筋萎縮性側索硬化症の臨床倫理—人工呼吸器離脱に関する議論と今後の課題を中心に

Clinical Ethics on Amyotrophic Lateral Sclerosis: Focusing on Discussions and Future Challenges Regarding Withdrawal of Ventilator Support

筋萎縮性側索硬化症の臨床倫理をめぐる倫理的課題は数多くあるが，最も悩ましい事案の1つとして人工呼吸器離脱がある。この問題は「外す」という場面だけでなく，「装着する」という意思決定にも大きな影響を与える問題であり，特に離脱する権利を「合法化」した場合，法制化されているということ自体が「無言の圧力」となることが懸念される。「法的権利」として明文化するのではなく，個別事案を精査し「特例」として違法性を阻却する方策が望ましい。

Abstract

Although there are many ethical issues related to amyotrophic lateral sclerosis, one of the most controversial issue is the withdrawal of ventilator support. This problem has a significant impact not only on the decision to “remove”, but also on the decision to “wear” it. In particular, if the withdrawal of ventilator support was to be legalized, there is a concern that its legislation may exert a ‘silent pressure.’ Therefore, rather than explicitly defining the withdrawal of ventilator support, as a “legal right,” we prefer the installation of a policy in which the details of individual cases are carefully scrutinized, allowing for justifiable non-compliance with the law in special cases.