The impact of religion on changes in end-of-life practices in European intensive care units: a comparative analysis over 16 years.

PURPOSE: Religious beliefs affect end-of-life practices in intensive care units (ICUs). Changes over time in end-of-life practices were not investigated regarding religions. METHODS: Twenty-two European ICUs (3 regions: Northern, Central, and Southern Europe) participated in both Ethicus-1 (years 1999-2000) and Ethicus-2 studies (years 2015-2016). Data of ICU patients who died or had limitations of life-sustaining therapy were analysed regarding changes in end-of-life practices and patient/physician religious affiliations. Frequencies, timing of decision-making, and religious affiliations of physicians/patients were compared using the same definitions. RESULTS: In total, 4592 adult ICU patients (n = 2807 Ethicus-1, n = 1785 Ethicus-2) were analysed. In both studies, patient and physician religious affiliations were mostly Catholic, Greek Orthodox, Jewish, Protestant, or unknown. Treating physicians (but not patients) commonly reported no religious affiliation (18%). Distribution of end-of-life practices with respect to religion and geographical regions were comparable between the two studies. Withholding [n = 1143 (40.7%) Ethicus-1 and n = 892 (50%) Ethicus-2] and withdrawing [n = 695 (24.8%) Ethicus-1 and n = 692 (38.8%) Ethicus-2] were most commonly decided. No significant changes in end-of-life practices were observed for any religion over 16 years. The number of end-of-life discussions with patients/ families/ physicians increased, while mortality and time until first decision decreased. CONCLUSIONS: Changes in end-of-life practices observed over 16 years appear unrelated to religious affiliations of ICU patients or their treating physicians, but the effects of religiosity and/or culture could not be assessed. Shorter time until decision in the ICU and increased numbers of patient and family discussions may indicate increased awareness of the importance of end-of-life decision-making in the ICU.

Dying a 'Good' Death: The Work, Care, and Support of End-of-Life Doulas.

End-of-life doulas (EOLDs) are a growing population of care providers who focus on the wishes of the dying person in order to cultivate an environment of comfort, peace, and support from the point of terminal diagnosis, during the dying process, and following death. The purpose of this study was to document the time commitment of EOLDs to dying persons and their loved ones during the dying process, as well as their experiences navigating family dynamics working towards increased acceptance of death. A mixed-methods approach was utilized to gather data on EOLDs, consisting of a quantitative survey with 618 respondents and subsequent qualitative interviews conducted with 39 participants. Results indicated that the amount of time spent with dying persons and their loved ones varies widely and often depends on when the EOLD is contracted regarding services. Factors that impede and lead to great acceptance of death are discussed as well as the role of EOLDs in navigating family dynamics.

Representación social de la muerte en un grupo de médicos / Social representation of death in a group of physicians

RESUMEN Introducción: En la relación de los médicos con la muerte en el escenario de lucha que es el hospital se manifiestan procesos psicológicos que legitiman sus conductas de rol. Objetivo: Caracterizar la representación social de la muerte en un grupo de médicos del Hospital Universitario "General Calixto García". Método: Investigación mixta, explicativa y de corte transversal realizada entre junio y septiembre del 2019 en una muestra de 35 médicos. En la etapa cuantitativa se aplicó el instrumento Asociación libre de palabras y para la etapa cualitativa la entrevista semiestructurada. Resultados: El núcleo central está integrado por la categoría Impacto afectivo (FR= 60; M= 3.5), en tanto que los contenidos del sistema periférico que se encuentra más próximos al núcleo en orden estructural son las categorías Concepción racional (FR=20; M= 2.8) y Estado postmorten (FR= 22; M= 4.4); esto en el contexto del Escenario del proceso morir donde ellos interactúan. Discusión: La representación social de la muerte se caracteriza por tener un núcleo central que refleja la diversidad de emociones que se vivencian. En tanto que el sistema periférico da cuenta de los aspectos cognoscitivos que se emplean para una Concepción de la Muerte y que se organizan en torno a la racionalidad biológica como parte del contexto de las características del Escenario del proceso de morir con el que se relacionan.

