| 特集名 | 超高齢化時代の透析看護 | |
|---|---|---|
| 題名 | 超高齢患者の透析導入・非導入・中止 | |
| 発刊年月 | 2000年 10月 | |
| 著者 | 大平 整爾 | 日鋼記念病院外科・腎センター |
| 【 要旨 】 | 透析療法の導入・非導入・中止の可否は基盤となる患者の自己決定権を尊重し，患者の意思が最優先されるべきである．高齢者・超高齢者は腎不全以外にも種々の合併症と主要臓器機能低下をもつ可能性が高いが，個人格差も大である．その施行には困難を伴う場合が少なくないが，暦年齢のみで透析開始の可否は判定しえない．人は「生きる権利」とともに，「死する権利」を有するものである． しかし，後者が時として「死する義務」とされる懸念があり，これは内発的義務であるべきであり外発的義務であってはならない． 医学的適応条件に適合することのほかに本人が療法を受容し，かつ，療法開始後にADLやQOLの向上を十分に望みうる状況下では，超高齢者といえども，療法の開始は躊躇されるべきではない．事前指示(書)の存在が望ましく，今後これを残す人が増えるであろうが，当分は代理判断を要する情況は続くと予想される． |
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| Theme | Degree of Dialysis Nursing Care for Old-old Population is Growing Rapidly | |
|---|---|---|
| Title | Dialysis therapy for old-old patients Initiation, non-initiation and discontinuation | |
| Author | Seiji Ohira | Department of Surgery, Kidney Center, Nikko Memorial Hospital |
| [ Summary ] | Initiation, non-initiation and discontinuation of dialysis therapy should be determined with respect for the patient's will (right of self-determination). It is true that old and old-old people are apt to show multiple comorbidities and dysfunction of vital organs, but there exist large individual differences. Performing dialysis for the senile is often accompanied by difficulties, however, one cannot judge only by calendar-age whether or not the patient should undergo dialysis therapy. One has the right to live and also the right to die. But the latter sometimes becomes the duty to die. "The duty to die" if it comes from self-determination, it must be autonomous and not be forced. The senile should be unhesitantly referred to dialysis therapy if there are proper medical indications, his/her own acceptance and expectation of improving ADL and QOL. The existence of an advance directive is hoped for, and the number of persons preparing them will increase in the near future. But until that time, we will be unable to shirk situations necessitating surrogate decisions. |
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