Aoi Oshiro (5th grade)

This time, I participated in the University of Washington School of Medicine Bioethics Program. The reason I decided to participate in this program was because Professor King told me about Chaplains in a fourth-year class. It was an unfamiliar occupation in Japan, so I was curious to see how it was utilized in the field. Then, I learned about this program and I really wanted to participate. I am also interested in generalists. I think that generalists have more opportunities to face the lives of others than specialists. Therefore, bioethics is very important. For these reasons, I participated in this program. I had many valuable experiences, but I would like to report on the one that made the biggest impression on me.

First, about the four box method by Dr. McCormick. I had heard about it from my seniors and I was curious about it. It came up many times in every lecture during these four days, so it seems to be a basic way of thinking and process. It consists of 1 Medical Indication for Intervention, 2 Preference of the Patient, 3 Quality of Life, and 4 Contextual Issues. I thought that if you have such a foundation when you are carefully dealing with a single patient, it will be easier to think about and understand the difficult topic of bioethics. However, when I asked how much of the four box method is used in actual clinical practice, it seems that it is hardly used at all. If I had to say, I got the impression that it is more likely to be used in situations where you are carefully dealing with the person, such as chronic diseases and palliative care, than in acute care.

In the second class of the same day, we learned about pediatric bioethics. I was surprised to learn that there is an independent concept of pediatric bioethics, but it seems that this field is developed because children are thought to have little individual judgment. An official website on pediatric bioethics has also been created, and I felt that it is more advanced than Japan. Also, in the United States, bioethics is considered a career. I felt that this is also more advanced than Japan. There were many surprising things in this lecture, and I was constantly thinking, so I was very tired when it was over. When resuscitating a newborn, it is not performed if the pregnancy is 20 weeks, but it is performed if the pregnancy is 40 weeks. This is a custom, or a feeling, and I thought it was correct. So when I was asked what to do if the pregnancy is 24 weeks, and why I thought that, I couldn't answer. There is no time to think carefully or discuss it in the emergency field, so I was glad to have the opportunity to think about it this time. As a medical professional and a person, it is natural to help someone who is suffering in front of you. But what is this natural thing to do? Who decided that? In the previous example, if a medical professional had the experience of not being able to resuscitate a baby at 24 weeks and 6 days, wouldn't they think that they could save the baby at 24 weeks, and why would they think that at 23 weeks and 5 days? In this way, we were asked to change many settings and discuss how to think and why we think that way. Even if we used our brains to the fullest, we couldn't come up with an answer, and I felt the depth and difficulty of bioethics. When asked if the parents' thoughts would change if the baby in the womb had Down's syndrome, all the students answered that they would. This is because they felt it through feeling, and they had learned that it was a problem in Japan as well. So, what happens if we apply this to the four box method? 1 Medical Indication for intervention and 2 Preference of the Patient can sometimes be in conflict. Even if there is a medical indication, the wishes of the baby in the womb cannot be heard, so the wishes of the parents are reflected. In this case, the parents and society are responsible for the child. This responsibility also includes the establishment of a uniform medical policy as a guideline or custom. Without this, it would be a chaotic situation in clinical practice. In the United States, the trigger for the creation of guidelines in this case was a precedent from 40 years ago. The precedent was taken up as a major issue and sparked debate across the United States. And then the guideline was created. I had the impression that guidelines are carefully created based on many papers and evidence levels. Although the times are different, I felt that the United States is flexible to change, and that is why the field of bioethics is developing quickly. This lecture taught me that a single precedent can create a system and change it. I am also interested in fields such as the flow of people, public health, and epidemiology. Social insurance first developed in Germany. Doctor assisted death began in Europe. Various systems are born from various backgrounds. Until now, I only thought of the system as something that was like that and that we should follow it, but I felt that it was very important to know the history, background, and how it developed in this way.

In the first class on the second day, we reviewed the concept and definition of bioethics, and learned about bioethics in the context of working as a doctor who is responsible for many things, including society, patients, and the work of doctors, in conjunction with the law. It was very abstract and difficult, but I realized a lot. The greatest happiness of the greatest number of people is generally considered to be a virtue, but as a doctor, who works on a case-by-case basis, it is difficult to think in terms of general, the greatest number, or the greatest happiness. I felt that it was not very appropriate to tell patients that other people are doing the same thing. Also, while surgery is successful 90% of the time, there are some cases where side effects like this occur. This is something that must be communicated, but depending on how it is communicated, patients may later say that they did not hear about it. With the development of the Internet these days, we are in an age where if a patient has some kind of dissatisfaction and posts it on the Internet, it immediately becomes a hot topic. We are in an age where medical professionals are identified and written about on the Internet regardless of whether it is true or not. It is not easy to work in such an environment, but I would like to think about it on a daily basis so that I can answer later when asked why I took that action.

In the lecture on family medicine, which I was interested in, I was able to see a Japanese doctor in action. By coincidence, Dr. Sairenji knew the family doctor I was studying with in Japan, and we had a lively conversation. I was very happy. In the lecture, I was surprised to see that a clinical psychologist was in the family medicine clinic and examined patients together. This is because I had never seen this in the family medicine scenes I had visited in Japan. Looking at the whole community and the whole life is the essence of family medicine, and family medicine in Japan varies depending on the region, so it is always refreshing, but I am very happy to have had the opportunity to learn very valuable things about family medicine in the United States. Family medicine is more closely connected, so it was surprising to see that you have to work while protecting yourself.

I come from a medically underserved area, so the lecture on WAAMI was very stimulating. This is a program that the University of Washington has been running since 1971, and it is similar to the regional quota admission system in Japan. The purpose of its establishment was to supply doctors to rural areas and establish a medical system in medically underserved areas. In Japan's regional quota system, there are social gatherings before and after admission and small study sessions. WAAMI had more programs that were more rooted in the local area in order to work as a doctor in that area. The entrance exam is conducted by an admissions committee created by each state, and the doctors there review the exam. In 1974, there were only a few related facilities and not many departments or fields, but by 2018, the map was filled with related facilities and many training programs were organized. A system, like research, does not produce results immediately and does not produce results immediately. This is a success story of being able to supply doctors who are proactive in local medical care to medically underserved areas, but I don't think there are many success stories in the Japanese system. I'm still not sure how I should approach this, but I don't think it's something I can do alone, so I want to get to know lots of people, exchange lots of opinions, and work to make medical care in Japan even better.

Every lecture was full of charm and I can't introduce them all here, but I am sure that this week will be beneficial for me. Outside of lectures, I actively conversed in English. My English is poor, but everyone was very kind and tried hard to listen and answer, which made me very happy. I am grateful for all the encounters I made. Seattle is a wonderful city, and I enjoyed sightseeing there very much. I had many experiences that I would never have had in my life, such as cruising and visiting Starbucks. Thank you very much.

Lastly, I would like to express my sincere gratitude to Mr. Yamanishi of Hirakata Rehabilitation Center for giving me this wonderful opportunity, as well as to Mr. Seki, Mr. Gamo, Mr. Kondo, Mr. Nakamura, Ms. Sakurai, and Ms. Umezawa, who helped me during this training, Ms. Yoshiko, our guide, Ms. Turid, our interpreter, Mr. McCormick and Mr. King from the University of Washington, and the many other teachers and students who gave wonderful lectures. Thank you very much.