ABSTRACT Introduction: In the relationship of physicians with death in the scene of struggle that is the hospital, inter and intrasubjective processes are manifested that legimitize their role behaviors. Objective: Characterize the social representation of death in a group of physicians from a clinical-surgical hospital in Havana. Method: Mixed, explanatory and cross-sectional research carried out between June and September 2019 in a non-probabilistic simple of 35 physicians. In the quantitative stage, the Free association of words was applied and for the Qualitative stage, the semi-structured interview Results: The central nucleus is made up of the Affective Impact (FR= 60; M= 3.5) category; while the contents of the peripheral system that are closest to the nucleus in structural order are the categories Rational Conception (FR=20; M= 2.8) and Post-mortem State (FR= 22; M= 4.4). Discussion: The social representation of death is characterized by having a central nucleus that reflects the diversity of emotions that are experienced. While the peripheral system accounts for the cognitive aspects that are used for a conception of death and that are organized around biological rationality. This in the context of the characteristics of the Dying Process Scenario with which they related.

The Relationship between Practitioners and Caregivers during a Treatment of Palliative Care: A Grounded Theory of a Challenging Collaborative Process.

The possibility of coming to a "good death" is a challenging issue that crosses ethical and religious beliefs, cultural assumptions, as well as medical expertise. The provision of palliative care for relieving patients' pain is a practice that reshapes the path to the event of death and gives form to a particular context of awareness, recalling the notion proposed by Glaser and Strauss. This decision redesigns the relationships between patients, practitioners and caregivers and introduces a new pattern of collaboration between them. Our study focuses on the implications of the collaboration between practitioners and caregivers, starting from the assumption that the latter may provide support to their loved ones and to the practitioners, but need to be supported too. We provide a qualitative analysis of this collaboration based on an empirical research that took place in four different settings of provision of palliative care, reporting the contrast between the affective engagement of caregivers and the professional approach of practitioners. We claim that this ambivalent collaboration, while embedded in contingent and incommensurable experiences, brings to the fore the broader understanding of the path to a "good death," outlining its societal representation as a collective challenge.

Farewell Letters I: The Dying Process of a Healthy Man.

This qualitative case study describes the dying process from a purely psychological perspective. The letters of Count Moltke, who was sentenced to death and executed during the Nazi regime, to his wife were analyzed content analytically. A work program of four self-imposed tasks emerged, namely first to avert the death sentence, second to prepare for the ideological and intellectual battle with the chairman of the court, third to support his wife in her anticipatory mourning, and fourth to achieve willingness for his dying by strangulation and for losing his life. Contrasting these findings with two cases of incurably ill men confirmed work and structure as the overarching way of coping. Religious coping is also of central importance. There was neither a linear trajectory nor a sequence of phases; rather, Moltke's dying process corresponds to a circular model. A consequence of the findings is outlined.

Taking care of dying patients through an 'interprofessional ecosystem': a grounded theory study on the experience of an interprofessional team in palliative care.

BACKGROUND: The interprofessional approach is part of the philosophy in palliative care, and its benefits are already documented. However, there are no evidence regarding the process through which the interprofessional team faces the process of the patient's end-of-life and how this experience might be of value for the team's development itself. The aim of this study was to analyse and understand the psychosocial processes that occurs when an interprofessional team accompanies patients and their families to death in palliative care, with the ultimate aim to develop a substantive theory to describe this phenomenon. METHODS: A Grounded Theory method, as theorized by Strauss and Corbin, was adopted for this study. Data were collected through semi-structured interviews and then independently analysed using constant comparison analysis. Fourteen healthcare professionals - belonging to different disciplines (doctor, nurse coordinator, nurse, nurse assistant, psychologist) - were interviewed in a Northern Italy palliative care facility. FINDINGS: The core category of this study was identified to be the process of accompaniment of the dying patient as an interprofessional ecosystem. Moreover, the results showed four main factors determining the development of the core psychosocial process: from professionals' 'Hidden Amazement' to 'Onerous Happiness' where 'Weaving of Professional Resources' and 'Work Meaning' are the underlying conditions to catalyse the process itself. CONCLUSION: Interprofessional care appears an essential value, which becomes the source of the team's strength when facing end-of-life experiences. Health policies and organisations should take the importance of the characteristics of the work environment more carefully. The meaning that professionals attribute to their work and to the team itself, indeed, it may have impact on the overall quality of care and contribute to sustain work engagement, even in stressful situations like end-of-life care.

Navigating the Murky Waters of Hope, Fear, and Spiritual Suffering: An Expert Co-Captain's Guide.

