The study of the ethical issues of end-of-life care for the terminal patients of the acute hospitals

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  • Irizawa Hitomi
    Hyogo College of Medicine Institute for Advanced Medical Sciences Laboratory of Cell and Gene Therapy Juntendo University Graduate School of Medicine
  • Kobayashi Hiroyuki
    Juntendo University Graduate School of Medicine
  • Sakurai Junko
    Juntendo University Hospital Patient Safety Management Unit
  • Karasawa Saori
    Juntendo University Graduate School of Medicine Juntendo University Hospital Patient Safety Management Unit
  • Kawasaki Shiori
    Juntendo University Graduate School of Medicine Juntendo University Hospital Patient Safety Management Unit

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  • 終末期患者の『身の置き所がない』状態に対する倫理的課題

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Abstract

<p>  In the nursing records of one acute care hospital, Juntendo University Hospital, the Japanese expression “mi-no-okidokoro-ga-nai” is often used to refer to patient-specific-distress at the end of life in the nursing records. It literally means feeling out of place, being so embarrassed one wants to disappear, or having a sense of restlessness. However, medical nurses at J Hospital seem to use this expression when patients have terminal restlessness.</p><p>  In this paper, I report from the electronic medical records of patients nursed during their final moments of life at the hospital, and examine the circumstances of “mi-no-okidokoro-ga-nai”. The results show that whenever the nurses judged that the distress symptoms in terminally ill patients was not sufficiently alleviated, this Japanese expression was used to imply that the medical team should quickly diagnose the cause of the pain and expand the range of treatments. In such a context, we consider ways to broaden the treatment range of patients, with consideration of various ethical issues.</p>

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