A Cultural Anatomy of the World of Terminal Care

Modern medicine in Jappan was never interested in taking care of terminally ill patients in hospitals until the practice of the terminal care such as "hospice movement" began in 1980s. Instead most doctors and nurses performed futile CPR (cardiopulmonary resuscitation) for patients with cardiac arrests and patient suffering from the incurable cancer. However. today many health care professionals recognize the necessity of the terminal care. This paper aims to examine the way in which the world of terminal care is embodied in Japan. and consider the issues of this world from different viewpoints. First. three cases are introduced for discussion: The first describes how a paternalistic doctor-patient relationship led a surgeon to take no terminal care of his patient whose cancer has recurred. The second describes how a doctor succeeded in forming a sense of "immortality" in the mind of a terminally ill patient by satisfying her last hope. And. the third case takes up a story of spiritual care in which the life of a young man suffering from cancer was saved by a priest who was his roommate in the surgical ward. "Immortality" here refers to the realization by the dying person that they somehow continue to exist through someone or something such as their sons and daughters. inventions and works. and belief in life after death. The three case studies show that not only the staff in the palliative care unit. but also health care professionals working in a general ward are able to bring about an ideal terminal care, only if both medical staff and patients can communicate very well and sympathize each other. Terminal care depends on the relations between them. Secondly, two more cases are taken up: that of a 67 year-old man who was severely "mentally retarded", and a four day-old baby "disabled" due to a chromosome anomaly. Through these case studies, I compared the view of "S.O.L. (sanctity of life) ethic" and that of "Q.O.L. (quality of life) ethic". The former emphasizes that every life has equal and sacred value, while the latter focuses on the fact that the value of each life is different, and that it is ethical to consider that the lives valued lowest such as "brain-dead" or "persistent vegetative" patients need not necessarily be protected any more. They are controversial in the recent context of the terminal care. The SOL ethic is a traditional view of "life and death" that Buddhism and other religions have historically upheld in their precepts and commandments. The position supporting the euthanasia and "death with dignity," which is a kind of passive euthanasia, is a sort of Q.O.L. ethics. Thirdly, the difference between at-home care and the care in the hospital was compared. Although large-scale medical treatment cannot be conducted in at-home care, it has the advantage of ensuring individual privacy easily, having a freer hand, and living a more convenient life at home. A hospital, however, is not the place where the patient and family can really exchange farewell with each other. At-home care is expected to become the dominant alternative way of terminal care in Japan, because not only family members and relatives but also friends and volunteer are able to participate more easily in terminal care. Finally, the question of what the original terminal care should be was discussed. It might cope with various types of deaths, which are not necessarily those of "well-conditioned" terminally ill patients with incurable cancer in the palliative care hospital. Terminal caretakers need not necessarily be so-called specialists of terminal care such as medical professionals in palliative care unit. Rather people closer to the dying. Such as family members and friends who gather by the bedside of the dying person to send him/her off, are more desirable