How can surgeons deliver compassionate, holistic care to patients who are beyond cure? Interacting emotionally and understanding hope, fear, and spiritual suffering is key. Responsibly reframing hope to underlying meanings, and away from specific outcomes, is critical. Facilitating moves from cure to comfort to a peaceful dying process requires some retooling of the surgical toolbox. Surgeons possess a unique set of skills, including imagination and an undying sense of hope. Surgeons who have the courage to delve into their emotions and sustain realistic hope for their patients, all the way to the end, will reap deep personal and professional rewards.

Hyoscine Butylbromide for the Management of Death Rattle: Sooner Rather Than Later.

CONTEXT: Death rattle (DR) is a dramatic sign in the dying patient. Existing studies with anticholinergic agents are controversial, as this class of drugs has been commonly administered without considering the rationale of the mechanism of action. A meaningful use of these drugs may provide a better outcome. OBJECTIVES: The aim of this study was to assess the efficacy of hyoscine butylbromide (HB), given prophylactically in comparison with HB administered once DR occurs. METHODS: Dying patients having a score of ≥3 in the Richmond Agitation-Sedation Scale-palliative version were included in the study. HB (60 mg/day) was given when DR occurred (Group 1) or as pre-emptive treatment (Group 2). The onset of DR (death rattle free time) and intensity of DR were recorded at intervals until death. RESULTS: Eighty-one and 51 patients were randomized to Group 1 and 2, respectively. Patients in Group 2 survived longer than those in Group 1 (P < 0.05). DR occurred in 49 (60.5%) and three patients (5.9%) in Group 1 and 2, respectively (P = 0.001). A significant difference in the number of patients reporting DR was found at intervals examined (30 minutes, one hour, and then every six hours until death [P = 0.001]). In Group 1 and 2, DR free time was 20.4 (20.5) and 27.3 hours (25.2), respectively (P = 0.001). In Group 1, the treatment was considered effective in 10 patients (20.4%) only, after a mean of 14.4 hours (SD 8.57). CONCLUSION: The prophylactic use of HB is an efficient method to prevent DR, whereas the late administration produces a limited response, confirming data from traditional studies performed with anticholinergics. This could be considered a new paradigm to manage a difficult and dramatic sign, such as DR.

Receipt of Vasopressors Is Positively Associated With the Length of the Actively Dying Process in Hospitalization.

BACKGROUND: End-of-life care is important in general hospitalization care. However, the clinical impact of using vasopressors on the length of the actively dying process is still controversial. METHODS: We reviewed patients who were hospitalized in general wards and died before discharge. We classified the patients into 2 groups: those who received vasopressors (RVs) and those who did not receive vasopressors (NRV). We analyzed the factors associated with the length of hospital stay (LOS) and the length of the actively dying process. RESULTS: In all, 745 participants, 10.01% of all admitted patients, were analyzed. Of them, 225 patients were RV group, and the remaining 520 were NRV group. Age and gender were comparable in the 2 groups. The use of vasopressors was associated with an admission diagnosis of sepsis and absence of Do-Not-Resuscitate consent and parenteral use of morphine. In multivariable analysis, a high Barthel index score, the absence of cancer and cardiopulmonary resuscitation (CPR), and no receipt of vasopressors were independent factors for LOS. For the length of the actively dying process, a longer duration of inotropic agent, the receipt of vasopressors, and the absence of CPR were independent factors. CONCLUSION: In-hospital mortality is not uncommon during hospitalization in a general ward. The length of the actively dying process is extended by the use of vasopressors. Further prospective study is required for cautious evaluation of the pros and cons of using vasopressors at the end of life during hospitalization.

Construção de uma boa morte numa estrutura residencial / Building a good death in a residential structure

