Narrative Analysis of the Mechanism of Medical Conflict and Accountability

2019 Fiscal Year Final Research Report

• Project/Area Number: 15KT0126
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 特設分野
• Research Field: Conflict Studies
• Research Institution: Yamagata University
• Principal Investigator: Nakanishi Toshimi 山形大学, 医学部, 准教授 (20420424)
• Project Period (FY): 2015-07-10 – 2020-03-31
• Keywords: インフォームド・コンセント / ナラティヴ / 対話過程 / 医療紛争の生成と予防 / 説明義務

Outline of Final Research Achievements

The purpose of this study was to construct and test the hypothesis of the dynamic mechanism of the actual informed consent (IC) process by correlating the structure of the cognitive process of both physicians and patients regarding the explanation and consent and the structure of the legal obligation to explain in lawsuits, based on factors such as the background and content of IC. The methods used were: acquisition and analysis of data on IC processes in actual healthcare settings, construction of sufficient explanations in IC, examination of conflict generation mechanisms, precedent,and narrative analysis. The results clearly showed the existence of an explanatory process with collaborative decision making based on acceptance and empathy for the specific patient. In addition, the interaction process of IC with the medical mediation concept was an evaluation of the collaborative decision-making process with high levels of understanding and satisfaction between patients and physicians.

Free Research Field

医療紛争・裁判外紛争処理（医療メディエーション）・臨床倫理・平和構築学

Academic Significance and Societal Importance of the Research Achievements

医師・患者関係における、より良い説明とIC過程について、患者・医師双方の立場から、入院や手術時での短期精神ストレスや満足感、意思決定、不安などを明らかにした。紛争や訴訟になるケースの多くは、説明義務が医療行為を点で考え、線として継続的な患者への説明が不足していた。患者が主体のより良いICのためには、患者にとって必要と思われる情報について、慎重に判断・確認して説明するためのIC概念が必要である。具体的には、患者に寄り添うことが出来る受容と共感の協働意思決定の双方向性がある対話過程や臨床倫理の視点のあることがICには必要で、救急・臓器移植のICや重症対応メディエーターの教育プログラムを作成した。