| 特集名 | 透析の導入・継続・中止 | |
|---|---|---|
| 題名 | 透析の中止 (1) 日本人の宗教観，尊厳死，高齢者の死生観 | |
| 発刊年月 | 1998年 07月 | |
| 著者 | 前田 貞亮 | 前田記念腎研究所 |
| 【 要旨 】 | 人間は社会における存在の一員としての意義をもつ．それゆえにこそ，安易に死を求めてはならない．生命尊重という社会倫理をつらぬくためには，患者の自己決定権の拡大が無条件に許されてはならない．死との対決とともに死は生の続きである．日本人の素朴な宗教観は自然界との融和であり，神仏混淆である．魂の救いは愛するものの身近にある．「草葉の蔭で」という表現こそ，その表われであろう． 苦痛に耐えることが患者にとって無意味である場合には，時には安楽死も止むをえない．透析を中止し安らかにこの世に別れを告げさせるべきか． 透析の中止については，本人の意思，家族の願いとともに客観的妥当性(これはなかなか困難だが)を真に求めるときに成り立つ医学的，倫理的(法理的)客観性が求められる．次のような条件が必要である．I. 医学的条件 1) 患者の状態が血液透析の実施により危険があり，他の方法(腹膜透析など)も行いえない場合． 2) 不治の合併症のため死期が間近い患者で透析療法を行うことにより，かえって患者の苦痛(医学的，客観的)が増加する場合． II. 倫理的(法理的)条件 患者の予めの意思を含め家族，医療スタッフ，弁護士および経験のある医師の合意ができた場合． |
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| Theme | Initiation, Maintenance and Discontinuation of Dialysis Therapy | |
|---|---|---|
| Title | Japanese religious values, the philosophy of life and death of aged person, the degnity death, and the withdrawal of dialysis treatment | |
| Author | Teiryo Maeda | Maeda Institute of Renal Research |
| [ Summary ] | Every human life is important and every human being has a responsibility to society to continue to live. Therefore people should not give up their lives easily and request euthanasia without due consideration. Society for it's part, should morally and ethically reject euthanasia and not allow patients to perceive euthanasia as a right. In our lives we are occationally be confronted with death and we must continue to fight for life until the very end. Death should be viewed as a part of the cycle of life. Japanese religious values are based on a combination of a belief in being harmony with nature, belief in various gods of good fortune, and the teachings of Buddha. In Japanese culture we believe the souls of our deceased relatives are always with us helping us in our daily lives. We often say "kusaba no kage de" which is a special Japanese proverb that means that we are continually helped by our deceased relatives spirits hiding just behind the tree or from beyond the grave. However these beliefs may not be adequate to sustain life, and it is sometimes meaningless for a patient to continue suffering great pain with no chance of survival. In these cases, euthanasia is sometimes unavoidable. Is stopping dialysis and allowing a patient the chance to say goodbye to this world with dignity and peace the best solution or not ? In making the decision to stop dialysis treatment it is of course necessary to take into consideration the patients opinions, the feelings of the family and to be objectives from a medical, ethical and legal point of view. This is of course very difficult to do. I). Medical considerations The patient should be allowed to pass on if : 1) The patient's condition takes a turn for the worse, even though they are on hemodialysis and peritoneal dialysisis not an option. 2) If the doctor knows the patient to be incurable and that death is imminent and the patient is in ever increasing pain. II). Ethical considerations There must be mutal agreement between the patient's family, the medical staff and an experienced doctor and as well as a knowlegable lawyer before the patient's opinions are considered and any further action is taken. |
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