Kumiko Yoshitake

In consensus building process in medicine, it is said that it is crucial for its participants to understand why each stakeholder, patient, his/her family, physician, nurse, etc., in decision-making has his/her own opinion. In order to understand this condition more deeply, I develop the notion of “reason of opinion” to characterize the process as “prospective consensus building.” This prospective consensus building should satisfy the requirements of having “history of reason” and “list of risks.” The former requirement, history of reason, can be characterized by making clear when one started to form the reason of an opinion, how one formed the reason, what kind of relationship is supposed to be between the present opinion and its reason, and what kind of result is expected to come out after a decision making. The latter requirement, the list of risks, should display what kind of outcomes are supposed to come out in each alternative of the decision making. Prospective consensus building makes it possible, firstly, for the stakeholders to understand the patient’s needs more deeply. For the patient, secondly, the each stakeholder would be able to become aware of his/her own sense of value and to confirm what he/she expects from the result of his/her decision-making. For all the stakeholders, thirdly, it would make it possible to decrease the amount of risks of misunderstanding and to share their expectations for their well-being. Finally, the stakeholders can reach a satisfactory consensus and find a way to the better solution.

Decision-making adhering to the “principle of autonomy" takes place within the wider context of decision-making processes in modern society. Within the medical area, as regards the decision through informed consent, the patient's intention assumes vital importance. The principle of autonomy is derived from the modern thought that the essence of human being is the reason. It becomes difficult, however, to rely on decision-making based on the principle of autonomy when a person’s intention is not clear and the opinions of those who are involved differ from each other. Here, I think that the principle of consensus, which seeks the agreement of those who are concerned, becomes as important as the principle of autonomy. This paper examines the problems of certainty, reliability, andcreativity of medical action through the consideration of the principle of consensus.