健康な中・高齢者における心肺蘇生法に関する意思決定について  [in Japanese] An analysis of CPR decision-making by middle-aged and elderly healthy people in Japan  [in Japanese]

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Abstract

高齢化社会を迎えつつある現在、医療現場における高齢者の治療法決定への参加のあり方は、早急に検討するべき課題となっている。本研究では、心肺蘇生法(CPR)を取り上げ、寿命があと2、3ヵ月の末期癌の入院患者において、CPR施行の決定者、CPR施行の希望、患者本人の意向と家族や周囲の者の意見が異なった際の対応等について、中・高齢者(50歳以上)を対象に面接による意識調査を行い、CPR施行について意思決定の過程を考察した。調査は1999年5月〜6月に都内A寺において行われ、110名より有効回答が得られた。解析の結果、患者自身による治療法決定の考え方(自己決定)が中・高齢者の間に浸透していることが明らかになり、CPR施行を希望しないという回答者が多数を占めた。また、決定者間で意見に不一致が見られた場合には、必ずしも患者本人の意向を優先しなくてもよいとする傾向や、おかれた状況が患者本人か家族であるかによって、回答内容が変化する傾向も明らかになった。

Because the concept of informed consent gradually prevails in Japan, patient participation in decision-making, especially for elderly people, has become a compelling issue for bioethics discussion. At the core of the discussion are their lowly estimated decision-making capacity and traditional values such as respect for the elderly and the family's expected role for them. To investigate the attitude for CPR (cardio-pulmonary resuscitation) and the decision-making process, 110 middle-aged and elderly healthy people [range of age : 50-90] were interviewed in the precinct of one famous temple in Tokyo from May to June of 1999. A fictitious situation was set where a cancer patient with a prognosis of survival of a few months is about to discuss future implementation of CPR with family and medical staff members. Two scenarios were presented. The first is that the cancer patient is one of the subject's family members, and the second is that the patient is the subject themself. Subjects were asked 1) who should decide whether or not to do CPR; 2) if they prefer to receive CPR; 3) what to do when surrounding people (family and medical staff members) had different but reasonable opinions. They were required to respond to both scenarios and to give reasons for their answers. This interview was performed with detailed explanation of the CPR procedure, which would facilitate the subjects' understanding of CPR and increase the quality of the data. More than 60% of the subjects answered that they would decide by themselves and would prefer not to receive CPR. However, the subjects would not insist upon their own choice when surrounding people have different but reasonable opinions. Moreover, the subjects dramatically changed their opinions between the two scenarios. It has been demonstrated that the concept of patient's self-determination has now been accepted by middle-aged and elderly healthy people in Japan. However, the results also indicate that traditional values implicitly underlie their preference of self-determination. Future studies targeting actual patients are needed. (324 words)

Journal

  • Bioethics

    Bioethics 10(1), 111-119, 2000

    Japan Association for Bioethics

References:  16

Cited by:  3

Codes

  • NII Article ID (NAID)
    110002276937
  • NII NACSIS-CAT ID (NCID)
    AN10355291
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    1343-4063
  • Data Source
    CJP  CJPref  NII-ELS  J-STAGE 
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