This study aimed to clarify the issues and endeavors perceived by advanced practitioners of dementia care regarding support for persons with dementia living at home who take medications. A questionnaire was given to advanced practitioners of dementia care to obtain open-ended responses, and an inductive, qualitative analysis was conducted.

  Perceived issues included 1) problems with medical exams, “The family does not cooperate and the person can’t continue being examined by a specialist“ ; 2) problems with prescriptions, “Appropriate amounts of medicine are not prescribed because insufficient information is communicated to the doctor“ ; 3) problems with taking medications, “Persons with dementia refuse to take medications“ ; and 4) problems with effects and efficacy, “It’s difficult to discover side effect“. In addition, it was notable that endeavors for overcoming issues other than taking medications were seldom described, making it apparent that the dignity and rights of persons with dementia living at home are easily jeopardized.

  This study demonstrates the necessity of adopting measures such as giving support to family that encourages an understanding of the relationship between drug therapy and the ability to make decisions, having professionals share information on drug therapy, and providing an infrastructure for accurately grasping the situation of persons with dementia living at home.

  This study aimed to develop nurses’ spiritual care practices (NSCP) scale for Japanese nurses and investigate its validity and reliability. The subjects of this study were 1058 Japanese nurses. With regard to the validity, the construct validity was investigated using a hypothetical model that assumes four factors : “care as a premise of spiritual care,” “to believe in patients and be with them,” “collaboration with others,” and “care for patients exploring self-existence” as primary factors and spiritual care as a secondary factor. In addition, concurrent validity in relation to moral sensitivity and convergent validity in relation to human care were investigated. Results showed that the construct validity, concurrent validity, and convergent validity were established. In the NSCP, “care for patients exploring self-existence” scored the lowest, indicating that this factor needs to be improved. Therefore, support for nurses’ preparedness to meet the challenges of spiritual care is required.

  Implanting a VAD (Implantable Ventricular Assist Device) is a preliminary procedure for transition to a heart transplant. In Japan, the waiting period for heart transplant is lengthening because of the lack of donor hearts. Patients who receive an implanted VAD frequently require DT (destination therapy) and approach the end-of-life because of complications. Therefore, when performing VAD implants, it is necessary for physicians to explain not only the risks and benefits of the operation and heart transplantation but also the importance of deciding about an approach to the end-of-life stage, prior to obtaining informed consent.

  We conducted an inventory survey of 64 representative authorized institutions and obtained responses from 44 such institutions (68.8% response rate). 17 institutions (38.6%) have established advanced directives regarding the kind of medical care required when performing an implanted VAD procedure. Among the 17 institutions, 12 institutions (70.6%) prepare advances directives before performing an implanted VAD procedure. The decision to determine the terminal phase was made by the physician (14 institutions : 31.8%), the team physician and other health care practitioners (31 institutions : 70.5%), or the hospital ethics committee (12 institutions : 27.3%).

  The findings confirm that appropriate directives for obtaining informed consent and end-of life decisions may be difficult to apply.

  Gestational Surrogacy and uterine transplantation are means that make it possible for women with congenital or acquired uterus loss to have children. Discussions about these methods are focused on how to harmonize the desires of individuals with preservation of the overall social order. In the case of gestational surrogacy, discrepancy from the biological order is large, as compared to other assisted reproductive technologies, and not only the surrogate mother, but also the child that is born, may face unfavorable outcomes, although this technique can satisfy the desire of infertile couples. In the case of uterine transplantation, on the other hand, there are open issues such as appropriateness of removing the intact uterus from a healthy woman, and the acceptability of organ transplantation for the purpose of child delivery rather than for treatment of the client. Both gestational surrogacy and uterine transplantation involve diverse medical, ethical and social issues. Therefore, they should be applied with caution in the clinical setting.

  Bioethical issue concerning prenatal diagnosis, preimplantation genetic diagnosis has been greatly innovated according to recent advances in engineering and medicine. These facts have continued to debate among nations and appeared to more complex arguments. It is still immature to accept genetic diversity of individuals in our society.