Bagheri Alireza, Asai Atsushi, Ida Ryuichi
Graduate School of Law, Kyoto University, Yoshida, Sakyo-ku, 606-8501 Kyoto, Japan.
BMC Med Ethics. 2006 Jun 10;7:E8. doi: 10.1186/1472-6939-7-8.
BACKGROUND The current debate about medical futility is mostly driven by theoretical and personal perspectives and there is a lack of empirical data to document experts and public attitudes towards medical futility.
To examine the attitudes of the Japanese experts in the fields relevant to medical futility a questionnaire survey was conducted among the members of the Japan Association for Bioethics. A total number of 108 questionnaires returned filled in, giving a response rate of 50.9%. Among the respondents 62% were healthcare professionals (HCPs) and 37% were non-healthcare professionals (Non-HCPs).
The majority of respondents (67.6 %) believed that a physician's refusal to provide or continue a treatment on the ground of futility judgment could never be morally justified but 22.2% approved such refusal with conditions. In the case of physiologically futile care, three-quarters believed that a physician should inform the patient/family of his futility judgment and it would be the patient who could decide what should be done next, based on his/her value judgment. However more than 10% said that a physician should ask about a patient's value and goals, but the final decision was left to the doctor not the patient. There was no statistically significant difference between HCPs and Non-HCPs (p = 0.676). Of respondents 67.6% believed that practical guidelines set up by the health authority would be helpful in futility judgment.
The results show that there is no support for the physicians' unilateral decision-making on futile care. This survey highlights medical futility as an emerging issue in Japanese healthcare and emphasizes on the need for public discussion and policy development.
背景 当前关于医疗无效性的争论大多由理论和个人观点驱动，缺乏实证数据来记录专家和公众对医疗无效性的态度。
为了调查日本与医疗无效性相关领域专家的态度，对日本生物伦理学会的成员进行了问卷调查。共回收108份填写完整的问卷，回复率为50.9%。在受访者中，62%是医疗保健专业人员（HCPs），37%是非医疗保健专业人员（非HCPs）。
大多数受访者（67.6%）认为医生以无效性判断为由拒绝提供或继续治疗在道德上永远无法得到正当理由，但22.2%在有条件的情况下批准这种拒绝。在生理上无效的护理情况下，四分之三的人认为医生应该将其无效性判断告知患者/家属，接下来应该由患者根据自己的价值判断决定该怎么做。然而，超过10%的人表示医生应该询问患者的价值观和目标，但最终决定权在医生而非患者。HCPs和非HCPs之间没有统计学上的显著差异（p = 0.676）。67.6%的受访者认为卫生当局制定的实用指南将有助于无效性判断。
结果表明，不支持医生对无效护理进行单方面决策。这项调查凸显了医疗无效性作为日本医疗保健中一个新出现的问题，并强调了进行公众讨论和制定政策的必要性。
