緩和ケアと医学

抽象的な

How We should Support Patients Decision Making at End of Life From a National Survey of Hospital Ethics Committees in Japan

Tomoko Kodama Kawashima

Objective: To overview frequent ethical issues arising in clinical setting and the role of hospital ethics committees (HECs) from a national survey in Japan.

Design: Cross sectional survey using questionnaire by post to 4,911 randomly selected hospitals throughout Japan.

Results: Among 1,555 hospitals responding to the survey, the most frequent ethical issue likely to arise in practice was end-of-life care (n = 1,022). A total of 787 hospitals (51.1%) reported that they already had an ethics committee in place and 259 hospitals (16.8%) were planning to establish HECs. Of existing HECs, 42% were engaged in consultation or advice regarding clinical aspects other than clinical research ethics. Measures to provide support for ethical issues in the clinical setting were “advice from hospital ethics committee” (38%), “documentation or guidelines” (26%), “telephone consultation with experts” (11%), and “staff education” (18%). Twenty-five percent of participating hospitals had no specific support for clinical ethics. The HEC members were composed mainly of medical professionals, with only 14% of HECs having ethicists on their panels. The meeting records of HECs were not often disclosed (fully disclosed 23%, partially disclosed 26%).

Conclusion: The most frequent ethical issue in practice was end-of-life care among responded hospitals, however, the role of HECs was not clearly separated from that of Institutional Review Board.