Japan Society for Dying with Dignity Newsletter No. …...1 Excerpts from Japan Society for Dying...
Transcript of Japan Society for Dying with Dignity Newsletter No. …...1 Excerpts from Japan Society for Dying...
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Excerpts from
Japan Society for Dying with Dignity Newsletter No. 171, October 1, 2018
Main Contents:
LW Facilitator Training Workshop Session #2 Report ------------------- 1
LW Study Workshop Session #7 -------------------------------------------- 4
LW Supporting Physician System Prospect --------------------------------6
Learning the fundamentals of terminal stage and end of life theme and
exchanging opinions
The two day training workshop was held on July 15-16 in Takeo City, Saga Prefecture. About
60 attendees openly exchanged their opinions. Dr. Satoru Mitsuoka, the President of Saga
Chapter and Director of JSDD headquarters, and Mr. Yutaka Shirahige, the President of
Nagasaki Chapter, organized this session as well as the previous session.
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Pictures:
Front: participants attentively
listening to a group presentation.
Left: Dr. Koichiro Itai explaining his
presentation.
The purpose of this training
workshop was to accomplish the
following:
1) deepen one’s knowledge and
understanding of the LW by sharing
new information regarding support for self-determination and enlighten and promote the concept
of LW as a helper or an assistant;
2) learn optimal techniques to enlighten and promote the concept of the LW through various
activities;
3) learn more about the sense of happiness and the perception of life and death which one must
always remember when talking about the final stage of life;
4) experience the development of consensus through diversity and dialogue.
This workshop was held in a unique dormitory-like environment to induce an intimate and
friendly atmosphere which facilitates the participants to work closely together as a team and
openly exchange opinions. This method of training seemed to work well, as reflected in the
number of participants from the previous session coming back for this training. About half of
the 60 participants were medical doctors who support their local community medical care, and
the rest consisted of nurses, pharmacists, health care managers, lawyers and Buddhist priests.
Day One
Table talk and workshop
1) The current status of support on self-determination (Mr. Yutaka Shirahige, President of
Nagasaki Chapter)
2) How to proceed with the support of self-determination and how to speak to an audience to
leave a powerful impression (Dr. Koichiro Itai, Professor from Miyazaki University School of
Medicine)
3) Effective ways to lecture with the purpose of promoting the concept of the LW (Dr. Kazuhiro
Nagao, Vice President of JSDD)
4) Workshop “Adventure trip to death” (Dr. Satoru Mitsuoka, Director of JSDD)
Day Two
Group Work
1) Effective ways to communicate the concepts of the LW and ACP (advance care planning)
2) How to support decision making for patients who are unable to express their wishes
Lecturing techniques that will draw the audience’s attention
On day one in his lecture, Mr. Shirahige explained in detail the fundamental facts regarding the
LW, AD (advance directive) and ACP (advance care planning) and guidelines by the ministry of
health, labor and welfare. He then put them in perspective by describing how they were used in
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an actual medical setting. The fact that he used a wide range of views and perspectives was very
well understood by the audience.
The next lecture was by Dr. Itai, who discussed the topic of clinical ethics. It is not an easy topic,
but a very delicate one. Nonetheless, his explanation was easy to understand as he used real
examples that could easy occur in your everyday life. He emphasized that this is an area in
which the relationship between the healthcare providers and the patients (and their families) must
deepen in order to become the core of the patients’ self-determination. Dr. Itai’s ability to talk
about a very serious topic nonchalantly was an attractive technique in gravitating his audience.
Dr. Nagao emphasized three key points of a successful lecture: 1) keep a consistent, upbeat
rhythm or tempo 2) pass on your true experience directly to your audience without adding any
fluff and 3) tell a story that captures your audience. He said that from his experience of traveling
all over the country lecturing different audiences, he learned that to draw the attention of an
audience, it helps a lot to catch them by surprise, find something they can relate to, and use some
trendy expressions and topics from time to time.
The last part of day one was Dr. Mitsuoka’s lecture and workshop reviewing the importance of
the topics, terminal medical care, end of life ethics, self-determination and the living will.
Workshops in general tend to increase partial knowledge rather than comprehensive one, and are
often limited to theories which can be unpractical. This workshop on the contrary, focused on
the general theme of “end of life,” and urged participants to include feelings and sensations
through sharing their own experiences which made it highly valuable and unobtainable by any
other means.
To benefit many
others... The group exercise on
day two started with the
group divided into teams
of six, three males and
three females in each
with different
professional backgrounds.
Through open
discussions, they came
up with very valuable
and interesting exchange of opinions and consensus formation.
When we have discussions with people with similar backgrounds and occupations, we tend to
reach similar conclusions; however, when we group together people of very different
backgrounds for discussions, especially when the topic benefits many others, interesting ideas
arise. It was quite interesting to watch the process of people of different professions brainstorm
their academic and integral proposals, one after another. We realized that our learning became
much deeper and more profound as we listened and exchanged our respective knowledge and
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expertise among the professionals, as opposed to relying solely on your own knowledge. It was
quite an invaluable event which was well worth the time and money.
