Contract or fiduciary

• Published in: Pediatric Oral and Maxillofacial Surgery Vol. 20; no. 1; pp. 1 - 4
• Main Author: HASHIZUME, Kohei
• Format: Journal Article
• Language: Japanese
• Published: JAPANESE SOCIETY OF PEDIATRIC ORAL AND MAXILLOFACIAL SURGERY 25.06.2010; 日本小児口腔外科学会
• Subjects: asymmetry of information; contract; fiduciary; 信任; 契約; 情報の非対称性
• ISSN: 0917-5261; 1884-6661
• DOI: 10.11265/poms.20.1

The relationship between doctor and patient has changed very rapidly during the past 20 years. Because of the rapidity of that change, a stable and happy relationship has not been established, and both sides are not fully satisfied with the present situation. It is generally believed that the relation between doctor and patient should be as equal as possible, and all medical practice should be done under contract. There are some points in medical practice that are not well suited for contracts, however. First, there is always asymmetry of information between doctor and patient. Even if informed consent is fully practiced, that asymmetry cannot be resolved completely. Second, the subject of a contract in medical practice would be the life and/or health of a patient. Because each patient has only one life, they are very precious for the individual and could not be subject to contract. A fiduciary is a different concept from a contract. Under a fiduciary, a trustee must act in a beneficial manner with respect to the beneficiary all the time, without a contract. However, because there are risks of negligence and abuse in a fiduciary, the morality of trustee is essential. If we want to perform medical practice under a fiduciary, the morality of doctors is definitely required.