Keigo Iwata (5th grade)

I studied medical ethics and bioethics at the University of Washington in Seattle from August 3rd to 9th, 2019. During this study abroad, I not only learned about medical ethics, but also had the opportunity to visit medical facilities in the United States. I was initially attracted to the latter aspect of applying to this program, but actually attending various lectures and discussing with the professors gave me very useful ideas and experiences. Below, I would like to first discuss the misunderstandings and my own interpretation of the medical ethics I learned in this program, and then introduce two lectures that left an impression on me.

First of all, before I went on this study abroad trip, I thought I would learn about standards such as "what is good and what is bad" and, to be honest, I thought I might not get much out of it. However, what I actually learned was the methodology of how to deal with ethical issues when you encounter them in actual medical care, some of which I will introduce below. In addition, I learned not only methodology but also why it was necessary to establish four principles of medical ethics. In other words, what we actually learned in this program was not standards such as good and bad, but how to summarize clinical information in order to match it with such standards... I was able to learn very clinical methods. (Of course, we learned other things as well, but I feel that this was the core of what I learned.)

Next, I would like to talk about two things that I learned that made a lasting impression on me. The first is the "4 box method." This was brought up in Dr. McCormick's lecture on the first day, and is the core idea of this program. When you encounter an ethical problem in the medical field, you can gather just the right amount of information to solve it by filling in the four blocks: medical indications, patient preferences, quality of life, and contextual features. The question then becomes how to actually use this method. This 4 box method is used clinically at Seattle Children's Hospital in Palliative Care for Pediatric Patients. The 4 box method used there allows you to describe the progress of what the patient values over time, like a medical record. This allows you to describe the things that the patient values, that is, their values, without any omissions, and you can provide care that is in line with the patient's own standards.

The second lecture was about the reality of euthanasia in the United States, given by Dr. James Green. Oregon was the first state in the United States to allow euthanasia, and euthanasia is performed with the assistance of a physician. Since euthanasia is not permitted in Japan, I did not know how euthanasia is performed. However, the following was said in the lecture: "The drug actually used is a barbiturate pill, which the doctor hands directly to the patient and the patient takes it themselves. Any doctor can prescribe this pill, but many doctors do not want to prescribe it." To be honest, I remember being very shocked by this content. I do not know if it will affect my life in the future, but I think that the content of this lecture and the atmosphere in which it was spoken by the person involved were a great benefit of this study abroad.

Apart from these lectures, the tours of the facilities and private sightseeing were also very fulfilling. Among these, the one that left the deepest impression on me was Professor King's home party. We were invited to a large group of people's home, where food and drinks were served, and the professor's children showed us around the house. In addition, we had the opportunity to talk at leisure with Professor King, Professor McCormick, and the professor's children.

I'm going off topic a bit, but one of the things that made me especially happy during these private exchanges was that Dr. King and Dr. McCormick supported my future clinical and research study abroad. One of the reasons I originally applied to this program was to gain information to help me decide whether to study abroad in the future. When I told the two professors that I was currently preparing for this program with the above in mind, they supported me by saying, "Please let me know if I can be of help in the future," and they even exchanged contact information with me.

Lastly, I would like to express my sincere gratitude to Dr. Yamanishi and the staff of Hirakata Rehabilitation Center who supported this program, to Dr. King, Dr. McCormick, Dr. Kondo, and Dr. Nakamura who helped us with lectures and other private meals, and to Dr. King's family who invited us to their home. I believe that it was only thanks to the support of so many people that I was able to enjoy a meaningful time and new encounters in faraway Seattle. The connections and experiences I made here are precious treasures. Once again, I would like to express my gratitude to those who supported this program. Thank you very much.