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How to Die - A Vast Gap Between Idealism and Reality

Japan is becoming a super-aging society in which one person out of five is over sixty-five years old. In these circumstances, there has developed a growing interest in how to spend the 'autumn of years' and, of principal concern, how to die.In a survey carried out by Japan Hospice Palliative Care a foundation in 2005, over 1000 people were questioned as to where they wanted to be when they had but a few days to live, and 83 percent expressed a desire to die at home.

There is, however, a vast gap between their desire and the actual place of death. According to vital statistics carried out by the Ministry of Health, Labour and Welfare in 2003, the percentage of people dying at some institution, including hospitals, was 84 percent versus death at home at only 13 percent. Similar statistics in 1953 however showed the opposite with the death rate in hospitals at 12 percent to 88 percent at home.
Annual Changes in the Place of Death

We can see from these data that although the completely reverse situation prevails after a lapse of fifty years, the constant desire remains to die at home, just as fifty years ago. In the survey by the foundation, those questioned were given a choice as to what they preferred. To that question, 80% responded that they wished to die at home. Out of that 80 percent, 60 percent of them wished to do so yet didn't believe it was possible from the very beginning. Why is this?

In 2004, the Ministry of Health, Labour and Welfare conducted an investigation into terminal care, which included the following question:
"Supposing you are in pain, have no hope of recovery and are approaching your end (with your remaining days being about six months or less), where would you like to receive medical care until the end?"
This question, describing the terminal stage in a more concrete way than the question in the above-mentioned survey, also offered some choices and which resulted in diversified answers.

"Health care at home and then enter a hospice" was the apparent majority answer, chosen by about 27 percent, followed by "Enter a hospice as soon as possible" by about 23 percent, and "Health care at home and enter a hospital when necessary" by about 22 percent. This amounted to 70 percent, nearly corresponding to the actual death rate at hospitals or other institutions.The fact that almost half of the people mentioned "Health care at home" in their answers is worthy of note. What does this signify?
People prefer to be home until they die only if certain conditions are met, but if unfortunately, the circumstances do not allow this, a hospice or a hospital is selected as the place of death. Isn't that what can be interpreted from the result of the investigation?

There is an old Japanese saying: "I want to die in my own bed", which means people have always had a strong desire to die naturally at home. Recently, front-line health care providers have become aware of the importance to respect the quality of life instead of just giving life-prolonging treatment. Death is not a defeat but is just something inevitable and the road to this should be peaceful and good, whether at home, a hospital or some other institution. Now is the time to think how to improve medical care "at patients' deathbeds".

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