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助成対象詳細(Details)

   

2016 研究助成 Research Grant Program  /  (B)個人研究助成  
助成番号
(Grant Number)
D16-R-0820
題目
(Project Title)
治療優位の価値の再考―高齢者の急性期医療の決定に伴う医療者のジレンマから―
Dilemmas for Medical Professionals in Determining the Course of Care for Oldest-Old Patients: Reconsidering "cure-oriented" values in the realm of medicine
代表者名
(Representative)
島田 千穂
Chiho Shimada
代表者所属
(Organization)
東京都健康長寿医療センター研究所
Human Care Research Team, Tokyo Metropolitan Institute of Gerontology
助成金額
(Grant Amount)
 1,300,000
企画書・概要 (Abstract of Project Proposal)

    高齢者の終末期医療の選択においては、患者本人と家族、医療従事者らケアチームによる合意形成をめざした話し合いのプロセスが重要とされる。超高齢者は脆弱性が高く、終末期が始まる時期は明確に定義できないため、より早期の急性期医療の選択から、倫理的課題として検討すべきであると考える。医療の進歩と共に侵襲性が低い治療法が開発され、脆弱な超高齢者も治療の適用とされるものの、治療が患者本人のQOLの向上につながっているのかという疑問が生じるケースも少なくない。特に、医療の選択の場面では、年齢による差別をしない理念があるがゆえに、年齢に伴う機能低下を考慮して判断しにくい状況になっており、超高齢者に対する急性期治療の選択に関わる医療従事者は、これらのジレンマに直面することになる。本研究は、対話型倫理検討会の実施を通じて、医療従事者が急性期医療の提供の際に直面するジレンマの解析を行い、新たなスキームに基づく超高齢者の急性期医療の選択における指標を提案する。最終的には、超高齢者の急性期医療におけるもう一つの価値として「衰えつつ生きる」ことを認め、そのプロセスを支える医療の価値の浸透を目指す。

    Recent advances in medical technology have increasingly complicated the way of determining the course of care for oldest-old adults in acute-care settings. On the one hand, development of less invasive techniques has made it difficult to justify withholding medical treatment for these adults simply on the grounds of their frailty and vulnerability. On the other hand, it is open to question whether these techniques can extend the lives of oldest-old patients while maintaining their quality of life. Accordingly, physicians and health care professionals are likely to face a formidable dilemma in their search for the optimal acute-phase treatment for oldest-old adults. 
    My aim in this project is to introduce a new scheme for determining the treatments for oldest-old patients in an acute stage. To this end, I organize a series of conferences in which physicians, nurses, and other health care professionals as well as specialists in the field of medical ethics participate and discuss ethical dilemmas that these professionals can and do experience in attempts to choose an appropriate treatment for oldest-old patients. On the basis of potential approaches to these solutions that are identified and evaluated in the conferences, I seek to propose guideposts along which to provide acute-phase treatments for oldest-old adults. I will also examine whether these guideposts are relevant and applicable to actual clinical practices in acute-care settings. 
    Findings from this project will serve as an empirical foundation to develop a new value in health care decisions that are needed in super-aging society. In the realm of medicine, attention has been focused on elimination of diseases in the pursuit of longevity, which has increased the volume of medical care provided for older patients. Through intensive, ethical examinations on the implications of providing highly sophisticated treatments for oldest-old patients, this project will help to reconsider such predominant, "cure-oriented" values in the delivery of health care.

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