In Japan, home death has decreased due to urbanization and nuclear familization, and since 1976, the rate of hospital death continues to exceed that of home death. As the rate of hospital death has now reached approximately 80%, improvement of the care of end-of-life patients is an issue even in acute care hospitals. In the nursing records of one acute care hospital, Juntendo University Hospital, the Japanese expression “Minookidokoroganai” is often used to refer to patient-specific-distress at the end of the term of life. In this paper, we report the electronic medical record of one patient who was nursed during the final moments of life at Juntendo University Hospital, and examine the circumstances of the assessment of “Minookidokoroganai”. As a result of the examination, when the nurses judged that the distress peculiar to the terminal-end patient was not sufficiently alleviating the symptoms in the ongoing treatment, the nurses used the Japanese expression “Minookidokoroganai” meaning that the medical team should quickly diagnose the cause of the pain and expand the range of treatments. In such a context, we consider the appropriate modality in the context of Ethics.

  This survey aimed to assess the state of implementation of clinical ethics case conferences by visiting nurse station managers and their needs for support. The participants were managers from 1,500 visiting nurse stations nationwide. Valid responses were obtained from 393 managers. The survey period was from November to December in 2019. The questionnaire included the following items : recognition and practice of the role of the clinical ethics consultant, feelings of burden, desire for online consultation with supportive specialists at the case conference, and desired systematic support. The results showed that the managers were aware of their role as a clinical ethics consultant, but not many of them practiced this role, with most of them finding it a burden. The managers wanted support from specialized nurses and experts in the health care and welfare system. They had concerns about the online consultation system, in view of breach in confidentiality, information leakage, and the reliability of consultation without in-person conversation.

  Disruptive behaviors in medical sitting are taken sufficient measures in the US as serious threats to patient safety. Meanwhile, in Japan, we have not recognized accurately disruptive behaviors yet. Therefore, this study elucidated the nature of disruptive behaviors in Japanese medical sitting and adverse effects on medical staff’s adaptation and patient safety. The questionnaire of disruptive behaviors in a medical setting was conducted for Japanese nurses. The categorical factor analysis identified spiteful disruptive behaviors such as instructive harassment and covert denigrating, and barefaced disruptive behaviors such as overt rejection and direct browbeating. The former made victims’ psychological and social adaptation worse, the latter was a menace to patient safety. Ultimately, countermeasures for 2 types of disruptive behaviors were discussed.

  In the case of tuberculosis, the treatment goals of patient survival and greater public health occasionally conflict with patient autonomy, so the ethical validity of the said treatment becomes questionable. This paper reports the case of an aged tuberculosis patient who was discussed during an ethics consultation.

  A 95-year-old man was admitted to the hospital for the treatment of active tuberculosis. He had dysphagia and was bedridden before admission ; it became impossible for him to take medicine orally. While the attending staff considered continuing his treatment with a nasogastric tube to let him return to a care facility familiar to him, he wished to not take curative treatment anymore but died naturally. Ethics consultation was provided for this case. After consultation, the staff, including the ethics consultants, felt it unwise to abandon curative treatment because of the issue of public health. The case was brought to the Committee for Examination of Infectious Diseases, which concluded that palliative care should be administered rather than curative treatment.

  The main treatment for tuberculosis is oral medication, and its purpose is rehabilitation. However, this is not suitable as palliative care for patients at the end of life. Here, the ethical challenges need to be recognized and tackled so that transparent, consistent, and ethically acceptable decisions are made.