■特集〔総合診療を考える〕 第24回公開「シンポジウム」（総合診療を考える）
尊厳生（そんげんせい）〜住み慣れた地域・自宅で最期まで自分らしく老いることができる社会を創造するために〜
伊藤 憲祐1,2,3, 矢澤 聰1,3,4, 秋山 健一1,5, 本田 徹1,2,3
1あやめ診療所
2NPO法人シェア＝国際保健協力市民の会
3NPO法人プライマリ・ヘルス・ケア研究所
4慶應義塾大学医学部泌尿器科学教室
5日本医科大学医療管理学教室
Life with Dignity -Creation of a Society Where People Can Age in Familiar Communities and Their Own Homes, with Their Individuality Respected Until the End-
Kenyu Ito1,2,3, Satoshi Yazawa1,3,4, Kenichi Akiyama1,5 and Toru Honda1,2,3
1)AYAME Clinic
2)NGO Services for the Health in Asian＆ African Regions（SHARE）
3)NPO Primary Health Care Institute（PHCI）
4)Deartment of Urology, Keio University School of Medicine
5)Department of Health Policy and Management, Nippon Medical School
Japan is a country at the forefront of the super-ageing society. Currently, Japan has the longest life expectancy in the world with an average of 83 years of age, and in 2015, twentyfive percent of population will be over 65 years of age.
Zaitaku (home care) Medicine, which was developed in Japan, is a style of home care and medical practice that integrates medicine and welfare. In an era where external environment is changing so rapidly, Zaitaku Medicine can become a powerful tool in solving the problems that arise from future unprecedented society. Zaitaku Medicine is important because, in a super-ageing society, the goals of medicine change dramatically from curing diseases and saving lives to that of supporting daily life and living of patients. We are living in times where medicine will share the same goals as welfare. Medicine and welfare will no longer be coordinated, but rather become integrated with each other.
Zaitaku Medicine is deeply rooted in the ideas of Primary Health Care (PHC) and Aging in Place (the ability to live in one's own home and community safely, independently, and comfortably, regardless of age, income, or ability level), and places emphasis on Death education. While medical treatment in hospitals is lead by doctors and done intensively, Zaitaku Medicine places patients and their families at its center, and its ideas correspond with the values of Bioethics, which began as a patients' rights movement. The spirit of Bioethics later evolved to concept of values such as Informed Consent and American Hospital Association Statement on A Patient's Right Bill (1972), and also includes the value of Health for All (a PHC strategy of WHO to promote health). With that respect, the value of Zaitaku Medicine and Bioethics is deeply connected with PHC.
In order for patients to achieve "life with dignity", a coined opposite term for "death with dignity", Death education for medical students is indispensable. Other requirements include shifting emphasis to the community and daily life, constructing a new type of care and system that incorporates medicine and welfare and implementing coordination between specialists. Zaitaku Medicine is exactly what will serve as the foundation for these measures. The new 21st-century model of medicine and its systems will be lead by Japan's Sanya district, which is the microcosm of future Japan.
日医大医会誌 2015; 11(2), 120-124
Key words
aging in place, bioethics, death education, primary health care (PHC), zaitaku (home care) medicine, Sanya
Correspondence to
Kenyu Ito, MD, AYAME Clinic, 3-32-3 Ryusen, Taito-ku, Tokyo 110-0012, Japan
E-mail：kenyu.i@nms.ac.jp
受付：2015年1月13日 受理：2015年3月12日 |
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