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Create a medical care system that serves terminal patients’ wishes

The Yomiuri ShimbunHow can it be made possible to provide patients with the medical and nursing care they want at their final stages of life and to let them have a fitting close to their life? With the advent of a super-aged society, this is a challenge that everyone must think about.

The guidelines concerning end-of-life medical treatment and nursing care, which the Health, Labor and Welfare Ministry has revised for the first time in 11 years, emphasize the importance for patients to have advance consultations repeatedly with teams providing medical treatment and nursing care services, and with their families. The guidelines also call for the outcome of the discussions to be put in writing every time such consultations are held.

A decision on how patients will spend their end stage is closely related to their values and their view of life. It can also happen that a patient’s wishes change halfway. In the United States and European countries, an approach that puts importance on the consultation process is coming into wide use. This is an effort intended to precisely grasp and respect the patient’s wishes.

The guidelines also call for having patients designate someone in advance, including family members, whom they can trust to make judgments on their behalf in the event that they become unable to express their own will.

It is hard to predict when the end-of-life stage will come. There has also been an increase in the number of elderly people whose wishes are difficult to confirm when they are suffering from dementia or have been leading a solitary life. There have also been conspicuous cases of medical emergencies in which patients’ own wishes could not be made out, and they end up being given a life-sustaining treatment which they do not want.

Set minds at ease

Where should patients die? To what extent do they want to receive end-of-life medical treatment? The need has grown for people to think about these matters while they are still healthy, and to share their perceptions with those around them.

Fewer than 40 percent of people have actually had such talks with those around them, while fewer than 10 percent have put their wishes in writing. Most elderly people want to die at home, but nearly 80 percent of them die at hospitals.

The government has advanced the establishment of a medical and nursing care service system that fits the super-aged society. It also plans to have venues where patients die expanded to their own homes and nursing care facilities. Thus not only hospital officials, but also patients’ families and those engaged in nursing care services, will come in touch with terminal patients. Creating a system that takes account of such developments is important.

On the home-based medical and nursing care front, attempts are now also under way to repeatedly inquire, through conversations, about patients’ wishes at their end-of-life stage. Some local governments even have made, and distributed among local residents, notebooks for patients to write down their wishes.

To be taken heed of is that there are those who are unwilling to think about their own death. There are also cases when people cannot express their true feelings as they are afraid of giving trouble to those around them. Pressing them to make a choice would be the reverse of what these attempts intend.

Understanding patients’ anxiety and confusion, and recognizing their feelings, can help them make their decisions. Fostering people who are capable of doing such things in medical and nursing care services is vital.

It is also a challenge to improve, both in quality and quantity, end-of-life medical and nursing care services for terminal patients.

If the guidelines are aimed at reducing medical expenses by holding back life-sustaining treatment, it will be difficult to gain public understanding. They should be advanced carefully, with the main focus placed on choosing the best option that goes along with the patients’ wishes to the very end.

(From The Yomiuri Shimbun, April 17, 2018)Speech



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