抄録
I. Terminal Care in Japan, past In the 1970 s, a small number of physicians who had a special interest in palliative care and in hospice care initiated a team approach to the dying patient. In Yodogawa Christian Hospital a team called OCDP (The organized Care of the Dying Patient) began work in 1973. This was the first palliative service in Japan. The year 1977 has a very special meaning in the history of Terminal Care in Japan, because of the fact that (1) The Japanese Association for Clinical Research on Death and Dying (JARD) started, (2) the word, hospice, was introduced to Japanese public for the first time, and (3) hospital death exceeded home death. The first hospice to open was Seirei Hospice in 1981 with 30 beds, followed by Yodogawa Christian Hospital Hospice in 1984 with 23 beds. II. Terminal Care in Japan, present Almost all terminal cancer patients die in the general hospital. However the general hospital is not a good place for the dying patient because of following reasons : 1. Physicians are strongly cure-oriented. 2. It is difficult to establish a good team in the general hospital. 3. It is difficult to provide an appropriate environment for the dying patient in the general hospital. In April 1990,the Japanese Government made a decision to give medical insurance benefits to three hospices and one palliative care center. As of 1992,there are seven government approved hospices. A daily payment of 30,000 yen is designated for each patient regardless of the cost. There is a new tendency that interested physicians and nurses start terminal care meetings in the general hospital. In several university hospitals also terminal care meetings have been started. III. Terminal Care in Japan, future Terminal care in Japan will take the following direction : 1. Increase in the number of hospices and palliative care units. 2. More hospice-minded care in general hospitals. 3. More home care service.
