神経難病における「協働意思決定」の倫理的ポイント—ACP（人生会議）をめぐる誤解と混乱を中心に

Ethical Issues in Collaborative Decision-Making for Intractable Neurological Diseases: Focusing on Misunderstandings and Confusion regarding Advance Care Planning

協働意思決定において医療者の果たすべき役割は，ガイドランナーのようなものである。選手よりも速すぎると失格にしてしまう。遅すぎると迷惑以外の何物でもない。コースアウトしそうになれば，しっかりと導きながらも，あくまでも選手が主人公であるのと同じく，医師をはじめ医療者は，患者が「コースアウト」しないように導きながらも，あくまでも主人公である患者自身が，自らの足で歩んでいけるように支えることが重要である。

Abstract

Medical professionals should play the role of a guide runner in collaborative decision-making. If the guide runner is too fast compared to the athlete, the athlete is disqualified. If he is too slow, he is nothing but a nuisance. The guide runner provides firm guidance to the athlete so that he does not go off course; however, as the athlete is ultimately the main character, the guide runner must respect the athlete's autonomy. Doctors and other medical professionals should guide patients so that they do not “go off course,” but at the same time, support the patient, who is the main character, so that they can walk on their own two feet.