透析医への意識調査 : 維持血液透析患者の悪性腫瘍終末期における透析中止について Questionnaire to nephrologists : Withdrawal from hemodialysis in a patient in the terminal stage of malignancy

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本邦では, 透析患者の終末期において, 血液透析 (HD) が安定して施行できている患者の自己決定を尊重し, HDを中止することについての生命倫理学的研究は殆どない. 今回, われわれは, 透析医 (552名) を対象として, 安定したHDを受けている悪性腫瘍終末期症例を提示し, いくつかのシナリオに対して, HDを中止するか, 継続するかの意識調査と, advance directives (AD), 尊厳死, 尊厳生についてどのように考えているかの意識調査を全国的規模で行った.<br>434名 (78.6%) から回答が得られたが, 有効回答は427名 (77.4%) であった. ADおよび尊厳死が法的に認められていない現状において, ADの有無で比較すると, (1) 家族がHD中止を申し出た場合, (2) 家族がHD継続を申し出た場合とも, ADがあるとHDを中止する回答は有意に増加した ((1) 48.0%→78.9%, (2) 0.2%→2.6%). さらに延命療法を中止しても法的責任は問われないと仮定すると, ADがあるとさらにHDを中止する回答は増加した ((1) 90.9%, (2) 11.9%). ADと尊厳死を必要であると回答した透析医はそれぞれ74.0%, 83.1%であったが, 法制化も必要と回答した透析医は56.4%, 63.7%に減少した. 尊厳死と尊厳生の比較では, 尊厳生を支持する透析医は, 尊厳死を支持する透析医よりも多かった (47.1%, 15.9%).<br>今回の結果は, 現状でも, 透析医および家族が患者の自己決定を尊重すると, ADによる尊厳死が行われる可能性があることを示唆し, 多くの透析医がADや尊厳死を必要と考えている. 一方, 尊厳生は人間にとって非常に大切なことであり, 尊厳死よりもこの言葉を支持する透析医が多かったと考える. すべての国民は個人として生きる権利を認められており, 本邦では, 終末期にも自分が考える尊厳ある生き方を貫くということから始め, 家族および社会が納得する範囲で, 先ず尊厳生によるADが自己決定のために重要であると認識させる努力をすべきである.

Very little has been reported in Japan about research into bioethics with respect for the patient's self-determination in withdrawing from stable hemodialysis (HD) treatment during the terminal stage of illness. We, therefore, conducted a survey among nephrologists (n=552) regarding their decisions whether to stop or continue HD for patients in the terminal stage of malignancy. We also surveyed their opinions about advance directive (AD), death with dignity and life with dignity.<br>Overall, 434 nephrologists (78.6%) returned questionnaires, and effective responses were obtained from 427 (77.4%). Currently AD and death with dignity are not legally permissable in Japan. When the patient has an AD, the number of nephrologists who answered that they would stop HD significantly increased in cases of family request to stop HD (48.0% vs. 78.9%) or to continue HD (0.2% vs. 2.6%). When it was assumed that stopping life-sustaining treatment was not legally prohibited and the patient has an AD, the number of responses indicating to stop HD further increased in cases of family request to stop HD (90.9%) or to continue HD (11.9%). The number of nephrologists who answered that they need an AD totalled 74.0% and those who believed in death with dignity totalled 83.1%, while the number of nephrologists who desired legislation regarding AD (56.4%) and death with dignity (63.7%) decreased. In a comparison of death with dignity and life with dignity, the number of nephrologists who support life with dignity (47.1%) was greater than that supporting death with dignity (15.9%).<br>Our results suggested that death with dignity may be performed when there is an AD and both the nephrologist and the family respect the patient's self-determination. Furthermore, many nephrologists consider that either AD or death with dignity is required. While, it is supposed that life with dignity is very important for human being, nephrologists were more supportive of life with dignity than death with dignity. Since the right-to-life of all Japanese citizens is guaranteed by the Constitution of Japan, we can start to live with dignity at the terminal stage. Thus, we should recognize that AD for life with dignity is the most important for self-determination within the social consensus.

収録刊行物

  • 日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy

    日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 36(8), 1315-1326, 2003-08-28

    一般社団法人 日本透析医学会

参考文献:  10件中 1-10件 を表示

被引用文献:  5件中 1-5件 を表示

各種コード

  • NII論文ID(NAID)
    10011598128
  • NII書誌ID(NCID)
    AN10432053
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    13403451
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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