「最期はどこで過ごしたいか」と聞かれたら

厚生労働省の調査では、「人生の最期は自宅で迎えたい」と希望する方は全体の約7割に上ります。しかし、実際に自宅で亡くなる方は全体の約15%にとどまっています。希望と現実の差には、様々な理由があります。「急変したときが不安」「家族に迷惑をかけたくない」「自宅で看取りなんてできるのか分からない」——こうした不安が、本人と家族の希望を阻んでいることが少なくありません。

在宅看取りは、決して特別なことではありません。適切な医療・介護の支援があれば、住み慣れた自宅で最期を迎えることは十分に可能です。岡田内科では、患者さんとご家族が「自宅で最期を迎えたい」という希望を持たれたとき、その選択を最大限にサポートします。

在宅看取りとはどういうことか

在宅看取りとは、病院や施設ではなく自宅で、自然な経過の中で人生の最期を迎えることです。老衰、末期がん、心不全、認知症、呼吸器疾患など、回復が見込めない状態になったとき、「これ以上の積極的な治療よりも、苦痛を和らげながら自宅で過ごす」という選択をされる方がいます。これを「緩和ケア中心の在宅医療」と言います。

在宅診療医は、痛み・息苦しさ・不安・口渇・浮腫などの症状を和らげる薬の管理を行いながら、本人が望む場所・望む形で過ごせるよう支えます。「苦しまずに逝かせてあげたい」というご家族の願いに応えることも、在宅看取りの大切な役割のひとつです。

「急変したとき」への備え

在宅看取りを選ぶ上で最も多い不安が、「急変したときどうすればいいか」です。岡田内科では、在宅看取りを担当する場合、事前にご家族と十分に話し合い、以下をお伝えします。

予測される経過と、どのような変化が起きるか（呼吸の変化・手足の冷え・意識の変化など）。変化が起きたときに連絡する先（訪問看護師や担当医師の電話番号）。救急車を呼ぶべき状況と、呼ばなくていい状況の見極め方。亡くなった後の手続き（死亡診断書の発行・葬儀社への連絡の流れ）。

「何かあったときに一人で抱えなくていい」という安心感が、在宅看取りを支える最も大切な基盤です。夜中に状態が変わっても、電話で対応できる体制を整えています。

ご家族の負担について

在宅看取りを選ぶとき、「家族に迷惑をかけたくない」と言う方がいます。確かにご家族の負担は小さくありません。しかし、岡田内科が関わった在宅看取りのご家族の多くが、後日「家で看取れてよかった」とおっしゃいます。病院のベッドではなく、自分の布団で、家族に囲まれて逝くことの意味は、やはり大きいものです。

負担を軽減するために、訪問看護・介護サービスを最大限活用します。夜間の急変に備えた連絡体制も、チームで整えます。「看取りはハードルが高い」ではなく、「チームで支えるから、家族の負担を最小限にできる」という視点で、一緒に考えてください。

「最期のことを、まだ先のこととして考えていない」という段階でも、ご相談いただけます。いつか来るその日に備えて、今から話し合っておくことは、本人とご家族の双方にとって大切な時間です。まずは外来でも電話でも、お気軽にご連絡ください。

岡田内科の方針

岡田内科では、「病院で治療を続けること」と「自宅で穏やかに過ごすこと」のどちらを選ぶか、あるいはご家族の負担や本人の苦痛を考慮した「施設に入所すること」について、本人とご家族の意向を最も大切にしています。在宅看取りを希望されても、途中で「やはり入院したい」という気持ちに変わった場合も、どちらも誠実に対応します。一度決めたからといって、変えられないわけではありません。

「最期のことを、まだ先のこととして考えていない」という段階でも、ご相談いただけます。いつか来るその日に備えて、今から話し合っておくことは、本人とご家族の双方にとって大切な時間です。

ご相談やお問い合わせは、お電話・受付窓口にて承っております。
詳しくは、在宅診療のページをご覧ください。

大林賢史
Kenji Obayashi, MD, PhD
　医師の研究者プロフィールはこちら

　
　
　
　
　
　
　

The Option of Home End-of-Life Care — On Spending One’s Final Days at Home

If You’re Asked: ‘Where Would You Like to Spend Your Final Days?

