Bito Seiji, Matsumura Shinji, Singer Marjorie Kagawa, Meredith Lisa S, Fukuhara Shunichi, Wenger Neil S
Division of Clinical Epidemiology, National Tokyo Medical Center Clinical Research Center, Tokyo, Japan.
Bioethics. 2007 Jun;21(5):251-62. doi: 10.1111/j.1467-8519.2007.00551.x.
Variation in decision-making about end-of-life care among ethnic groups creates clinical conflicts. In order to understand changes in preferences for end-of-life care among Japanese who immigrate to the United States, we conducted 18 focus groups with 122 participants: 65 English-speaking Japanese Americans, 29 Japanese-speaking Japanese Americans and 28 Japanese living in Japan. Negative feelings toward living in adverse health states and receiving life-sustaining treatment in such states permeated all three groups. Fear of being meiwaku, a physical, psychological or financial caregiving burden on loved ones, was a prominent concern. They preferred to die pokkuri (popping off) before they become end stage or physically frail. All groups preferred group-oriented decision-making with family. Although advance directives were generally accepted, Japanese participants saw written directives as intrusive whereas Japanese Americans viewed them mainly as tools to reduce conflict created by dying person's wishes and a family's kazoku no jo--responsibility to sustain the dying patient. These findings suggest that in the United States Japanese cultural values concerning end-of-life care and decision-making process are largely preserved.
不同种族群体在临终关怀决策上的差异引发了临床冲突。为了解移民到美国的日本人对临终关怀偏好的变化，我们开展了18个焦点小组讨论，共有122名参与者：65名说英语的日裔美国人、29名说日语的日裔美国人以及28名生活在日本的日本人。对处于健康不佳状态下生活以及在这种状态下接受维持生命治疗的负面情绪在所有三个群体中都很普遍。担心给家人带来“迷惑”（身体、心理或经济上的照顾负担）是一个突出的问题。他们更倾向于在进入晚期或身体虚弱之前“噗通一下”（突然死去）。所有群体都倾向于与家人进行集体决策。虽然生前预嘱普遍被接受，但日本参与者认为书面预嘱具有侵扰性，而日裔美国人则主要将其视为减少因临终者的意愿与家庭的“家族の義務”（维持临终患者生命的责任）之间产生冲突的工具。这些发现表明，在美国，与临终关怀和决策过程相关的日本文化价值观在很大程度上得以保留。
