多死社会における神経内科

抄録

Since palliative care is defined as it is for all ages and all diseases and it should be supplied as a human right, all neurologists are required to provide quality palliative care for various kinds of neurological disorders including stroke, dementia, and motor neuron diseases, etc.

In order to attain the successful palliative care for stroke, what the care team should provide are 1) patient–centered and family–centered approach, 2) to make an effort to prognosticate more accurately, 3) to plan and implement appropriate goals of care, 4) to be familiar with EBM of decision–making at the end–of–life, 5) to assess and manage pains and symptoms, 6) to have experiences with the end–of–life care in stroke, 7) to assist in referring a patients to the palliative care specialist if needed, 8) to be able to provide patients and their families with resource of spiritual care and bereavement care if needed, and 9) to actively engage in quality improvement project.

The Japanese government survey has demonstrated that the dementia patients will increase rapidly up to 9.53 million in 2040, with a 40% increase from 6 million at present. Two key issues in palliative care for dementia patients are artificial nutrition and hydration (ANH) and finding the best place to live at the end–of–life. Clinicians in Japan have recently begun realizing the importance of advance care planning (ACP) as well as the difficulty in implementing the end–of–life conversation effectively.

With a lack of “self-determination act” in Japan, a patient with amyotrophic lateral sclerosis (ALS) with total locked–in state (TLS) who possess an advance directive (AD) mentioning he/she would wish to withdraw from a mechanical ventilator once he/she becomes TLS, cannot be approved legally or socially of withdrawing from the mechanical ventilator. This ethical issue in Japan continues to be discussed among all disciplines nationwide.

Palliative care in a death–ridden society should be regarded as an issue of public health. Thus, medical professionals should educate the community people and collaborate with them to create a compassionate community where all people actively engage in helping and supporting the neighbors.