Clinical Philosophy in Terminal Care(Symposium Medicine and Nursing)

Abstract

The need of terminal care has been pointed out for a long time, but its practice has not come to be common in clinical work. This is mainly because of the lack of philosophy and methodology of terminal care. To practice terminal care it is indispensable to have a philosophy and methodology of comprehensive medicine based on whole person medicine (Balint, M.), which pursues the possibility of humanistic medical care. In the context of whole-person medicine, the bio-psycho-socio-existential medical model is the basic viewpoint to understand a patient. Furthermore, to perform comprehensive medicine, mutual respect between the current occidental medicine and the traditional oriental medicine with an interface with psychosomatic medicine is essential. Especially to care for a cancer pain patient, this viewpoint is indispensable. The core of psychosomatic medicine is Balint's medical interview, in which a patient is accepted, supported, and assured by a medical professional. In this interview, the medical professional works as a medicine (Balint, M.), that is to say, it is "therapeutic self (Watkins, J. G.). Logotherapy (Frankl, E. V.) is one method of the psychotherapy the main approach of which is to seek after a patient's meaning of life. "Life review interview" (Butler, R.) is one of the concrete methods of logotherapy. Through logotherapy, some cancer patients could gain awareness of their own meaning of life, then overcame cancer, and created their own new life. That is to say, they could live with cancer. The common attitude of such patients is "gentleness and toughness", through the experience of cancer. A nurse always takes care of a patient who is a human being with some disease. In the practice of nursing, a nurse meets many patients and observes many lives, which are living and dying. Nursing is one of the most humanistic occupations.