김천수 Cheonsoo Kim
DOI:10.36430/kjp.2024.28.1.003
Abstract
This paper examines shared decision-making (SDM) as an alternative to expert decision-making in the medical field from the perspective of self-determination principles. The Code of Ethics for Social Workers stipulates that self-determination is the core principle in social welfare decision-making. Since most social welfare recipients can make their own decisions, social workers support clients in this process. When clients have cognitive impairments, SDM can be an alternative. If a client’s decision-making capability is completely lost, a guardian can make decisions, but clients with residual capability should still participate as much as possible.
In social welfare, SDM involves various parties such as families, friends, and peers, unlike the medical field, where it is primarily between experts and patients. In the medical field, SDM aims to overcome the limitations of expert decision-making, while in social welfare, it supports individuals with decision-making difficulties.
In medical practice, if a patient can consent, no one else has the right to consent. However, the ability to consent can be ambiguous. Medical practitioners aim to get consent from both the patient and someone who can act on their behalf if necessary. When decisions conflict, the medically reasonable decision takes precedence. If both are reasonable, the patient's decision is prioritized. Legal liability for not obtaining valid consent involves damages for failing to disclose necessary information, usually limited to mental damages. However, if hypothetical refusal is proved, damages for physical harm are also included. Ambiguity in consent ability can be mitigated by objectifying negligence, but legislative measures are advisable to establish regulations for assessing consent ability.
Key Words
Patient’s ability to consent, Physician’s appropriate explanation, Legal liability for medical malpractice