Marui

Where shall we die:In the Hospital or at home ?: 

Where shall we die: In the Hospital or at home ? MARUI Eiji Department of Public Health Juntendo University School of Medicine

Yesterdays: our concern: 

Yesterdays: our concern 1) When shall we die? How long can we live? Length of life 2) How do we die? Cause of death: acute to chronic With or without medical care 3) Then, finally “where shall we die?” As an entrance door leading further issues Quality of Life Quality of medical care

Trends in Deaths by Place of Occurrence: Japan: 

Trends in Deaths by Place of Occurrence: Japan

Last fifty years: 

Last fifty years Belief: More medicalized, better death Modern technologies meant good care Sought to stay and die in the hospitals with more medical instruments Poor people had to die at home Less physicians, But many medical practitioners in community

Today, after 50 years: 

Today, after 50 years More medicalized, less QOL Believe that poor people have to die in the hospital Need more humanistic medical care Less medical practitioners in community Home care physicians, again Willing to pay for death at home Rich people can stay home to die

Why is this an ethical issue?: 

Why is this an ethical issue? Death: Ultimate form of health QOL on the final stage of life Right to decide where place to die Against preference “Spagetti syndrome” in hospital “Ubasute-yama” story in Japan Effort to seek better solution Should be socially acceptable Nursery home?

Problems: 

Problems Role of hospitals Medicalization of death Death is not natural event! Should be behind the curtain Changes of family situation Who (and how) decide the place of death?

Number of hospitals: 

Number of hospitals

Number of Total Beds: 

Number of Total Beds

Number of Physician and Nurse: 

Number of Physician and Nurse

Trend of National Medical Expenditure: 

Trend of National Medical Expenditure

Household composition: 

Household composition

Household with member(s) over 65 yrs: 

Household with member(s) over 65 yrs

Survey on Death of the Aged: 

Survey on Death of the Aged In September 1995, MOHW Subject: 5,454 caregivers of elderly people who died in April 1995 Nation wide survey (13 prefectures)

Deceased subjects preferred places to die and actual places of death: 

Deceased subjects preferred places to die and actual places of death

Preference where to die: 

Preference where to die

Actual place (1): 

Actual place (1)

Actual place (2): 

Actual place (2)

Where the good place to die?: 

Where the good place to die? Own home Hospital or clinic with beds Nursing home Hospice ・・・

Challenges in the 21th Century: 

Challenges in the 21th Century Can not go back to the good old days Medical environment changed Family structure changed Orientation to home care (hospice) More options: Facilities for dying people How the preference can come true? Effort to Attitude change Patient and physician Role of medical practitioners in community Hospital to clinic movement