O crescente envelhecimento da população e o desenvolvimento de doenças crónicas, degenerativas e incuráveis nesta fase da vida, confrontam o idoso com a morte. As representações sociais da morte e do final da vida sofreram diversas mudanças, transportando a emergência de novas preocupações voltadas à gestão do morrer. A oferta do aumento do tempo de vida acarreta aos profissionais de saúde e nomeadamente aos cuidadores de uma estrutura residencial um processo de gestão dos limites entre profissionais, idosos e familiares, colocando discussão ética, em torno dos novos significados que passaram a ser atribuídos à morte. Com a finalidade de contribuir não só para a reflexão dos profissionais de saúde em relação aos cuidados prestados em fim de vida, mas também para o desenvolvimento de estratégias de intervenção favoráveis à construção de uma boa morte, colocamos a questão de investigação: "Qual o significado de boa morte na perspetiva do idoso em processo de fim de vida e cuidador formal numa Estrutura Residencial?". Constitui-se objetivo deste estudo: compreender o significado de boa morte para o Idoso em processo de fim de vida e cuidador formal numa estrutura residencial para idosos, na procura de descobrir quais as melhores atitudes a adotar perante um idoso em processo de fim de vida, com o propósito de proporcionar um final de vida com qualidade, segundo as expetativas destes idosos Estudo de natureza qualitativa, usando como metodologia o estudo de caso, com recurso à entrevista semi-estruturada. No estudo participaram idosos em processo de fim de vida e cuidadores numa estrutura residencial. Os dados foram analisados segundo Bardin (2004). Os resultados obtidos evidenciam unanimidade em relação às opiniões dos idosos e cuidadores. A morte é encarada como um processo natural, mas gerador de sentimentos e emoções negativos. Poder estar acompanhado, ser respeitado, com os pedidos satisfeitos e sem sofrimento seria uma boa morte. Como fatores potenciadores de uma boa morte foram realçados a presença de tranquilidade e a necessidade de uma preparação para a morte. A solidão, o abandono, não poder despedir-se dos seus entes queridos são alguns dos fatores que poderiam inibir a boa morte. Os idosos temem a morte, mas anseiam que lhes proporcionem a morte idealizada, segundo as suas necessidades, perspetivas, desejos e que lhe sejam perdoados os pecados. Os cuidadores preocupam-se em proporcionar o máximo de conforto e tranquilidade no momento final da vida de forma que o idoso morra em paz. Sobressai deste estudo que a boa morte deve ser encarada como um direito do idoso numa estrutura residencial.

The growing ageing population and the development of chronic, degenerative and incurable illnesses in this stage of life, confront older people with death. Death and end-of-life social representations have undergone major changes throughout the years, giving rise to new concerns focused on the dying process. Increasing of lifetime makes health professionals, and particularly residential home care providers take part in a management process that includes inter-professional boundaries, elderly and family members, bringing about an ethical discussion around new meanings attributed to death. In order to contribute not only to the reflection of health professionals with respect to end of life care provided, but also for the development of intervention strategies favourable to the construction of a good death, the research question addresses the meaning of "good death" both from the perspective of the dying elder and the residential home care provider. The overall study purpose is to understand the meaning of good death both for the dying elderly and the residential home caregiver, seeking to discover the best approach before the dying process, and aiming to provide quality end-of-life care, according to older people's expectations. The research draws on a qualitative case study methodology, using a semi-structured interview. Dying elders and residential home caregivers participated in the study. Data analysis was based on Bardin (2004). Results show unanimity concerning the views of older people and carers. Although death is seen as a natural process, it also generates negative feelings and emotions. Dying not alone, with respect, with personal problems resolved and not in pain are attributes of a good death. Tranquillity and preparation for the end of life are highlighted as major components of a good death. Loneliness, abandonment, and not being able to say goodbye to their loved ones are some of the factors that could inhibit the good death. The elderly fear death, and crave for an idealized death, regarding their needs, perspectives, desires and forgiveness of sins. Caregivers provide maximum comfort and tranquillity to the elder nearing the end of life helping them to die in peace. The study emphasizes that good death should be regarded as a right of the elderly in a residential home.

