死の臨床(ライフサイクルと心身症)

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On the clinical aspects of dying patients, we tried to review the history, the present status and the problems, roles and importance of hospices, factors to determine the clinical aspects of death, the relationship with psychosomatic medicine, quality control and assurance, etc. Based on life cycle, the problems of terminal care and medical practice for elderly patients are discussed. (1) In our country, main stream of the terminal medical case is based on the principle to provide the patients with longer life, and the terminal care in hospices is not yet widely developed or propagated .(2) The hospices in Japan, which have been developed under strong influence of hospice movement in Europe and America, are mostly based on palliative care, concentrating on physical care and reflecting cultural and social features of Japan. (3) There are a number of problems in hospice care, including the approach of how to introduce the technical progress in medicine into medical practice. (4) There are many problems related to mental stress. Essentially speaking, the whole person of each patient must be taken into account in the terminal care, and the clinical study of death is closely related to psychosomatic medicine. (5) In the clinical study of death, there are many difficult problems such as the bioethical problem, the problem of informed consent, euthanasia, issues of medical economics, etc. (6) In the clinical study of death, quality control and quality assurance are imporant, and these are the problems to be solved in future. (7) In the problems of life cycle and clinical medicine of death, the death of a patient is involved in the problem specific to his (or her) own generation. For the patient up to middle age, grief care for the bereaved family is more important, while it is more essential for the older patient how to end his (or her) own life.(8) In the clinical care of the older patients, it is essential to maintain the life up to death in comfortable way and to provide assistance to terminate the life in more delicate and dignified manner so that the patient may encounter sound death, the better death, and spiritually elevated death. Musical therapy is useful, and spiritual care is important for this purpose. (9) A patient cannot die in a manner different from the way, in which he (or she) has been living. A patient can be cared only in the same manner as he (or she) has been living. A patient can be cared only in a manner suitable for his (or her) own personaiity.
日本心身医学会の論文
1994-03-01

死の臨床(ライフサイクルと心身症)

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