With "medical care, care at the final stage of the life"
From August, 2019, distribution place increased. For more information:
In late years cases which we can prolong even if in a condition that recovery is not anticipated by the medical development increase.
However, it has been connected to tube and machine when we do measures for life extension and will continue growing in state not to like depending on people. Therefore thinking about what you want to spend the satisfying life to the death increases.
■Why do you think beforehand?
We expect what about medical care and care to receive on reaching last moments, and situation when we make decision what you do not expect visits. They stop by to individual cases, but right or wrong such as tracheal intubation and use, tubal feeding of respirator, stomach rou may need to express own hope to treatment including contents said to be so-called life-prolonging treatment.
However, it may not be in condition to be able to declare the intentions by oneself when iza decision making was necessary. Aggravation and dementia of condition, state including the senility at that time are uncertain.
Therefore we think about hope beforehand, and it is recommended that we leave.
■In the spot of medical care, care
The following situation often happens. We think beforehand, and it becomes necessary whom you share with by process when you think.
- After saving, and dealing, for condition without possibility of recovery, family does not expect from patient who has been conveyed by first aid. Hope of the person and hope of family do not accord.
- In the spot of care, the person cannot do intention confirmation of the person because of dementia.
- In the situation that we cannot declare our intentions of patient to, opinions are different among families over life-prolonging treatment (with family of distant place they cannot communicate)
- There is not relative, and intention confirmation of the person is not possible when it was conveyed first aid.
Advance care planning ※Based on thought of (ACP), it is said that it is desirable for decision making to pass through talks with caretaker concerned with healthcare worker and care plan such as family doctor.
In talks, it is necessary to repeat talks that stood on backbones such as view of life or sense of values and thought that it is, and to perform what the person regards as important not choice of simple therapeutic method when we reach last moments.
In addition, we share talks, thought with trustworthy people such as families, and it is recommended that we push forward the making of relationship with family or guardian and person concerned with medical care, care.
Advance care planning (ACP: nickname "life meeting")
It is process that we are based on the person, and family and trustworthy person, medical care, caretakers talk with about beforehand you possess at the time of emergency, and what kind of medical care and care you expect.
<< purpose >>
During "the final stage of the life", medical care, care along hope be carried out including view of life and sense of values of the person
<< important thing >>
- The person is the main constituent
- Family and trustworthy person, medical care, caretaker share thought, sense of values of the person
- We leave content that we talked about for record
- We review regularly and talk about repeatedly
<< content to talk about >>
- The situation (family constitution, medical history, care service)
- Sense of values (what we value, thing anxious)
- Intention (places spending medical care, care, death to hope for)
- People who want you to talk with medical care, caretaker about instead when you were not able to make decision
"Notebook" - about approach - medical care, care of Yokohama-shi
In Yokohama-shi, we held review meeting consisting of the multi-types of job such as healthcare worker and caretaker, lawyer about medical care, care at the final stage of the life to declare the intentions of thought, hope from house where each citizen's was fine and examined method of enlightenment.
And based on discussion at review meeting as enlightenment Tours toward the citizen "made "notebook" (PDF: 3,013KB) about medical care, care.
■It is purpose of notebook
It is intended that it is a chance to think from cheerful house to leave own thought about medical care and care at "the final stage of the life". In addition, we expect that it is help when we talk about thought of the person with trustworthy people or medical care, caretakers such as families.
We assume time when "we suffer from diseases not to be cured" and "were not able to declare our intentions" and prepare for three questions in middle aspect. We assume choice method to check and make it easy to reply.
[question 1] Hope of treatment and care
[question 2] Hope of substitute person (whom you want you to talk with medical care, caretaker about to)
[question 3] Hope of place reaching last moments
We introduce characteristic of 3 representative patterns to spread side about change of body function before reaching the last.
- Period when function of whole body was kept relatively well continues
- In 1-2 months before death, state turns worse rapidly
- Prognostic prediction is relatively easy
- Heart failure, respiratory failure (chronic disease)
- State turns worse calmly while repeating sudden aggravation and improvement due to the onset of infectious disease
- It changes relatively rapidly in just before the death
- Dementia, neurologic incurable disease , senility
- Time when function of whole body decreased lasts for a long time
- Slow drop continues generally, and function decreases to the death
Spread (the left)
Spread (the right)
"We think" about 1
- At first, we arrange own thought while the person answers question.
It is effective to look back on question that we answered without being particular in order of question when we think.
"We talk about" 2
- We talk with people having thought that the person arranged concern in medical care, the care for the final stage of the life about while looking at notebook.
In this way, the person can tell people having medical care, care that the person expects affect. In addition, contents which we are thinking about by talking about may deepen more.
"We lack in 3 again"
- In talks and progress of time, we may change mind of the person by turn of eventss. When we changed mind, we will write again again. We do talks again if we write again.
■Form, distribution method
It is compact size (9.5cm *13cm) that is easy to carry in spread thinly.
We distribute with case and set of prescription notebook (explanation flyer (PDF hands including 833KB)).
By carrying contents which we thought about, lead to family medicine and family talks with drugstores.
Notebook is not "will" and "prior remit", and there are no legal binding force and emergency on-site compelling force.
Adobe Acrobat Reader DC (old Adobe Reader) is necessary to open file of Portable Document Format.
Person who does not have can download free of charge from Adobe company.
To downloading of Adobe Acrobat Reader DC