O processo de morrer no domicílio / The dying process at home

A morte e o processo de morrer são ainda nos dias de hoje uma problemática de difícil abordagem que gera nas pessoas uma multiplicidade de sentimentos e uma complexidade de atitudes, que influenciam a postura em todo o processo de cuidar. Quem assume o compromisso de cuidar no domicílio durante o processo de morrer, tem que primeiramente ultrapassar obstáculos pessoais, redefinir prioridades e atender a pessoa como um todo. Tendo por base a temática central deste estudo "O Processo de morrer no domicílio" constitui-se como objectivo: compreender a operacionalização do processo de morrer no domicílio, tendo como finalidade contribuir para a sensibilização da sociedade e comunidade científica para a necessidade de acompanhar o processo de morrer no domicílio, dignificando a morte. Estudo de natureza qualitativa, desenvolvido numa perspectiva fenomenológica, recorreu-se á entrevista semi-estruturada como técnica de recolha de dados em que os participantes eram familiares cuidadores da pessoa em fim de vida que residiam na área de influência do ACES Cávado II Gerês/Cabreira. Os dados obtidos foram submetidos a análise de conteúdo segundo Bardin (2011). Os resultados sugerem que cuidar de um ente querido no domicílio durante o processo de morrer representa para os familiares cuidadores uma actividade imersa em dificuldades e exigências pelo fato de existir uma falta de cobertura assistencial por parte dos cuidados de saúde primários e pela desarticulação existente entre os diferentes níveis de cuidados, estando muitas vezes as famílias entregues a si própria, sem apoio, acompanhamento e atenção. Porém, a maioria dos familiares considera que cuidar no domicílio durante este período da vida, permite-lhes elaborar o seu processo de luto e dignificar a morte. Revelam que algumas pessoas em fim de vida, vivem os seus últimos dias repletos de sofrimento e dor, e procuram adotar estratégias como o toque, a presença contínua, as manifestações afectivas e a comunicação oral, como forma de promover o conforto. Sobressai deste estudo a necessidade de uma mudança no paradigma de cuidar, devendo este ser centrado na pessoa, na família e na satisfação das necessidades desta unidade a cuidar. São necessárias equipas de saúde presentes, disponíveis e dedicadas, com formação em cuidados paliativos para que o processo de morrer no domicílio seja uma realidade.

Nowadays, death and the dying process are still very difficult to address and therefore, creates a multitude of feelings and a complexity of attitudes on people, which influence posture throughout the care process. Who is committed to caring at home during the dying process, must first overcome personal obstacles, reset priorities and meet the person as a whole. Based on the central theme of this study, "The Process of dying at home" the main goal of this thesis is: to understand the operationalization of the process of dying at home, aiming to increase society's and the scientific community's awareness to the necessity of monitoring the process of dying at home, therefore dignifying death. This qualitative study, developed under a phenomenological perspective, resorted to a semi-structured interview as a technique for data collection in which participants were family caregivers of the person at the end of life who lived in the area of influence of the "ACES II Cávado Gerês / Cabreira". The obtained data were subjected to content analysis according to Bardin (2011). The outcomes from this work suggest that caring for a loved one at home during the dying process is for family caregivers an activity immersed in difficulties and requirements, because there is a lack of health care coverage by primary health care and a disconnection between the different levels of care. As a consequence of this, families are often left on their own, without support, monitoring and attention. However, most families caring at home believes that this period of life allows them to cultivate their grieving process and dignified death. It is revealed that some people live their last days filled with suffering and pain, thus the family adopts strategies such as touch, continuous presence, affective manifestations, oral communication, in order to promote comfort. From this study arises the need for a paradigm shift in care, which must be centred on the person, the family and in meeting the needs of this unit to care. Health teams present, available and dedicated are necessary, trained in palliative care for the dying process at home to become a reality.

About death and dying: a space for observation / Sobre a morte e o morrer: um espaço de reflexão

This article discusses thoughts and concepts about Palliative Care and Thanatology, sciences dealing with death and the dying process subjects, aiming to widen observations, analysis and discussions already in place about the themes, aiding either the uninitiated public as health care professionals, to handle death and the dying process in a more humanized and closely way, like conditions associated to each and every human being.(AU)

Este artigo discute pensamentos e conceitos na área da Tanatologia e dos Cuidados Paliativos, ciências essas que tratam dos assuntos da morte e do processo de morrer, visando a ampliar as reflexões, análises e discussões já existentes sobre os temas, auxiliando tanto o público leigo como os profissionais de saúde a poderem lidar com a questão da morte e do morrer de forma mais humanizada e próxima, como condições que dizem a respeito a cada ser humano.(AU)

About death and dying: a space for observation / Sobre a morte e o morrer: um espaço de reflexão

This article discusses thoughts and concepts about Palliative Care and Thanatology, sciences dealing with death and the dying process subjects, aiming to widen observations, analysis and discussions already in place about the themes, aiding either the uninitiated public as health care professionals, to handle death and the dying process in a more humanized and closely way, like conditions associated to each and every human being.

