Mayumi Fujihira (5th grade)

This time, I participated in the bioethics program at the University of Washington School of Medicine in Seattle for eight days from August 4th to 11th. The reason I wanted to participate in this training was because I wanted to hear about the current situation and issues, as well as the first-hand accounts of doctors involved in the law, in the state that introduced it before anywhere else in the world. All of the lectures at the University of Washington were given by professionals in the field, and in addition to the lectures on the law, the other lectures were all very interesting and educational. I would like to report on three that made the biggest impression on me.

The first is about spiritual care. The word spirituality is not very familiar in Japan, and I cannot find a suitable word, but my own interpretation, which I came up with through various lectures in this training, is that spirituality is the root that makes up a person's personality, mind, and heart, and that it is through this that a person finds meaning, hope, and peace of mind in life. The reason why spirituality is important in medical care is that by knowing it, we can know what contributes to reducing the patient's pain and improving their QOL, and can help them. In spiritual care, we know the patient's spirituality, sometimes think with the patient, and draw out the deep psychology that the patient himself did not realize, so we can select the treatment and support that is truly necessary. When facing death, there are many people who cannot think well about how to perceive it and what to value in spending the rest of their lives, and if they continue as they are, they may die without being able to deal with the mental pain. For this reason, in the United States, there is a profession called a chaplain who specializes in spiritual care, and there is a system in which knowledgeable experts can face the spirituality of patients and provide support. They also said that they are working with hospitals to ensure that no patients are left out. In Japan, paramedical staff provide spiritual care, and there are a few similar organizations, but unfortunately, this support does not reach all patients. Also, spiritual care is beneficial for the treatment of all patients, not just those who are about to die. Therefore, when I thought about what I can do now, I thought that the first thing I should do is to pay attention to, feel, and cherish the spirituality of the patients I will meet as I conduct my training.

The second is about death with dignity. Under Washington State's death with dignity law, if certain conditions are met, patients can die by taking a lethal dose of a pill prescribed by a doctor. This is also known as physician-assisted suicide, but I had never known about this type of death with dignity, and it was very interesting to learn about it. Patients who have a short life expectancy and have reached a stage where they cannot control their pain may spend their days worse than death. In such a situation, if they can control their own life and death, they may feel a little better. This can reduce mental pain and improve the patient's quality of life. In fact, in Washington State and other places with the same law, there are people who received a lethal dose of a prescription but did not actually take it, and there was an opinion that just having it makes them feel at ease. Although physician-assisted suicide with dignity is still a difficult topic that is debated a lot, I thought it was very useful as a means of respecting the patient's autonomy, relieving them from excessive pain, and improving their quality of life. In addition, one of the major problems with the commonly known type of euthanasia, in which a doctor administers a lethal dose of a drug to the patient, is the heavy mental burden on the doctor. However, I felt that this mental burden could be alleviated at least somewhat by a method in which the patient takes the drug themselves, as is the case in Washington State.

The third topic is about family medicine. Family medicine is not very familiar in Japan, and I did not know much about it myself, but it is a widely used medical field in the United States. Family medicine provides holistic medical care, including family background and social aspects, and covers all health issues from children to adults, from birth to the end of life. When only individual specialists treat patients, there is no doctor who knows everything about the patient, and there is a high risk of duplicate treatment, unnecessary tests, passing the buck, and overlooking. On the other hand, if there is family medicine, it becomes a window where patients can consult about anything, and if necessary, they can be referred to a specialist. Family doctors have a comprehensive understanding of the patient's lifestyle and current condition, so they can coordinate the best treatment for the patient.

There are quite a few doctors who specialize in family medicine in Japan, but the reality is that most of the other doctors are private practitioners in specialized fields who play the role of family doctors. However, in recent years, general practitioners, who are similar to family doctors, have been certified as specialists and are receiving more thorough education, so it is expected that the number and quality of doctors who play the role of family medicine will improve in the future. This time, I learned about the current state of family medicine in the United States, and I would like to make use of it when I become a doctor in the future and need to work with general practitioners and doctors in specialized fields. In addition to the above, this training included interesting lectures, facility tours, discussions, and opportunities to talk with the doctors personally, so I was able to think and learn a lot. It was a very valuable experience to have the opportunity to think about bioethics in various fields for a week, and it is a treasure that I will treasure for the rest of my life. I will use what I learned and thought during this training in my future training and studies, and I will definitely use it when I become a doctor in the future.

Lastly, I would like to express my sincere gratitude to Dr. Yamanishi for giving me this wonderful opportunity, as well as to our supervisors Dr. Seki, Dr. Gamo and his wife, Dr. Nakano, Dr. Tomita, Mr. Kanazawa and Ms. Kajiwara from Hirakata Rehabilitation Center, Dr. McCormick and the other teachers at the University of Washington, and to everyone who was involved in this training. Thank you very much.