On Supporting the Self-determination of Patients in Terminal Care:Thinking from the Philosophical Perspective

2018 Fiscal Year Final Research Report

• Project/Area Number: 17H06553
• Research Category: Grant-in-Aid for Research Activity Start-up
• Allocation Type: Single-year Grants
• Research Field: Philosophy/Ethics
• Research Institution: Utsunomiya University
• Principal Investigator: YAMADA YUKIKO 宇都宮大学, 教育学部, 准教授 (90344910)
• Research Collaborator: Murakami Eri ; Chishima iwao
• Project Period (FY): 2017-08-25 – 2019-03-31
• Keywords: 哲学 / 倫理学 / 生命倫理 / 終末期 / ケア / 自己決定 / 死生学

Outline of Final Research Achievements

This is a philosophical study in order to be able to support "the self-determination of terminal patients". In this study we have ① prospected for making "self-determination support manual" by Tochigi Medical Center, and also had "the monthly sessions studying medical ethics" with the palliative care team. ②Through these chances of the exchange of opinions and by the way of questionnaire surveys, it has become clear that for the medical team not only 1)relationship with patients, 2)relationship with their families and 3) inner relationship in the medical team, but also 4) the problems in their working environments are more serious than expected. ③ “Self-determination” (or traditionally, living will) in bioethics is empty in the actual field of terminal care and instead of them the necessity for ACP, and for a support from outside of the medical field (“Social Prescription” in the community)became clear.

Free Research Field

哲学

Academic Significance and Societal Importance of the Research Achievements

１）医療スタッフとの「生命倫理勉強会」を通じ、生命倫理学の理論的蓄積と医療現場との「ギャップ問題」を解決するため、理論と実践のフィードバック的研究を目指した。２）終末期医療では、個人の「自己決定権」にかえてACPの取組み、地域での「社会的処方」のの必要性が明らかとなった。３）ACP普及のために、連携医師らと共に、いわば潜在的患者としての若年層（小５～高校）を対象とした「死生学教育」の試み（18年8月「とちぎこども未来創造大学」）を実施した。４）患者の「全人的ケア」のためにも、現場で疲弊する＜医療ケア者のためのケア＞こそがむしろ急務であることが明らかとなった。