Este artigo discute pensamentos e conceitos na área da Tanatologia e dos Cuidados Paliativos, ciências essas que tratam dos assuntos da morte e do processo de morrer, visando a ampliar as reflexões, análises e discussões já existentes sobre os temas, auxiliando tanto o público leigo como os profissionais de saúde a poderem lidar com a questão da morte e do morrer de forma mais humanizada e próxima, como condições que dizem a respeito a cada ser humano.

Sobre a morte e o morrer: um espaço de reflexão / About death and dying: a space for observation

Este artigo discute pensamentos e conceitos na área da Tanatologia e dos Cuidados Paliativos, ciências essas que tratam dos assuntos da morte e do processo de morrer, visando a ampliar as reflexões, análises e discussões já existentes sobre os temas, auxiliando tanto o público leigo como os profissionais de saúde a poderem lidar com a questão da morte e do morrer de forma mais humanizada e próxima, como condições que dizem a respeito a cada ser humano.(AU)

This article discusses thoughts and concepts about Palliative Care and Thanatology, sciences that deal with issues such as death and the dying process, aiming to broaden the already existing observations, analysis and discussions about the theme, in order to help the layman public as well as the health professionals, to handle death and the dying process in a more humanized and approachable way, considering that these are conditions that relate to each and every human being.(AU)

Sobre a morte e o morrer: um espaço de reflexão / About death and dying: a space for observation

Este artigo discute pensamentos e conceitos na área da Tanatologia e dos Cuidados Paliativos, ciências essas que tratam dos assuntos da morte e do processo de morrer, visando a ampliar as reflexões, análises e discussões já existentes sobre os temas, auxiliando tanto o público leigo como os profissionais de saúde a poderem lidar com a questão da morte e do morrer de forma mais humanizada e próxima, como condições que dizem a respeito a cada ser humano...

This article discusses thoughts and concepts about Palliative Care and Thanatology, sciences that deal with issues such as death and the dying process, aiming to broaden the already existing observations, analysis and discussions about the theme, in order to help the layman public as well as the health professionals, to handle death and the dying process in a more humanized and approachable way, considering that these are conditions that relate to each and every human being...

Formação médica, ciência e atendimento ao paciente que morre: uma herança em questão / Medical training, science, and end-of-life care: a legacy at issue

Esta pesquisa foi realizada em instituição pública universitária com o objetivo de melhor conhecer visões, valores e atitudes dos médicos docentes em relação aos pacientes em processo de morrer. Trabalhou-se com o conceito de representação social (Moscovici) e a metodologia qualitativa de análise do discurso do sujeito coletivo (DSC) proposta por Lefèvre e Lefèvre. Os discursos dos investigados revelaram que sofrem muito os médicos, os estudantes e os pacientes diante da morte. Articulados com o predomínio da ótica da biomedicina, prevalecem o despreparo profissional e a ausência de reflexão mais abrangente sobre a morte. Os investigados parecem não perceber relações entre o que falam de si próprios e o que dizem dos estudantes. Alterações na vida institucional parecem necessárias para o enfraquecimento de uma herança não percebida e que envolve médicos, pacientes e estudantes.

This study was conducted in a public university with the aim of learning the views, values, and attitudes of medical professors toward end-of-life treatment for patients. The study focused on the concept of social representation (Moscovici) and the qualitative methodology of collective subject discourse analysis, as proposed by Lefèvre & Lefèvre. The subjects' discourses revealed that end-of-life entails extensive suffering for physicians, medical students, and patients. The predominant view of biomedicine is associated with a lack of professional preparedness and absence of more in-depth reflection on death and dying. The subjects appeared not to perceive the relations between what they say about themselves and what they say about their students. Changes in the teaching hospital's institutional life appear necessary in order to mitigate an unperceived legacy involving physicians, patients, and medical students.

Tairyoku as a belief system of health and illness: a study of cancer patients in Japan.

The aim of this paper is to investigate the concept of tairyoku (body power) within the context of palliative care in contemporary Japan, and to explore its use by cancer patients at palliative care units (PCUs). Tairyoku is thought to be vital energy, analogous to qi in Chinese Medicine. In this paper it is shown that tairyoku is used to monitor bodily condition by patients and that it plays an important role in treatment decision-making for them. Medical professionals also use the word tairyoku; however, they do not agree with the patients' idea of increasing tairyoku in order to cure cancer. This situation causes disagreement about treatment between patients and medical staff at PCUs; however, this paper will show that tairyoku is the important concept to help patients manage their illness and sustain their autonomy, and finally accept imminent death.