According to a survey by Japan’s Ministry of Health, Labour and Welfare, roughly 70% of people say they would like to spend their final days at home. In reality, however, only about 15% of people actually pass away at home. There are many reasons behind this gap between wish and reality. Concerns such as “I’m worried about what happens if my condition suddenly worsens,” “I don’t want to be a burden on my family,” or “I don’t know if dying at home is even something we could manage” often stand in the way of what patients and their families truly want.

Passing away at home is by no means something extraordinary. With the right medical and caregiving support in place, it is entirely possible to reach the end of life in the comfort of one’s own home. At Okada Naika Clinic, when patients and their families express the wish to spend their final days at home, we do everything we can to support that choice.

What Does It Mean to Pass Away at Home?

Passing away at home means reaching the end of life through a natural process, in one’s own home rather than in a hospital or care facility. When someone reaches a stage where recovery is no longer expected—due to conditions such as frailty of old age, terminal cancer, heart failure, dementia, or respiratory disease—some choose to spend their remaining time at home with comfort care rather than continuing aggressive treatment. This approach is known as “home-based medical care centered on palliative care.”

Home care physicians manage medications to ease symptoms such as pain, breathlessness, anxiety, dry mouth, and swelling, while supporting the patient in living out their remaining time in the place and manner they wish. Fulfilling a family’s wish to “let them go peacefully, without suffering” is also one of the most important roles of home-based end-of-life care.

Preparing for a Sudden Change in Condition

The most common concern when considering end-of-life care at home is: “What should we do if something suddenly happens?” When Okada Naika Clinic takes on responsibility for a patient’s home end-of-life care, we hold thorough discussions with the family in advance and make sure to cover the following points.

We explain the expected course of the illness and the kinds of changes that may occur, such as changes in breathing, coldness in the hands and feet, or changes in consciousness. We provide contact information for when a change occurs, including the phone numbers of the visiting nurse and the attending physician. We help families understand how to distinguish situations that call for an ambulance from those that do not. We also walk families through the procedures that follow a death, including the issuing of a death certificate and how to contact a funeral service.

The sense of reassurance that comes from knowing “you don’t have to face this alone if something happens” is the most important foundation supporting end-of-life care at home. We maintain a system that allows us to respond by phone even if a patient’s condition changes in the middle of the night.

On the Burden Placed on Family Members

Some people say, “I don’t want to be a burden on my family,” when considering end-of-life care at home. It’s true that the burden on family members is not small. However, many of the families who have gone through home end-of-life care with Okada Naika Clinic later tell us, “I’m glad we were able to care for them at home.” There is real meaning in passing away surrounded by family, in one’s own bed, rather than in a hospital bed.

To help ease that burden, we make full use of home nursing and caregiving services. Our team also puts a contact system in place in preparation for sudden changes during the night. Rather than thinking “end-of-life care is too difficult to manage,” we encourage families to consider it from the perspective that “because a team is there to support you, the burden on the family can be kept to a minimum.”

Even if you feel that thinking about the end of life is something for “someday, not now,” you are still welcome to consult with us. Talking things over now, in preparation for the day that will eventually come, is valuable time for both the patient and the family. Please feel free to reach out to us, whether during an outpatient visit or by phone.

Okada Clinic’s Approach

At Okada Naika Clinic, we place the highest priority on the wishes of the patient and their family when it comes to choosing between continuing treatment in a hospital, spending time peacefully at home, or—taking into account the family’s burden and the patient’s suffering—entering a care facility. Even if a patient who initially wished for home end-of-life care later feels, “Actually, I’d like to be hospitalized after all,” we will respond sincerely to either choice. A decision made once does not mean it can never be changed.

Even if you feel that thinking about the end of life is something for “someday, not now,” you are still welcome to consult with us. Talking things over now, in preparation for the day that will eventually come, is valuable time for both the patient and the family.

　

　　

　

　

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