Comparative Study on Spiritual Care between Japan and Indonesia : Focus on "Care after Death" in the Medical Field

Abstract

Background In the Japanese medical (nursing) field, in which caregivers are involved with patients of various religious backgrounds, the humane aspect tends to be taken lightly. Therefore, systematic care that considers the humane aspect, i.e., spiritual care, has not yet been established in Japan. Objective On the basis of a study on the clinical medical practices of different cultures from anthropological and sociological viewpoints, we aim to clarify the hidden significance of spiritual care, fixed ideas on death and obstacles to performing spiritual care. Method The method is participant-observation, actually joined the Jakarta Islamic Hospital (Rumah Sakit Islam Jakarta) for observations. Results Care after death in Japan can be summarized in these ways. Care after death constitutes routine medical work. Care after death is the last nursing activity for a patient. Care after death is a courtesy shown toward the patient and his/her families. Care after death is customary or traditional practice. Care after death for Muslims in Indonesia does not mean disconnection of ties between the dead and this world, it rather offers a stage for reconfirmation of ties in which everyone is united. Conclusion We present the significance of care after death in relation to nursing care. 1. Care after death offers a site for sharing between the caregivers and the dead. 2. Care after death in nursing means caring in a deplorable situation. 3. