International Exchange Programme

"Caring for the people in clitical situation by profession;what does it mean?"

under the sponsorship sponsorship of
Vihara project, Institute of Palliative Care, NAGAOKA

Society for Reserch of Care, Global COE Program Ars Vivendi

Date:20090628 14:30-17:00
Venue:Institute of Palliative Care, Nagaoka
#360-2,Mitsugouya Machi, Nagaoka, Niigata FAX only 0258-28-0262

■International Exchange Programme,Global COE Program Ars Vivendi
◆DATE:June 28th(SUN),2009 14:30~17:00
◆Venue:Institute of Palliative Care, Nagaoka
#360-2,Mitsugouya Machi, Nagaoka, Niigata, FAX 0258-28-0262

  ●Report1 "Re-examination of Care for the Dying: How modern hospice movement in UK developed into Palliative Care Service within NHS?"
  Kazuko Matoba (Institue of Palliative Care,nagaoka;Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University) )
  ●report2 "Attending deathbed as a Buddhism Priest: from the experience in Vihara Unit"
   Takafumi Morita(Buddhism Priest, Nagaoka-Nishi Hospital)
  ●report3 " Reconsideration the Act of Nursing : What is happening at Acute Medical Care Setteing?
   Mitsuko Obata (Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University)

    Pam Smith(Proffesor,CRNME,University of Surrey)
    Haruo Sakiyama( , Ritsumeikan University)

 ●Special Report
   "An Interim Report of Viha-ra-research Project.」
   Takeshi Deguchi(,University of Meiji)

  ●Free Discussion
◇the languages for discussion:Japanese and/or English ◇This progrrame is under the sponsorship sponsorship of
>Vihara project, Institute of Palliative Care, NAGAOKA

Society for Reserch of Care, Global COE Program Ars Vivendi
◆Futher inquiry
Kazuko Matoba ; matobak@gmail.com

"Re-examination of Care for the Dying: How modern hospice movement in UK developed into Palliative Care Service within NHS?"

Palliative Care Services in Japan is now facing a turning point. The New Law has been enforced since last year, which requires all medical doctors who is dealing with cancer patients have to attend training session of Palliative Care. Although It started in a corner of Public Health service about 20 years ago in Japan. it has come to near the center of Japanese Health system. Recently It is well-known that modern Hospice Movement in UK was originally planed outside of the NHS service by Cicely Saunders. It emerged from her personal experience as the services which has been offered as NHSis not suitable for dying peopleat all as it is originally designed.
However, it changed drastically. It seems now that offering quality of care for dying people is now higher priority in NHS. Since the process of conversion of Hospice concept into Palliative Care Service in NHS stands for the process of the Hospice Philosophy into Action in Society as practical fulfillment, an examination of this process and outcome will provide us good food for thought.
In addition, the development of the principles of Palliative care in Japan has been under the influence of UK movement. For example, many doctors leading Japanese movement has experienceof attending Training Course at St. Christopher's Hospice, and so many conferences were held and invited British Experts as s keynote speakers.
Therefore, to investigate How modern (private) Hospice Movement in UK developed into (public) Palliative care Service within HNS will offers us variable information in order to decide how Japanese Palliative Care Service for nation should be designed within our Health Service System.
Above all, this research project aims to clarify the process of establishment of Palliative Care Service within NHS and to obtain good reference for construction of Japanese Palliative care for the nation within thr public health care system.

The research activity is performed mainly through literature review and interview to British Palliative Care Workers as supplemental.
Data are collected according to three Axis as follows;

Axis 1: Cecily Saunders
   ー What is her hospice concept?
   ー How it become Care Service System?

Axis 2: Development Palliative Care Policy in UK
   ー Policy development based on official documents

Axis 3: Affairs regarding End of Life Care in UK
   ー Right to die Case
   ー Right to life Case
   ー ADTI Bill 2003-2005
How People who is concerning with Palliative Care and NHS responded these affair?

Trough analysis of how these three Axes are mingled each other, I would like to understand the impact of palliative Care for British Society.

"Attennding deathbed as a Buddhism Priest:from the expirence in Vihara Unit
   Takafumi Morita(Buddhism Priest, Nagaoka-Nishi Hospital)

One of the important aspects of Palliative Care must be the issue related to religion /spiritual domain. It is well-known that the original concepts of the Hospice Movement which has been developed into and flourished as “Palliative Care” was under the influence of Christianity. However not all countries have affinity with Christianity. In Japan, Vihara Unit (Nagaoka West Hospital) was established as the first care facility for dying based the Buddhism in 1992. “Vihara” means “The rest place, or stroll for leisure (diversion) ” in Sanskrit. Vihara unit where composes one full-time Buddhism priest as a staff and the Buddhism priest in local as a volunteer hangs out three ideas of the Vihara.
Three ideas of the Vihara are・・・
●The Vihara is a place where persons with a limited life expectancy watch while reflecting upon their lives and being watched and taken care of by others.
●The patient/user is central decisions related to their own care or medical treatment. Therefore,the Vihara should have strong links with the hospital or surgery.
●The Vihara is a place where the Buddhist philosophy is followed. However, the patient or their family are not required to be Buddhist but can follow any religious tradition or belief.

