JAMA Intern Med.に非常に興味深い記事が掲載された。

「Medical Assistance in Dying」




We learned the following lesson from this experience. When many of our other patients died, the hardest part for the family was dealing with the uncertainties; when will they die, how would they die, what will it look like, is he or she in pain? And they have to make serial decisions; when to stop blood work, intravenous hydration, vital signs, and remove tubes? All of these uncertainties and decisions induce enormous distress. With MAID, all of that uncertainty and agonized decision making is removed. As a result, the family and the patient undergo much less stress.


とあるように、不確かさ(不確実性)に対して対処することが家族にとって大変つらいことであり、それに伴う意思決定が家族に任されることが重圧となるという言は、医師として臨床にいる人が感じている声であり、たしかにそうなのだと思う。 がん患者自身が自分の安楽死を望むことは、これらの事から家族を解放するための有力な手段だ。ただ、彼らが結びで述べているように、


“Today we did a good thing,” one of us remarked to the other during a mentoring moment when leaving the hospital that evening. We’re not sure if we’ll ever do this again, but we believe that in this circumstance it was the right care, for the right patient, at the right time.