2021 Fiscal Year Final Research Report

Philosophical development of clinical ethics system and contribution to super-aged society and medical and healthcare education programs

Research Project

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Project/Area Number	18H03572
Research Category	Grant-in-Aid for Scientific Research (A)
Allocation Type	Single-year Grants
Section	一般
Review Section	Medium-sized Section 1:Philosophy, art, and related fields
Research Institution	Iwate University of Health and Medical Sciences
Principal Investigator	SHIMIZU Tetsuro 岩手保健医療大学, 看護学部, 教授 (70117711)
Co-Investigator(Kenkyū-buntansha)	会田薫子東京大学, 大学院人文社会系研究科(文学部), 特任教授 (40507810) 田代志門東北大学, 文学研究科, 准教授 (50548550) 霜田求京都女子大学, 現代社会学部, 教授 (90243138) 相澤出岩手保健医療大学, 看護学部, 准教授 (40712229) 濱中喜代岩手保健医療大学, 看護学部, 教授 (70114329) 浅井篤東北大学, 医学系研究科, 教授 (80283612) 宮下光令東北大学, 医学系研究科, 教授 (90301142)
Project Period (FY)	2018-04-01 – 2022-03-31
Keywords	臨床倫理 / 皆一緒と人それぞれ / 社会の倫理 / 情報共有－合意モデル / 意思決定支援 / ACP / 超高齢社会 / ポスト健康寿命期
Outline of Final Research Achievements	We tried to analyze the ethics in our society using the two principles of human relationship: "live by helping each other" and "live and let live," and recognized that, e.g., Paternalism, besides Aristocracy, was natural and even might have been appropriate in societies where the former principle was dominant, while respect for autonomy is absolutely recognized in those where the latter one is dominant. In Japanese society nowadays, by contrast, a balance between the two principles should be sought, which can be actualized in medical contexts by our version of shared decision-making. "Post healthy life-span" is the period when elderly people are living with frailty. It is said to last for about ten years on average. The period is appropriately understood as "end-of-life period" and advance care planning (ACP) for this period should be promoted. We made support tools for elderly people's ACP, as well as contributed to some authorized guidelines for ACP.
Free Research Field	哲学、臨床倫理、臨床死生学
Academic Significance and Societal Importance of the Research Achievements	(1) 学術的意義　〈皆一緒〉と〈人それぞれ〉という倫理外の関係にも使える要素に基づき、両者のどのようなバランスを社会が要請するかが、倫理を決めると共に、社会のあり方自体をも決めていることを明らかにした。 (2) 社会的意義　現在の社会に相応しい意思決定支援の考え方を臨床現場に提供した。すなわち、「情報共有－合意モデル」および「人生と生命の区別」は、高齢者の人工的水分・栄養補給に関するガイドライン（2012）を皮切りに、最近では慢性腎不全や呼吸不全をテーマに関係学会等が協働して作成した患者の治療選択を支援するツールに採用されるなど、社会における医療・ケアのあり方に実質的に影響を及ぼしている。