Development of an all-purpose life and medical ethics advisory program usable at community hospitals

当地社区解决问题的能力未能赶上先进研究机构和高科技医疗设施的技术创新，明显表现在临终病人的代理决策和临终关怀方面的混乱。在这项研究中，我首先讨论了临终关怀问题，这是一个涉及医疗工作者和福利工作者的伦理问题。我在兵库县所有的特殊养老院进行了问卷调查，澄清了工作人员意识到对临终关怀的需求不断增加，并愿意接受高度医疗元素的护理。然而，调查也澄清了这些活动缺乏系统的支持，缺乏可靠的行动指南，以及在这种情况下感到紧张和无助的感觉正在给工作人员带来负担。当我由于道德困境而在继续治疗和护理方面遇到困难时，我可能希望通过法律或规则进行监管。然而，这种法律家长主义不可避免地会带来官僚主义的弊端，即通过法律规则直接管理。我通过比较一般的医疗保健，包括设施和精神护理，阐明了这一点。然后，我评估了由组织外成员进行的伦理咨询系统，作为一种解决问题的模式，以帮助在医学、卫生保健和福利领域所需的各种伦理判断。在临终病人的护理中经常出现两难境地，一个不依赖法律规则进行干预以解决这些问题的支持系统对于防止工作人员精疲力竭和工作倦怠是不可或缺的。

Failure of the problem-solving ability of local communities to catch up with technical innovations at advanced research organizations and high-tech medical facilities is clearly manifested in the confusion concerning surrogate decision-making for dying patients and terminal care. The establishment of a system that provides ethical advice concerning these problems to medical workers at the clinical front line is urgently needed.In this study, I first addressed terminal care, which is regarded as an issue involving both medical and welfare workers, among ethical problems. I performed a questionnaire survey at all special elderly care homes in Hyogo Prefecture, and clarified that staff members were aware of increasing needs for terminal care and were willing to take on care with highly medical elements. However, the survey also clarified that such activities lack systematic support, that reliable guidelines for actions were deficient, and that feelings of tension and helplessness felt under such circumstances are burdening the staff.I next attempted to reconstitute ethical problems in relation to legal regulations. When I face difficulty in continuing treatment and care due to an ethical dilemma, I may wish for regulation through laws or rules. However, evils of bureaucracy are unavoidable by such legal paternalism, i.e., direct management by legal rules. I clarified this point by comparing medical care in general including facility and mental care.I then evaluated an ethical consultation system by out-of-organization members as a problem-solving model to help with various ethical judgments required in the fields of medicine, health care, and welfare. Dilemmas constantly occur in the care of dying patients, and a support system that intervenes for their resolution not dependent on legal rules is indispensable for the prevention of staff exhaustion and burnout.