人生の最終段� �における医療� ��ケアの決定プ ロセスに関す� �ガイドライン.pdf

Guidelines for the decision-making process regarding medical care at the end of life

1. Principles for medical care at the end of life
Medical care at the end of life should be based on the patient's own decision-making, with sufficient discussion between the patient and a healthcare team consisting of multiple specialties.
The patient's wishes may change, and the healthcare team should provide support to enable the patient to express their wishes at any time.
If the patient is unable to express their wishes, family members or other trusted individuals should be involved in the discussion.
The healthcare team should make judgments about medical care based on medical appropriateness and adequacy.
Pain and other unpleasant symptoms should be alleviated as much as possible, and comprehensive care, including emotional and social support, should be provided.
Active euthanasia with the intention of shortening life is not within the scope of these guidelines.

2. Procedure for determining the direction of medical care at the end of life
The direction of medical care at the end of life should be determined based on the following:
(1) When the patient's wishes can be confirmed
The patient's wishes should be respected, and the direction of medical care should be determined through sufficient discussion between the patient and the healthcare team.
The patient's wishes should be confirmed at each stage, and the healthcare team should provide support to enable the patient to express their wishes.
If the patient is unable to express their wishes, family members or other trusted individuals should be involved in the discussion.
The content of the discussions should be documented at each stage.
(2) When the patient's wishes cannot be confirmed
In cases where the patient's wishes cannot be confirmed, the healthcare team should make a careful judgment based on the patient's best interests.
If family members or other trusted individuals can estimate the patient's wishes, their opinions should be respected.
If family members or other trusted individuals cannot estimate the patient's wishes, the healthcare team should discuss the patient's best interests with them.
The content of the discussions should be documented at each stage.
(3) Establishment of a discussion forum with multiple specialists
In cases where the direction of medical care is difficult to determine due to the patient's physical or mental condition, or where there is no consensus on the content of medical care, a discussion forum with multiple specialists should be established to examine and provide advice on the direction of medical care.