（iv）为使能力评估可靠（进而公平），该方法应在心理测量学上合理；（v）与此同时，为使能力评估有效，能力评估的结构应与患者的心理、文化和社会背景相匹配；以及（vi）由于知情同意是一个过程而非一个横断面事件，能力评估应在日常实践中进行。使用简短且半结构化的访谈来评估患者给予知情同意的能力可能符合上述所有要求。
