Hospice Nursing Ethics in Japan

本研究的目的是在特定的物理和哲学背景下增加关于日本护理伦理的知识。研究问题为：(1)日本安宁疗护出现哪些伦理议题？(2)这些与在综合医院照顾绝症患者的JP护士和挪威和丹麦（N&D）的临终关怀护士所面临的伦理问题相比如何？(3)这些发现对日本护理伦理有什么理论和实践意义？我们进行了问卷调查和访谈。共有147名JP安宁疗护护士、147名综合医院护理临终病人的JP安宁疗护护士和106名新及发展区的JP安宁疗护护士完成问卷，并有3名JP安宁疗护护士和14名临终病人参与访谈。通过跨文化比较，可以看出欧洲护理伦理与日本护理伦理在临终关怀方面的异同。安宁疗护护士与安宁疗护医院护士所经历的伦理问题有许多共同点：对末期病人讲真话、治疗问题（如治疗/护理过渡）、以及家属参与病人决策。N&D护士也经历了道德问题，但问题与JP护士不同：姑息与治疗；有尊严地死去；主动/被动安乐死及临床护理中的问题。研究结果表明，在临终关怀中，只有一种护理伦理模式会出现问题。这种模式是在西方发展起来的，这一事实使这些问题变得更加困难。这项研究使护理专业在对普遍伦理的质疑中走得更远，同时又不完全依赖道德相对主义。我们在最近的一章中进一步讨论了道德普遍主义和相对主义：安妮·J·戴维斯，近西惠美子。日本护理伦理学的教学。参见：AJ Davis， V Tudin, L de Raeve（编）：护理伦理学教学要点：观点和方法。巴特沃斯·海涅曼，2005年，爱丁堡（出版中）。少

The purpose of this study was to add knowledge about Japan nursing ethics in a specific physical and philosophical context. The research questions were: (1) What ethical issues arise in hospice nursing in Japan(JP)? (2) How do these compare with ethical issues confronted by a) JP nurses caring for terminally ill patients in general hospitals and b) hospice nurses in Norway and Denmark (N&D)? (3) What theoretical and practice implications do these findings have for Japanese nursing ethics? We conducted questionnaire surveys and interviews. One-hundred-and-forty-seven JP hospice nurses, 147 JP nurses caring for terminally ill patients in general hospitals and 106 hospice nurses in N&D completed the questionnaire, and three JP hospice nurses and 14 terminally ill patients responded to the interviews. A cross-cultural comparison highlighted some differences and similarities between European nursing ethics and Japanese nursing ethics in terminal care. Ethical problems experienced by the JP … More hospice nurses and those experienced by JP hospitals nurses had major commonalities: telling the truth to terminally ill patients, treatment issues such as cure/care transition, and family involvement in the patient decision making. N&D nurses also experienced ethical problems but the issues were different from those experienced by JP nurses: palliation versus treatment; dying with dignity; active/passive euthanasia and issues in clinical caring. The findings suggested the problems emerging from having one model of nursing ethics in end-of-life care. These problems are made more difficult by the fact that this model was developed in the west. This study have brought the nursing profession farther along in the questioning of universal ethics while at the same time not entirely relying on moral relativism. We discussed further on moral universalism and relativism in our recent book chapter: Anne J Davis, Emiko Konshi. The teaching of Nursing Ethics in Japan. In: AJ Davis, V Tudin, L de Raeve (ed): Essentials in teaching and learning in nursing ethics: Perspectives and methods. Butterworth Heinemann, 2005, Edinburgh(in press). Less