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Ethical Issues faced by Home Care Physicians and Nurses in Japan and their Ethics Support Needs: a Nationwide Survey

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Abstract

This study aimed to identify the ethical issues faced by home care physicians and nurses, and the support they require. It was conducted in collaboration with the Japanese Association for Home Care Medicine from November to December 2020. An e-mail was sent to 2785 physicians and 582 nurses who are members of the society, requesting their participation in a web-based survey targeting physicians and nurses with practical experience in home care; 152 physicians and 53 nurses responded. Home care physicians and nurses face ethical issues, some of which are that “the patient’s wishes cannot be reliably understood owing to their impaired decision-making capacity” and “there is disagreement between the patient and their family members over the necessary healthcare.” The respondents sought “experience with, and insight into, healthcare ethics” and “home care” from people with whom they would consult on ethical issues, but at the time of the actual consultation, those individuals were the main healthcare professionals involved with the patient. In addition, the respondents desired to have “multidisciplinary discussions in the community,” “participation of healthcare ethics experts at meetings,” and “meetings held by healthcare ethics experts” to discuss specific cases. Given these results and the history of healthcare ethics education in Japan—which has been implemented mostly for healthcare providers—we conclude that it is important for academic societies that offer healthcare ethics education to healthcare providers and regional core hospitals with ethics support resources to collaborate to provide ethics consultation services in the community.

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Data Availability

The data of this study are available from the corresponding author upon reasonable request. All data are in Japanese.

References

  • Akabayashi, A. 2019. About CBEL. CBEL Report. http://cbel.jp/about-cbel/. Accessed 16 Nov 2020.

  • American Society for Bioethics and Humanities. 2022. Healthcare ethics consultant certified program. https://asbh.org/certification/hcec-certification. Accessed 16 Nov 2022.

  • Asai, A., T. Okita, and S. Bito. 2022. Discussions on present Japanese psychocultural social tendencies as obstacles to clinical shared decision-making in Japan. Asian Bioethics Review 14(2): 133–150. https://doi.org/10.1007/s41649-021-00201-2

  • Cabinet Office of Japan. 2017. Annual report on the ageing society. https://www8.cao.go.jp/kourei/whitepaper/w-2017/html/gaiyou/s1_2_3.html (in Japanese). Accessed 16 Nov 2022.

  • Dohzono, T, and K. Takeshita, eds. 2020. Ethics consultation casebook. Tokyo: Ishiyaku Shuppan. (in Japanese)

  • Fins, J.J.E., F Cohn Kidish, M. Danis, A.R. Derse, N. N. Dubler, B. Goulden, M. Kuczewski, M.B. Mercer, R.A. Pearlman, M.L. Smith, A. Tazian, and S. Youngner. 2016. A pilot evaluation of portfolios for quality attestation of clinical ethics consultants. American Journal of Bioethics 16(3): 15–24. https://doi.org/10.1080/15265161.2015.1134705

    Article  Google Scholar 

  • Honke, J., and T. Dohzono. 2021. Characteristics of ethical issues experienced by home health nurses: A comparison with hospital nurses. Journal of Seizon and Life Sciences 1: 179–192 (in Japanese).

    Google Scholar 

  • Iwamoto, T., A. Tanaka, and M. Obayashi. 2002. Ethical issues nurses confront in home care medicine about medical practice. Journal of Japan Association for Bioethics 1: 99–107 (in Japanese).

    Google Scholar 

  • Japan Association for Clinical Ethics. 2013. Japan association for clinical ethics. http://square.umin.ac.jp/j-ethics/english/index.htm. Accessed 16 Nov 2022.

  • Japan Association for Clinical Ethics. 2021. Registered hospitals and regions. https://square.umin.ac.jp/jethics/gaiyo_6.htm (in Japanese). Accessed 16 Nov 2022.

  • Japan Association for Clinical Ethics. 2022. Renewal of clinical ethics advisor certification. https://square.umin.ac.jp/j-ethics/adviser_update.htm (in Japanese). Accessed 16 Nov 2022.

  • Japan Medical Association. 2013. Revision of the “Designation Criteria for Designated Physicians under the Maternal Protection Act” model. https://www.med.or.jp/dl-med/teireikaiken/20130424_2.pdf (in Japanese). Accessed 16 Nov 2022.

  • Japanese Nursing Association. 2022. Certified nurse specialist. https://nintei.nurse.or.jp/nursing/qualification/cns (in Japanese). Accessed 16 Nov 2022.

  • Kaneda, H. 2020. Towards sustainable clinical ethics consultation. Journal of Japan Association for Bioethics 30: 67–77 (in Japanese).

    Google Scholar 

  • Kodish, E., J.J. Fins, C. Braddock, F. Cohn, N. N. Dubler, M. Danis, A.R. Derse, R.A. Pearlman, M. Smith, A. Tarzian, A. Youngner, and M.G. Kuczewski. 2013. Quality attestation for clinical ethics consultants: A two-step model from the American Society for Bioethics and Humanities. Hastings Center Report 43(5): 26–36. https://doi.org/10.1002/hast.198

    Article  Google Scholar 

  • Kyoto University. 2022. Public courses clinical ethics introductory course 2022. https://www.kyoto-u.ac.jp/ja/event/2022-06-03-0 (in Japanese). Accessed 16 Nov 2022.