When I asked a doctor who attended the event if he would come back next year, he said,
“Absolutely. I’ll bring our young staff from the hospital next year.”
Reported by Ms. Masako Eto (JSDD Public Relations and Projects)
Learning the fundamentals of terminal stage and end of life theme and
exchanging opinions
Palliative sedation:
Is it necessary to eliminate terminal stage pain and suffering?
Picture: Endless questions during the panel discussion
The 7th
session of Living Will Study Workshop was held on June 23rd
at Tokyo University Ito
International Research Center with an audience of about 400 people. The hall was full, and some
people were standing with enthusiasm to watch and listen to the topic being discussed,
“Palliative Sedation: Is it necessary to eliminate terminal stage pain and suffering?”
The first topic was introduced by JSDD President, Dr. Soichiro Iwao. He stated that palliative
sedation is a legitimate medical treatment to alleviate the pain of terminal cancer patients, but
possibly because of its association with death, it’s a topic people avoid to discuss openly. It is
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time to make it an open topic, not a taboo. This topic was selected for today’s session because it
is in demand to be the topic of discussion.
JSDD Director, Dr. Satoru Mitsuoka who also owns a clinic in Saga city, presided as the
facilitator during the speech session and panel discussion as he did previously.
The first speech titled, “The definition of sedation and introduction of two sick condition cases”
was discussed by Dr. Tatsuya Morita who explained that the definition of sedation is to alleviate
pain by reducing the level of consciousness when there is no alternative, and emphasized that
this is the very last resort in this situation.
Participation by Cancer Surviving Family Support Group members The next speech was by Professor Kaoruko Aida of Tokyo University, who talked about her
experiences when she was attending Harvard University School of Medicine on a fellowship
program in medical ethics. She discussed the reasons behind allowing sedation and where the
line is drawn between sedation and death with dignity. Later, Dr. Akio Yamazaki of Care Town
Kodaira Clinic in Tokyo joined the discussion and introduced some real cases.
The second part was the panel discussion. JSDD Vice President, Dr. Nagao, talked about the
following topics below while showing videos, joined by Mr. Sadahiko Nakano representing a
cancer survivor family support group called the “Blue Sky Organization:” 1) Criteria for
deciding whether or not sedation is necessary using example cases; 2) Differences in the
effectiveness of sedation depending on the facility the medical care is being provided; 3) How to
measure levels of pain and determine what is considered “unbearable” pain; 4) The meaning of
wishing to die in their sleep, etc.
Picture: A full, attentive audience. Many were seen taking copious notes.
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“Three months have passed since I personally experienced unforgettable,
powerful emotions, and now peaceful time is elapsing.”
Three months have passed since my training experience in the Kubler-Ross workshop (reported
in the last newsletter #170 published in July). On August 5th
, FRIENDS’ Meeting was held in
Saitama Prefecture. Those who participated in the Kubler-Ross workshop are calling themselves
FRIENDS, and are meeting several times a year for the purpose of refreshing their dialogue
between them and the workshop staff, in a forum called the FRIENDS’ Meeting. Since I was
interested in this reunion with people I met during the last workshop session to see how they
changed in terms of mental and physical conditions, I decided to participate in this meeting.
Three “FRIENDS” who recently participated in the May workshop were introduced to nine other
FRIENDS over lunch, which created an amicable and friendly atmosphere to start the meeting.
The scope of FRIENDS’ activities is very diverse. Some FRIENDS give lectures outside of their
professional job to educate the public with the right pharmaceutical knowledge and volunteer in
various activities to support the victims of natural disasters. Another FRIEND specialized in
communication methods as part of therapeutic care for dementia patients. The location of this
meeting was actually a FRIEND’s deceased parents’ house which was donated as a social
meeting house for local children.
Watching them talk about change of heart was very impressionable
During this session, we discussed the topic of “self-esteem” with
the help of slides. The FRIEND leading the workshop was a veteran
FRIEND who had been there since the beginning of the workshop.
He started by talking about his own experience of having a low
self-esteem.
One FRIEND who participated in the previous workshop said, “I
always set myself aside and take care of others first, but I now
realize that I can place my own needs above some others. I still felt
unsure, but I wanted a job that made me feel satisfied, so I switched jobs. Another FRIEND said
“I frequently recall what my mother used to say which makes me feel like I am protected and
assured. When I hear now from my brother and other friends that she used to worry about me a
lot while she praised me. I find myself accepting my mother more genuinely and openly.”
During my Kubler-Ross workshop session, I experienced some powerful emotions that shook me
vigorously, but this gathering of FRIENDS gave me a serene, peaceful and comfortable feeling.
As a JSDD phone consultant, I was so pleased when one caller told me that she could talk to me
about everything related to death, something about which she could not even talk to her very
close friends. I hope everyone will utilize the JSDD medical consultation with ease and comfort.
