The Dying Process across Human Life Cycle: Ethical Considerations on Terminal Care

Dying is an event that affects human development throughout the life cycle—impacting individuals, communities, and society. Providing terminal care may mitigate the suffering of patients and families. Notwithstanding, it poses challenges concerning patients’ decision-making and autonomy, in regard to communicating bad news, resuscitation orders, and voluntary termination of life. This study seeks to discuss ethical issues underlying terminal care, showing how the problem of patients’ decision-making and autonomy can be addressed at the end of life. It distinguishes the notion of worthy death, which could ground ethical decisions for health attention across different developmental stages.

The Impact of Repeated Death Conference Participation on Nurses’ Terminal Care and Nursing in Death Conference Using the Death Conference Nursing Self-Assessment Sheet

Background: Increasing the number of DC (Death Conference) experiences, nurses are expected to improve the quality of nurses’ terminal care and developing nursing minds. Therefore, there is a need for further evidence on the impact of repeated DC experiences on nurses’ terminal care. Aim: This study aims to clarify the impact of repeated DC experiences on nurses’ terminal care and nursing in DC using the prepared Death Conference Nursing Self-Assessment Sheet. Method: The study is approved by the Ethics Review Board of St. Mary’s College, Chukyo Gakuin University, and the hospital where the survey was conducted. This study was an observational and cross-sectional study using an anonymous, self-completed questionnaire composed of the newly created Death Conference Nursing Self-Assessment Sheet. Its evaluation items in the Death Conference Nursing Self-Assessment sheet consist of four categories (Cooperation, Future direction of nursing, Specific measures for nursing, and Feeling of the nurse) and 14 questions. The questionnaires were conducted on 144 nurses in the ER, ICU, and Palliative Care Ward (Hospice Ward) in a general hospital in Japan. For analysis, JMP ver.14.2 was used to perform Fisher’s exact test, Wilcoxon/Mann Whitney test, univariate, and multivariate logistic regression analysis. Results: Thirty-four participants (23.6%) who answered the number of DC experiences were included in the final analysis. Seventeen nurses had DC experiences, and 17 had no experience. There were significant differences in all of the above categories impacting nurses’ terminal care and nursing in DC. Conclusion: Repeated DC affected nurses’ terminal care and nursing in DC using the Death Conference Nursing Self-Assessment Sheet. In the future, verification of the reliability, validity of the questionnaire, and more evidence of the way of terminal concerns by raising the quality of DC for developing nursing minds will be needed.

Literature Review on Support for Children and Families Experiencing Parental Bereavement

Purpose: This study aimed to understand the actual nursing support in a wide perspective by reviewing overseas literature on support for children who have experienced parental bereavement and their families. The goal was to identify future challenges in nursing support in clinical practice in Japan. Method: Literature searchable as of May 2023 was retrieved using PubMed, resulting in 11 relevant articles. Result: The results revealed the following: 1) For support provided to children, 13 codes were condensed into 5 subcategories and 4 categories. 2) For support provided to families, 36 codes were condensed into 11 subcategories and 4 categories. Conclusion: Open communication was found to be essential for supporting children and their families who have experienced parental bereavement. Moreover, involvement of multiple professions facilitated the provision of specialized support to address diverse needs of children and families, playing a crucial role in overcoming grief. Additionally, the effectiveness of support systems for bereaved families highlighted the need for nursing professionals in Japan to gain knowledge through learning opportunities and to establish a multi-disciplinary approach to support, thus indicating future challenges in nursing support.

Human Rights Jurisprudence in Hospice Care——Thoughts on the Concept and Boundary of “Death with Dignity”

Death with dignity is the embodiment of the dignity of human life in the context of end-of-life medical care.However,in the development of its concept,it has been alienated into a single way of death and is often confused with the concept of euthanasia.It is therefore a theoretical and practical necessity to re-expand the connotations of death with dignity Death with dignity is the subjective value of dignity reflected in the context of dying.It takes equality,freedom,and virtue as the core,and uses the right to life as its external support.It is projected onto the medical context and incorporates the patient’s right to informed consent.Subject to public interest,legal paternalism,and the principles of public order and good customs,the boundary of the right to death with dignity should be between active treatment and natural death,and active euthanasia in the form of giving up the right to life should not be included in the right to death with dignity.