2011 年 1 巻 p. 22-31
Advance care planning (ACP) is a process aimed at extending the rights of competent patients to guide their medical care through periods of decisional incapacity. The process involves three steps: (1) thinking through one's values and preferences, (2) talking about one's values and preferences with others, and (3) documenting them. Advance directives usually are the written documents that provide information about the patient's wishes and/or her designated spokesperson. Verbal directives may be ethically valid, but most patients and health care providers prefer written documentation in the form of official forms. Advance directives will not always be the outcome of most advance care planning. At a minimum patient should become familiar with the concept and rationale for advance care planning. Some patients will want to mull things over, others will want to discuss the topic with their close friends or family and health care providers. Fewer will be ready to sign documents and even fewer will be interested in personalizing their advance directives so that they are clear and contain pertinent information with clinical relevance.
In this report, we examine a system about the usage of advance directives as ACP. And also, we consider how to construct the clinical ethics consultation, which support health care providers who face ethical dilemmas in clinical settings.
From the following two viewpoints;
1. Conceptual discussion about advance directives from literatures.
2. Practical discussion that assumed a pilot study about advance directives as ACP, which we perform through the clinical ethics consultation (clinic ethics support) that a reporter practice now in Miyazaki prefecture.