Masumi Inoue (5th grade)

I participated in the bioethics program at the University of Washington in Seattle from August 4th to 11th. I decided to participate in this program because I had never really thought deeply about bioethics before, but through my clinical training I felt that it would be essential knowledge for a doctor in any department in the future. Although I am not good at English, I am interested in medical care overseas and have never studied abroad before, so I applied. Now that I am undergoing clinical training where I have many opportunities to come into contact with patients, I felt that I wanted to experience the differences between Japan and overseas. It was my first time visiting Seattle, and everything felt fresh. In this environment, classes began on the third day after arriving. All of the lectures by the teachers were interesting and memorable. I would like to talk about the things that particularly interested me.

On the first day of class, we visited the University of Washington. It is a very large university, so we had to move around the campus by bus. There was a large fountain, and I was very excited to be able to study in such an open environment. The most memorable thing about this day's class was about Family Medicine. This is what is called "family medicine," but it is a concept that is not yet common in Japan. It is a little similar to the concept of a family doctor in Japan, but I was very interested in the consistent medical care that is provided, such as childbirth, terminal care, and seeing all ages of newborns from childhood to adulthood. It is considered important to build a relationship of trust with patients, obtain informed consent, and provide appropriate treatment, and I felt that family doctors are the ones who can build the deepest relationship of trust with patients. I also think that if a deep relationship is built between the patient and the family doctor, who is the first point of contact in medical care, the patient's awareness of health will increase, preventive medicine will become more widespread, and the problem of medical expenses will improve. I think that because we are an aging society, the existence of family doctors who are more easily accessible than a family doctor should be emphasized, and I felt that family medicine can be said to be holistic medicine.

On the second day of class, we learned about the profession of Chaplain. Chaplains are people who support the spiritual aspects of patients. I had never thought about spirituality in medicine before. I felt that this kind of thinking is important precisely because America is a country where many people of various religions gather. I have never heard much about the idea of spirituality in Japan, and I think this is because many Japanese people are non-religious and are a skeptical race. The idea of spirituality includes not only religious aspects, but also various personal thoughts such as self-esteem, anxiety due to illness, and interpersonal relationships. Of course, each patient's worries and anxieties are different, so individual responses are important, especially in palliative care. However, doctors alone cannot set aside time to respond to all of these issues, so I felt that a specialized profession like a chaplain should exist in Japan as well. On the third day of class, I had the opportunity to visit the Kidney Center in the morning. I heard that this facility was the first place in the world where artificial dialysis was performed, and I was very surprised to be in such a place. There, too, I felt the difference between medical care in Japan and the United States. In the afternoon, we also had the opportunity to visit Harborview Medical Center, which is also the setting for a famous movie. It is a very large hospital, and the walls and rooftop garden are very beautifully designed for patients, and the bright atmosphere makes it hard to believe that it is a hospital. I felt that I would like to work in an environment like this. On the fourth day of class, we had a talk at the University of Washington. What made the biggest impression on me that day was about the dignified death law. Although it is due to my lack of knowledge, I did not know that such laws existed in the world. In fact, only seven states in the United States have dignified death laws in place, but the number of DWDA prescription recipients and deaths is increasing year by year, and it is thought that this will increase further as the population ages, and new ethical issues may arise. I asked the professor how he would respond if the opinions of the patient who wishes to die with dignity and the patient's family differ. The professor said that the patient's autonomy should be respected, so he would take the time to talk to the family and get them to understand. I felt that the existence of such laws is unique to the United States, where respect for individual autonomy is very important. Although there is an advantage in that it gives patients the option to relieve pain, I think that doctors should not prescribe medicine to end a patient's own life, because it does not harm the patient. There are various pros and cons, and I realized that it is an issue that should continue to be discussed. This training was my first visit to the United States. When I arrived in Seattle, the spacious cityscape was impressive. When I went to the center, I realized that it is a very urban city, with the headquarters of world-famous companies such as Amazon, Google, and Microsoft. From the hotel, I could walk to Pike Place Market and the first Starbucks Coffee store, so I was able to take a walk after dinner on the first day and visit various places. I also visited the University of Washington Book Store on the second day, and was overwhelmed by the number of university goods. At Pike Place Market, I was able to see a fishmonger throwing fish. All the meals in Seattle were delicious, and the big salmon I ate at the Welcome Party and the food I ate while cruising while looking at the beautiful scenery were particularly memorable and are wonderful memories. This training was a truly memorable and valuable experience. In addition to the topics mentioned above, we were able to think about ethics from various perspectives, such as the American health insurance system, infectious diseases, and transplants. In line with the Four Box Method that Dr. McCormick taught us in the first class, I would like to become aware of and recognize ethical issues on a daily basis so that I can deal with them when I face them. Finally, I would like to thank Dr. Yamanishi of Hirakata Rehabilitation Center for giving me this wonderful opportunity, as well as Dr. Seki, Dr. Nakano, and Dr. Tomita, as well as Mr. Kanazawa and Mr. Kajiwara who accompanied us, and Dr. King, Dr. McCormick, and the other teachers who taught in Seattle.