Reported by Ms. Chihoko Hirabayashi, JSDD telephone medical consultant
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Report and interview:
The Struggle of Dr. Yoshiro Suzuki (63) who supports his local community medical system
along with in-home medical care with the attitude, “I stand by my patients.” His motto has
been “Patients First” ever since he transitioned from being a pharmacist to a physician. He
is pushing against the wave of an increasing elderly population by closely collaborating
with his local community.
Picture: Dr. Yoshiro Suzuki on the computer at his clinic. He appears to be a nice, easy going
guy, but when it comes to medicine, he has a wide range of perspectives and sharp insight,
according to his colleagues.
Terminal medical care is not necessarily only for the elderly. Sometimes, he has to take care of
terminally ill young patients. He told us about one unforgettable case deeply inscribed in his
heart.
Mr. S (38 years old) was a patient who was referred to me from a local hospital. He was lying in
bed with his eyes wide open, expressing pain and suffering in a dark room. He was diagnosed
with terminal stage of stomach cancer. He said, “I’d like to ask for one thing.” When I asked
him what it was, he said “I want to live to see my youngest son turn one.”
He had edema all over his body, ascites, and hydrocele which made his scrotum ten times bigger.
His doctor seemed to have given up on him, and he seemed to have lost his trust in doctors.
Dr. Suzuki told him, “I can’t cure your illness, but I will definitely improve your painful
condition."
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When asked “It takes a tremendous amount of courage as a doctor to tell the patient face-to-face
that you can’t cure his illness. How do you deal with it?” his reply was “Yes, but he was a non-
believer of medical care, so I thought it was important to eliminate that distrust first.” He
administered albumin to regulate his urination and improve his hydrocele and ascites conditions,
which finally enabled him to carry on a normal conversation. He started to smile. His wife was
a nurse, and obviously her devotional care had a tremendous impact.
Even when there is no cure, pain can be reduced to a reasonable level. That improves the quality
of life for both the patient and his family. “I felt strongly that this was what it means to stand by
the patient.” The patient died while receiving Dr. Suzuki’s terminal care, only a few days before
his youngest son’s first birthday.
Determined to become a doctor after being a pharmacist
Picture: His clinic is located in a busy
commercial street near Hiyoshi Station of
Toyoko Line where a lot of college students live
and hang out.
Among his colleagues, he has a high reputation
of being down to earth and exceptionally
approachable by his patients. He is a great role
model of what a primary doctor or a home doctor
should be.
However, his road to become a physician was
not an easy one. After graduating from high
school, he went straight to pharmaceutical
college and immediately started working at a hospital as a pharmacist.
What he found was that his work was treated as a sub-contractor of nurses and much lower in
status compared to physicians. He made a life time commitment by resigning from three and a
half years of hospital work, and started hitting the books hard to become a medical doctor.
When I asked him if he developed a strong feeling against job bias and status quo, he responded,
“After becoming a pharmacist, my strong determination was spawned. In those days, my
impression was that the majority of doctors were focused on pleasing the school from which they
graduated or their superiors instead of their patients whom they were supposed to assist.”
A year and a half later he successfully passed the entrance examination to Saga Medical College,
now called Saga University School of Medicine. He moved from Yokohama to Saga, Kyushu
with his three children and wife. He had to work a side job as a tutor and a pharmaceutical part
time job for six years when he finally graduated from medical school.
Dr. Suzuki moved back to Yokohama and took an internship. The wage was not enough to make
a living, so he had to take a night shifts in hospitals to supplement his income. Many patients
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now make comments about him: “Since he is also a pharmacist, I feel more comfortable about
his choice of prescriptions.” “He is very familiar with the latest studies of medicine, and he is a
very hard worker above all.”
He takes the same stance as JSDD about how to treat incurable, terminally ill
patients
His clinic is located on the second and third floors of a building near Keio University by Hiyoshi
Station of Toyoko Line. It is only one minute walk from the next station, which is crowded and
full of retail stores. He opened his clinic 23 years ago. Three years later, he started a visiting
nurse station. His in-home medical care is rapidly growing and expanding. For the last several
years, he has taken care of 20 to 30 terminally ill patients a year, and the number is increasing
year after year. His emphasis has always been primary health care and in-home care from the
beginning. He speaks passionately that he wants to overcome the challenges of a progressively
elderly society by closely collaborating with local hospitals, clinics and other health care
facilities.
One of his clinic’s primary missions is to identify the needs of the patients precisely and
implement them immediately. His “Patients First” motto has never changed from the time when
he first became a pharmacist and through his journey to become a medical doctor. “I’m
committed to stand by my patients every single day. I try to show it every day to remind myself
to never forget it.”
Two years ago, I was introduced to the JSDD LW supporting physicians program by a healthcare
manager. I found out that I share the same view towards the treatment of incurable, terminally ill
patients, so I registered to become a part of it. We must accurately identify the wishes of
terminally ill patients with the help of their families, and help prepare and implement their
wishes with respect and dignity. I was immensely impressed by his firm conviction of “Patients
First” attitude, which he will never relinquish.
Reported by Mr. Takeshi Gunji, JSDD Editing Department