It aims to analyze how the religion in Japan is functioning and what is the role of Bonze (Buddhism priest) in the palliative care unit based Buddhism through hands-on activities in the Vihara unit, especially in the points of a spiritual pain.

Three Focus group was organized from the member of The Association of Buddhist Vihara, which has been working as the voluntary group to help Vihara for the daily services and some other seasonal ceremony. Each group consisted of 3 to 4 people who willing to participate the research, and have a talk with a facilitator in a secure and private room. Semi-structured Topics (motive, evaluation, and commitment) were produced by the facilitator. In Addition, it referred to the semi-structured interview having been executed by several Buddhism people. The interview could be executed after it explained the outline and the content of the research as ethical consideration in the investigation and agreement was obtained, and to take the confirmation, it recorded.

11 people participate the Focus group in April 2008, and 7 people were interviewed in June 2008. All conversation was recorded and transcripted. The object people were all man, and in the focus group interview, the age distribution was one's thirties four people, one's forties four people, one's fifties 0 people, one's sixties two people, and one's seventies one person. Because the standpoint of super-sect is taken in Vihara unit, the belonging sect is various. Therefore, they were three JODO-SHINSHU HONGANJI faction people, two SHINSHU OTANI faction people, three SOTO sect people, and three SHINGONSHU BUZAN faction people. In one's years of experience as a member of “The Association of Buddhist Vihara”, 20 years or more were 2 people, less than 20 years of 15 years or more were 2 people, less than 15 years of ten years or more were 3 person, less than ten years of five years or more were 2 person, and less than five years were 2 person.
▼Talking about member who is related to Vihara unit of long time

“It becomes a true Buddhism, Buddhism related the sufferer, from the Buddhism called a ceremony Buddhism for the first time by relations to the people who make the death the near future.”

“I have not understood what you do as a religionist.・・・I think that the understanding of person's mind, and worry and suffering together more are more important than training (SHUGYO) as a religious person.”

“The most important one is spiritual though it is not visible. It is a existential suffering. If remove a existential suffering, I think that it might not be saving (SUKUI).”

▼Talking about member who is related to Vihara unit recently

“Some confidence was not popular as the priest, and I thought that I did something guilty business. It is likely to have participated by the desire that the priest was able to be good in a dignified manner when going to the Vihara.”

“It doubted that only visiting the parishioner as a priest and returning were original work.・・・It began to have the concern a little at the time thought might do more as a priest.”

“Anyway, it is important though the approach that can become feelings (coming here and safety) is difficult. That is to say, it is not a place where it explains the theory and the doctrine of the Buddhism in Vihara unit.”

“Some consideration can remain, and it go in the direction that the person accepts while thinking about a lot while there is a pain, too for that. It is a Vihara to value the process that man who sees it in surroundings can learn by it very much.”

“Perhaps, when whether it can be done is said, it is not possible to do though I do not understand a spiritual care well still either.”

“I think it is impossible even if a spiritual care is requested by a religious person.”

“Perhaps, I think that only it is official, exists to the last, and the patient himself can do nothing but feel it though it is said that a spiritual care is religious person's role.”

●In present Japan ridiculed with “Funeral Buddhism”, the view to the Buddhism is very negative (For instance, the images that it is inauspicious, associates the death, and is evil existence are formed easily), and the Buddhism person is judging that to be a crisis situation begins to practice some activities (Though it is still small number of people if it sees on a nationwide scale).
●Holding various desires to the identity as an own Buddhism person stood out in relief because the Buddhism priest who was related to the Vihara unit was not an exception either, and the tendency to always grope for the some roles became clear through practice with the Vihara unit that was the activities other than legal affairs in daily life.
●In short, a monotonous composition that the Buddhism priest only did palliative care based on the Buddhism was not approved, the Buddhism person was holding various desires to an own role, and, therefore, it was looked to always update the view to the Buddhism through practice in the Vihara unit.
●In the Palliative care unit (Vihara), the Buddhism person at the age who holds fast to teaching of waiting for that time at ease to leave all because Buddha watches for a long time, and it saves surely though the limit is in same man, can feel the fact of the Buddhism.
●Because the identity of person who succeeds to the traditional Buddhism being held fast is difficult to say, guilty feeling to an existing Buddhism might be exposed in the member who is related to the Vihara unit recently when the self as the Buddhism person is objectively seen.
●If religious circumstances of present Japan are considered, it is thought that it is hoped the Buddhism is not pushed out forward but to understand individual needs, and to correspond to the demand flexibly (the Buddhism is “processed” and “used” well in other words), because the view to user's religion is diversified, and the thing with an intense difference of the extent is forecast.

●The tendency that consideration what were you able to have to do as a Buddhism priest and what to do by you worked in various shape at these 15 years or more became clear.
●It seems that the difference between generations is seen as for the answer of the Buddhism priest who is related to the Vihara unit, and this is related to religious circumstances of present Japan.
●Especially, because the view to the religion (especially Buddhism) is negative, it might be hoped that the religionist doesn´t push the religion (Buddhism) out forward but attaches importance to relations between the person and the person, and puts out the essence of the religion in recently (I wonder whether it is the one that this is called as a result spiritual care.).

Kazuko Matoba
UP: 20090626 REV:20090626

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