[TJS1-4] Whose life is it, and who makes the choice between life and death?
【
ライブ配信】
The history of end-of-life care in intensive care medicine settings began in the 1950s with the first use of positive-pressure mechanical ventilators for treatment rather than anesthesia. The 1960s saw the choice by the much-criticized “God Committee” in Seattle regarding which patients should receive dialysis treatment and arguments about the definition of death from the perspective of transplant medicine, and bioethics became an established academic field. In the 1970s, the Karen Quinlan trial led to a rise in interest among the general public concerning the fact that the lives of patients in a vegetative state were being maintained mechanically, and in the same decade, the Japan Euthanasia Association was founded. In 1974, the Journal of the American Medical Association published ‘Orders not to resuscitate,’ and in 1976, the New England Journal of Medicine published a report on the four systems of optimum care for hopelessly ill patients in Massachusetts General Hospital. The term “terminal weaning” was introduced in 1983 in Critical Care Medicine. The period between 1990 and 2000 saw the publication of numerous studies on end-of-life care in the ICU, and in 2003, an International Consensus Conference involving the European Society of Intensive Care Medicine, the American Thoracic Society, and the Society of Critical Care Medicine was held on the theme ‘Challenges in end-of-life care in the ICU.’ This brought to light differences between the end-of-life care provided in ICUs in Europe and the United States. In Japan, in 2007, the Ministry of Health, Labour and Welfare issued ‘Guidelines’ in 2012, a cross-party group of legislators proposed a law on dying with dignity. In 2014, the Japanese Circulation Society, the Japanese Association for Acute Medicine, and our own society jointly published ‘Guidelines on End-of Life Care in Acute and Intensive Care,’ and in combination with the increasing aging of the population, more opportunities arose for members of the public to consider or become interested in the issue of life-extending treatment. In other countries, however, laws have been passed on dying with dignity and assisted suicide, and fierce debate is underway within the countries and states where such laws are in effect. The reality is that this is still a troubling issue in ICU settings. The problems that arise in everyday clinical practice relate not only to the legal issue of whether doctors might face criminal prosecution and issues of the distribution of medical resources, but also to the ethical issues of the right of patients to make their own decisions and respect for dignity and way of life, and extend further to the philosophical question of the nature of life and death itself. I intend to compare Western mind–body dualism with Oriental mind–body unity in the context of the historical background and end-of-life care in other countries, and to discuss life and death with intensivists in Thailand.