In ethics consultations, it is difficult to formulate an ethical reasoning process. Being able to widely share the reasoning process of individual cases is an essential activity for its progress ; as such, this paper seeks to participate in this activity. This paper describes and analyzes the written requests and responses of 15 consultations (July 2017 to June 2019) conducted by the ethics consultation team of Tohoku University Hospital. The reasoning process was mainly based on the “principle” approach, with most cases involving difficulties in applying, comparing, and contrasting principles due to the patient’s limited decisional capacity, a lack of relatives, and disagreements between the patient, their family members, and medical professionals. There were even cases in which the assessment of the decisional capacity and the consideration of the appropriateness of medical care led to proposals that differed from the patient’s preference. Although the reasoning process in this consultation was generally consistent with the views of previous studies, it is important to have an opportunity to examine each case to see if appropriate reasoning is being performed.

  This study aimed to clarify the coping methods for the dilemma and ambiguity of nurses considering treatment and care policies for end-stage renal disease (ESRD) patients on maintenance hemodialysis. Semi-structured interviews were conducted with nine nurses working in a dialysis department, regarding the cases in which they experienced dilemma and ambiguity while providing care to ESRD patients on maintenance hemodialysis, and how they dealt with it. The interviews were transcribed and the contents analyzed. The following coping methods, adopted by the nurses, were identified : [Confronting patients’ true feelings], [Promoting common understanding among patients, their families, and doctors], [Collaborating with doctors, despite conflicting beliefs, to ensure a better life for the patients], [Have a thorough dialog between medical professionals and care workers], [Observing the patients’ physical condition carefully to determine dialysis withdrawal], and [Settling with the terminal medical care system]. Nurses need to discuss ways to ensure a better quality of death―for ESRD patients on maintenance hemodialysis―with doctors and other healthcare professionals, and collaborate with them.

  Nanto Municipal Hospital, a small/medium-sized hospital in Nanto City, Toyama Prefecture, launched a clinical ethics committee and an ethics consultation team in 2015. The committee is attended by the experts in philosophy/ethics and law, who regularly give lectures on ethics issues. An ethics consultation team is composed of a multidisciplinary member and holds a meeting within two days of receiving a request. After the meeting, not only the members’comments but also a summarized recommendation are returned to the client. From 2019, we have also trained in-hospital clinical ethics advisors so that ethics issues can be discussed on a daily basis at various sites by the leadership of those advisers. The ethics conferences are regularly hold mainly on a ward basis, and if the case is difficult to be resolved by the conferences, the case is re-examined by the ethic consultation, which system might be useful for fostering clinical ethics throughout the hospital. In this paper, we summarize the experience of establishment and activation of clinical ethics in our hospital, hoping that it will be helpful for hospitals and facilities that are considering promoting clinical ethics in the future.

  In this study, an anonymous self-administered questionnaire survey was conducted among nurses with at least 2 years of experience working in emergency medicine at 289 designated emergency hospitals nationwide, with the aim of clarifying the ethical issues and characteristics of nurses working in emergency medicine for elderly patients with dementia. As a result, we received responses from 240 individuals. Regarding the acceptance frequency of elderly dementia patients, 154 individuals chose “always accept these patients”. Regarding the difficulty level of coping with dementia patients, 142 individuals chose “often find it difficult”, while 63 individuals chose “sometimes find it difficult”. In emergency medical care, more than 90% of all hospitals accept elderly patients with dementia. However, 96% of nurses found it difficult to cope with dementia patients due to the difficulty they have making decisions as a result of their reduced judgment ability and preconceptions that elderly patients with dementia patients engage in problematic behaviors. “Dignity and rights”, “The right of self-determination”, and “Ensuring safety”, specifically, the ethical issues of physical restraint, the attitudes of medical professionals, and support for decision-making have become clear, so the issue is to create a manual of responses based on this content.