Yuta Nakaguchi (5th grade)

I had the opportunity to study bioethics at the University of Washington School of Medicine in Seattle for about a week. This was my first opportunity to study abroad, and the opportunity to listen to and think about ethical issues in the United States, the cutting edge of medical care, was extremely valuable. The lectures ranged from internal medicine to public health, and were given by authoritative professors in their respective fields. I also had the opportunity to visit many facilities, including the University of Washington School of Medicine, Seattle Children's Hospital, Seattle Cancer Care Alliance, and Northwest Kidney Center. Below, I would like to mention some of the many lectures that particularly impressed me. First, there are ethical issues in organ transplantation. In the lectures, I learned a lot about the history, present, and future of organ transplantation. As expected, transplant treatment in the United States is more advanced than in Japan, and I felt that more lives could be saved in the United States. However, due to rapid development, there are ethical issues that have not yet been resolved. For example, transplants after cardiac arrest require a prompt response, but it is very painful to force the bereaved family to make a hasty decision. However, there is a major dilemma here, as organs lose function over time. There are many other situations in the medical field where patients and their families are forced to make decisions. However, of course, it is impossible to make a decision immediately on the spot. Therefore, doctors need to inform patients in advance of the possibility that a decision may be necessary as early as possible. They must also convey all the information necessary for decision-making, both advantages and disadvantages. I strongly feel that doctors need to always have the ability to see into the future. Next, I learned for the first time that there is a profession in America called "Chaplain" that specializes in spiritual care. There is a not insignificant idea among Japanese people that spiritual = religion. However, Chaplain is not a religious job, but rather provides spiritual support to patients, helps them find their value as human beings, and mainly relieves their suffering and pain. This kind of job does not exist in Japan, but I think there is a great demand for it, such as for terminally ill patients and people who work under daily stress. Unfortunately, in both Japan and the United States, there is still a negative image of end-of-life care, including hospice care. However, I feel that there is not a big difference between Japan and the United States in the way we think about and accept "death". The fear of death and the desire to avoid pain are common to all human beings, so it is essential for doctors to be involved in the spiritual aspects of the patient. It is difficult for all doctors to specialize in spiritual care, but it is possible to connect patients with people in the profession of chaplaincy.

And I think that one of the points of this training was to think about death with dignity. Washington State is one of only seven states in the United States where death with dignity is legally recognized. Many rules are necessary to recognize death with dignity, but the most noteworthy is that the patient must take the medicine themselves. If a family member or friend makes the patient take the medicine, it would be murder, and even if the patient has a disability, they must take the medicine themselves. Here, the final decision on death with dignity is made by the patient himself, and the patient's decision is respected. Also, patients may change their mind by opening the medicine bag themselves, which is probably why there is a difference in the number of people who receive prescriptions and those who die. There are various opinions on the merits of death with dignity, but I am still positive about it because it respects the patient's wishes. In the United States, the most populous state, California, has passed a bill to recognize death with dignity, and there is no doubt that the situation in the world will change dramatically from now on. I hope that understanding of death with dignity will deepen in Japan as well, and that active discussion will take place.

Although it was a very short period of one week, I was able to recognize and think about many ethical issues. What I felt throughout the training was that there are no borders when it comes to ethical issues. When providing medical care, differences in thinking between medical professionals and patients are bound to arise. And each patient's thoughts are different. In order to sincerely face each patient, I think it is most important to first properly understand the patient's thoughts and the ethical issues that arise, and to always continue to think about ethical issues. Medical technology is advancing rapidly, so the ethical issues that come with it also change every day. It is also necessary to always be on the lookout and have the ability to see into the future. And, as expected, the importance of English ability was ingrained in me. The professors at the University of Washington were all kind-hearted, and they spoke to me in simple English to match my poor English, which made me feel very sorry. Also, Japan is a very small country and is lagging behind the world in many fields. English is an indispensable tool for learning cutting-edge knowledge and technology from Europe and the United States and communicating with them. If you cannot speak English, you cannot provide medical care to approximately 7 billion people in the world. Although an interpreter was present this time, in order to properly convey my opinions, I need to express them in my own words. I strongly felt that I should use this training as an opportunity to improve my own English skills.

Lastly, I would like to express my gratitude to Hirakata Rehabilitation Center's Chair of the Board of Trustees Yamanishi, as well as the group leaders Seki, Nakano, and Tomita, and the many staff members who provided me with this opportunity. I will work even harder from now on so that this training does not end as a one-off. For the sake of my juniors, I sincerely hope that the training at the University of Washington will continue next year and beyond. Thank you very much.