From November 21st to 23rd, 2024,Support for sustainable decision-making and arrangements that preserve dignity for everyone during and after life" project, we conducted a survey in Taiwan. We interviewed Professor Kodama and Researcher Sawamura, who conducted the survey, and will share what they learned and realized during the survey in three parts.
The first part of the interviewHerePlease see the article.
Taipei General Hospital
- On November 23rd, Dr. Kodama and Mr. Sawamura each visited different institutions. First of all, Dr. Kodama, what was your experience like visiting Taipei General Hospital?
(Kodama) Sawamura-san mentioned a system for registering funeral wishes, and we also heard about a system for registering patient medical data at Taipei General Hospital. In Taiwan, records of treatment at hospitals are stored in the cloud as public data, and patients can access the data online at any time if they have their health insurance card, and doctors can access the data online if they have their own ID card and the patient's health insurance card. Decisions about treatment policy, etc. are also made by digitizing and storing advance directives created by patients after consultation with the hospital. It's very efficient, isn't it?
また、台北市立総合病院では、独自のパンフレットやすごろくを作り、ＡＣＰ(*1)のプロモーションを行っているそうです。ＡＣＰの前後で死に対する理解度を調査する「Death Literacy Index」があることも伺いました。
(Sawamura) Games such as Sugoroku have also been developed in Japan. The idea is to make it easier to talk about self-care by making it into a game. I think there are people who are proactive in participating and people who are not, so I'm interested in the differences between them.
(Kodama) The most interesting thing about Taipei General Hospital was the talk about "Advance Total Planning." It's about the need to not only provide medical care, but also financial aspects. It's a concept similar to the "mijiri" (closing oneself) we're thinking about in this project. I think they're facing similar issues to those in Japan.
(*1) ACP (Advance Care Planning): Discussions between individuals regarding future medical care and plans with their families and medical professionals.
Gyoichi Clinic
- Next, Dr. Kodama visited Gyoichi Clinic, a facility that supports home medical care for terminally ill patients. What did you talk about?
（児玉）行一診所では終末期医療のお話を伺ったのですが、国立台湾大学病院で話題になった「ＶＳＥＤ」（*２）のお話が出てきました。ＶＳＥＤを実践して亡くなった男性の話が「勇気のあるおじいちゃん」として紹介されており、ＶＳＥＤを立派な死に方と捉える価値観もあることを改めて感じました。
(*2) VSED: An abbreviation for "voluntary stopping eating and drinking," which means voluntarily stopping eating and drinking.
Veterans General Hospital
―沢村さんは栄民総病院で栄民（*３）の身じまい問題や、身寄りなし高齢者の問題について調査されたんですよね。いかがでしたか。
(Sawamura) First of all, it seemed that the vegetarians were not having much trouble with their affairs. Vegetarians immigrated to Taiwan without their families, so systems and mechanisms were established without the assumption that they would have families. There are elderly care facilities and support services for vegetarians, and apparently there is a rule that doctors can make medical decisions for vegetarians. The situation is very different from Japan, so it is not something that can be compared simply, but it was suggestive that if systems and mechanisms were in place, they might not have any problems. Dealing with elderly people without relatives poses challenges such as loneliness and poverty, but at least in terms of procedures, I think it can be seen as a problem that can be overcome with some compromises and local assistance.
--The Veterans have a special position. Is it different for other people?
(Sawamura) Although Veterans General Hospital was originally a hospital for veterans, it has now become an advanced medical center that also accepts general patients, and it seems that they often accept elderly people with no relatives.
I heard that in Taiwan, elderly people without relatives are supported by the community. Neighbors accompany elderly people to medical appointments, or check on elderly people who do not answer the hospital's phone calls, and they have a support system in place in cooperation with hospitals. The person who plays a particularly important role is the person in a position equivalent to the head of a neighborhood association in Japan, who keeps track of elderly people without relatives and elderly care households in the area, and supports them in cooperation with related organizations.
(*3) Veterans: veterans who came to Taiwan with the Kuomintang after losing the civil war with the Chinese Communist Party in 1949.
In the next part, we will share what the two thought and what insights they gained from their three-day research.
