Abstract
1. Recent views on palliative care
Unlike in the West, palliative care in Japan started in hospitals. About 200 hospices/palliative care wards have been founded in Japan. However, without a culture and history highly valuing hospices like in the West, and in an environment which makes it hard for home-based hospice care to evolve, palliative care in Japan, which started in hospitals, has tended to remain there. In Japan's aging society, in which the rate of death from cancer is ever increasing, hospitals will sooner or later reach capacity, resulting in the emergence of “terminal cancer refugees”. Under these circumstances, the “Cancer Control Act” was enacted in April 2007, stipulating “palliative care for pain shall be available early in the course of an illness as required”, “cooperative systems for providing medical care for cancer at home shall be established”, and “the opportunities for health care providers to receive training in palliative care shall be ensured” to “improve patients' quality of life”. Since 2009, the Ministry of Health, Labour, and Welfare has obliged all regional cancer centers to hold a “palliative care workshop” for about 12 hours over 2 days to “provide basic palliative care education for all cancer care doctors”. However, it is likely to take 5 to 10 years for all cancer care doctors to fully attend the workshop. New efforts to facilitate home-based palliative care and regional cooperation have been led by doctors at clinics and the Japan Medical Association in a number of places, such as Natori-shi in Miyagi Prefecture, Onomichi-shi in Hiroshima Prefecture, and Nagasaki-shi in Nagasaki Prefecture. In Tochigi Prefecture, “Palliative Home Care Tochigi” was founded 2 years ago, and is working to establish a network for regional cooperation.
2.Spiritual pain and “loss simulation”
What do we experience mentally in the course of dying? The mental pain of patients who have realized that they cannot be cured and their days are numbered is beyond the understanding of other people.
Over the course of losing what is important to them and becoming unable to perform various activities, patients are compelled to change their daily lives and ask themselves questions, such as “what is really important?” and “what have I lived for?”, and agonize over them. This is the “spiritual pain” that shakes one's identity to its foundations.
