臨牀透析 Vol.21 No.4(9)


特集名 末期腎不全患者の悪性腫瘍
題名 透析患者の悪性腫瘍:生前の意思と透析中止
発刊年月 2005年 04月
著者 岡田 一義 日本大学医学部内科学講座腎臓内分泌内科部門
【 要旨 】 悪性腫瘍の終末期患者に心から接し,人間としての尊厳を保ちながら患者が本当に望んでいる治療やケアを行うことが重要である.日本では事前指定書による尊厳死は法的に認められておらず,判断能力があり意思表示できる悪性腫瘍を合併した終末期維持透析患者が透析中止を望んだ場合,すべての情報を理解したうえで,死を受容し,自らの価値観に基づいた透析中止の決定は,他者に害を与えないかぎり,最大限に尊重されるべきであり,あらゆる努力が行われたうえで,なおかつ,ほかの手段が残されていない場合は,医師は透析中止を患者/家族の同意のもとで受け入れるべきであろう.医師は終末期患者/家族の気持ちを理解したうえで医療やケアを提供し,患者によい最期の生き方/よい死の迎え方をさせる義務がある.
Theme Malignant neoplasms after renal transplantation
Title Malignant tumors in dialysis patients : living wills and discontinuation of dialysis
Author Kazuyoshi Okada Division of Nephrology and Endocrinology, Department of Medicine, Nihon Univeisity School of Medicine
[ Summary ] For terminally ill patients with malignant tumors, it is important that they be fully cared for to provide the treatment and medical care which the patients really wish for while preserving their human dignity. In Japan, advance directives for death with dignity are illegal. Therefore, if a terminal patient with complications from malignant tumors who is receiving maintenance dialysis should request to discontinue dialysis, the patient's decision to stop dialysis must be made on the basis the patient's own choice, understanding all information and being ready to accept death. This wish should be respected to the utmost, unless it harms others. Additionally, if no other way is available after all efforts are taken, the physician should allow discontinuation of dialysis with the families's consent. Physicians are obligated to serve patients by providing medical treatment and care with full understanding of how and what the patient and his or her family members feel, allowing the patient to accept the end of their life and providing a good death.
戻る