  • Ministry of Health, Labor, and Welfare of Japan. 2016. Long-term care insurance system of Japan. https://www.mhlw.go.jp/english/policy/care-welfare/care-welfare-elderly/dl/ltcisj_e.pdf. Accessed 16 Nov 2022.

  • Ministry of Health, Labor, and Welfare of Japan. 2022a. Current status of home care. https://www.mhlw.go.jp/content/10800000/000909712.pdf (in Japanese). Accessed 16 Nov 2022.

  • Ministry of Health, Labor, and Welfare of Japan. 2022b. Overview of the 2022b Revision of Medical Service Compensation. Home care (home medical care, home nursing). https://www.mhlw.go.jp/content/12400000/000920430.pdf (in Japanese). Accessed 16 Nov 2022.

  • Ministry of Health, Labor, and Welfare of Japan. 2022c. Standards concerning personnel and operation of designated home-visit nursing care services. https://elaws.e-gov.go.jp/document?lawid=412M50000100080_2022c0401_504M60000100032 (in Japanese). Accessed 16 Nov 2022.

  • Miyazaki University Graduate School of Medicine and Veterinary Medicine. 2022. Training course for bioethics coordinator. https://www.miyazaki-u.ac.jp/ijudaigakuin/cource6.html(in Japanese). Accessed 16 Nov 2022.

  • Nagao, N., A. Takimoto, and A. Akabayashi. 2005. A survey on the current state of hospital ethics consultation in Japan. Journal of Japan Association for Bioethics 1: 101–106 (in Japanese).

    Google Scholar 

  • Takeshita, K. 2018. Experience of ethics consultation at Kitasato University Kitasato Institute Hospital. Journal of Seizon and Life Sciences 2: 153–156 (in Japanese).

    Google Scholar 

  • Takeshita, K. 2019. What cases have been considered in ethics consultation at the Annual Meeting of the Japan Association for Clinical Ethics: A proposal for a survey of ethics consultation activities among certified clinical ethics advisors. Rinshorinri 7: 81–88 (in Japanese).

    Google Scholar 

  • Takeshita, K., N. Nagao, H. Kaneda, Y. Miura, T. Kinjo, and Y. Takimoto. 2022. Report on the establishment of the Consortium for Hospital Ethics Committees in Japan and the first Collaboration Conference of Hospital Ethics Committees. Asian Bioethics Review 14(4): 307–316. https://doi.org/10.1007/s41649-022-00219-0

    Article  Google Scholar 

  • Takeshita, K., N. Nagao, T. Dohzono, Y. Miura, and K. Kamiya. 2023. Ethical issues and needs for ethical support of home healthcare professionals. Rinshorinri, forthcoming. (in Japanese)

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Acknowledgements

We are sincerely grateful to the Japanese Association for Home Care Medicine for their generous cooperation in conducting this study. We would like to thank Editage (www.editage.com) for English language editing.

Funding

This work was supported by the Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research (JSPS KAKENHI Grant), #19K10543.

Author information

Authors and Affiliations

  1. Department of Medical Ethics, School of Medicine, Tokai University, Isehara, Kanagawa Prefecture, Japan

    Kei Takeshita

  2. School of Nursing, Kitasato University, Sagamihara, Kanagawa Prefecture, Japan

    Noriko Nagao

  3. Division of Social and Human Studies, College of Humanities and Social Sciences, Shizuoka University, Shizuoka, Shizuoka Prefecture, Japan

    Toshihiko Dohzono

  4. Kamiya Law Office, Tokyo, Japan

    Keiko Kamiya

  5. Department of General Internal Medicine, The Jikei University Kashiwa Hospital, Kashiwa, Chiba Prefecture, Japan

    Yasuhiko Miura

Authors
  1. Kei Takeshita
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  2. Noriko Nagao
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  3. Toshihiko Dohzono
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  4. Keiko Kamiya
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  5. Yasuhiko Miura
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Contributions

Kei Takeshita contributed to the study conception and design. Material preparation, data collection, and analysis were performed by all authors. The first draft of the manuscript was written by Kei Takeshita and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kei Takeshita.

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Ethical Approval

We obtained ethical approval from the Institutional Review Board for Clinical Research of the Tokai University School of Medicine (20R240) on 16 November 2020.

Consent to Participate and Consent for Publication

In the cover letter to the questionnaire, we explained that participation was voluntary and that by responding, the participants were providing their consent to take part in the study, and that the data obtained would be published in academic communities.

Conflict of Interest

The authors declare no competing interests.

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Takeshita, K., Nagao, N., Dohzono, T. et al. Ethical Issues faced by Home Care Physicians and Nurses in Japan and their Ethics Support Needs: a Nationwide Survey. ABR 15, 457–477 (2023). https://doi.org/10.1007/s41649-023-00238-5

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  • DOI: https://doi.org/10.1007/s41649-023-00238-5

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