Ikegaya H, Kawai K, Kikuchi Y, Yoshida K
Department of Forensic Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
J Med Ethics. 2006 Feb;32(2):114-6. doi: 10.1136/jme.2004.009480.
The Japanese Medical Act section 21 states that doctors must report unnatural deaths to the police, even though the term "unnatural death" is not defined by law. However, many doctors are reluctant to report potential therapeutic deaths (PTDs). The Japanese Society of Legal Medicine has submitted guidelines for unnatural death, including PTD. These define a PTD as an unexpected death, the cause of which is unknown, but which is potentially related to medical practice. Such deaths are "reportable" to the coroner in the UK. In this study, we addressed the question of whether physicians would report each of eight hypothetical PTDs. Although the clinical societies (the Japan Society of Internal Medicine and the Japan Surgical Society) declare that doctors must report deaths due to gross negligence, 60% of the participants said that they would not report gross negligence involving an overdose in cases where they had obtained informed consent or had provided an explanation after the death occurred. This can be accounted for by the mistaken belief on the part of the participants that obtaining informed consent exempts Japanese physicians from the duty of reporting PTDs. The attitude of Japanese physicians is caused by the death investigation system, which is designed to discover whether a crime has been committed rather than focusing on the cause of death. Accordingly, the Japanese Government has decided to commission a pilot study from an independent organisation in which medical specialists will investigate PTDs in order to prevent deaths occurring as a result of gross negligence.
日本《医疗法》第21条规定，医生必须向警方报告非自然死亡事件，尽管法律并未对“非自然死亡”一词作出定义。然而，许多医生不愿报告潜在治疗死亡（PTD）事件。日本法医学协会已提交了包括PTD在内的非自然死亡事件指南。这些指南将PTD定义为意外死亡，其死因不明，但可能与医疗行为有关。此类死亡事件在英国需向验尸官报告。在本研究中，我们探讨了医生是否会报告八起假设的PTD事件。尽管临床学会（日本内科医学会和日本外科学会）宣称医生必须报告因重大过失导致的死亡事件，但60%的参与者表示，在已获得知情同意或在死亡发生后已作出解释的情况下，他们不会报告涉及用药过量的重大过失事件。这可以归因于参与者的错误观念，即认为获得知情同意可使日本医生免除报告PTD事件的责任。日本医生的这种态度是由死亡调查系统导致的，该系统旨在查明是否发生犯罪行为，而非关注死因。因此，日本政府决定委托一个独立组织开展一项试点研究，由医学专家对PTD事件进行调查，以防止因重大过失导致的死亡事件发生。
