Kumano Hayate (5th grade)

I participated in the bioethics program at the University of Washington from August 3rd to 10th. The reason I decided to participate in this program is that while I have had many opportunities to learn about medicine through practical training and lectures, I have not had many opportunities to learn about ethics. That is why I applied to participate in this program in the hope that it will be useful for my future medical career.

On the first day, we had lectures on Clinical Ethics, Ethical Issues in Pediatrics, and Ethical Issues in Genetics Palliative Care for Pediatric Patients. The most memorable lecture was the 4 box method that Professor McCormick mentioned in the Clinical Ethics lecture. This is the core of all the bioethics lectures, and it is a way of fitting cases into four frameworks: 1. medical indication, 2. patient preference, 3. quality of life, and 4. contextual features. In the lecture, we applied this method to the case of a newborn with Down's syndrome and duodenal atresia. In this case, 1 is surgery for duodenal atresia, 2 is that the patient is a child and cannot make his/her own decision, and the parents are his/her surrogate, but they refuse the surgery, 3 is that if the surgery is not performed, the child will die of dehydration and malnutrition, but if the surgery is performed, the child will live as long as a person with Down syndrome, and 4 is the time, place, and social expectations. In this case, the parents refuse the surgery for financial reasons, but we learned how to think about the ethical issue of the child dying if the surgery is not performed. In this way, each framework is considered important, but the idea of considering the four equally is unfamiliar in Japan, and I felt that this is due to the American emphasis on autonomy.

On the second day of the lecture, we went to Seattle Cancer Care Alliance in the morning. First, we were given an explanation of the structure of the facility. Then, we went to FRED HUTCH and received explanations from three Nobel Prize winners and those who have undergone stem cell transplants. After that, we received a lecture on medical ethics from Professor Elizabeth Loggers. In this lecture, we learned that there are four elements of medical ethics: nonmaleficence, benefit, autonomy, and justice, and that medical professionals need three elements: expert knowledge, act in the best interest of the patient, and regulate themselves. In the second period, we received a lecture on immunotherapy for skin cancer from Professor Shallender. In this lecture, we learned that there are many treatments for skin cancer, which is the fifth highest cause of death in the United States, and new drugs are being developed one after another, but on the other hand, there is also the problem of rising medical costs.

On the third day, we went to the Northwest Kidney Centers in the morning. They mainly perform dialysis there, which costs $10,000 per person per year. However, I felt that it was different from Japan in that 75% of the cost of dialysis is paid by the US government, 15% by the state government, and the remaining 10% by private insurance. In addition, in Professor King's lecture on spirituality, we were explained about the role of the chaplain. Although it was completely unfamiliar in Japan, through this lecture, I learned that the most important thing for a chaplain to do is to provide warm support to patients, listen to worries that they cannot talk about with people close to them, and provide various types of support and care, such as asking patients what they would call their life if they were to give it a title.

On the last day of the lectures, the fourth day, we learned about dignified death and family medicine at the University of Washington. We learned that the dignified death law was decided by vote in the United States and that dignified death is recognized in seven states in the United States. In the family medicine lecture, we learned that it is rare for family doctors to see patients from birth to the end of life, which is rare in Japan. We also learned that it is important to be aware of the ethical issues that exist in various situations because we treat patients holistically.

In addition to studying, I was also able to visit various places such as the first Starbucks store, the Space Needle, cruising, and a public market. Of course, I studied during this week, but everything about life in America, the customs of the local people, and the cityscape was fresh and valuable, and I was able to have a very valuable experience.

Lastly, I would like to thank Dr. Yamanishi of Hirakata Rehabilitation Center for giving me such a wonderful opportunity, as well as Dr. Seki, Dr. Gamo and his wife, Dr. Kondo, Dr. Nakamura, Mr. Umezawa, Ms. Sakurai, Dr. McCormick, Dr. King, and the other teachers at the University of Washington, our guide Yoshiko, and our interpreter Turid.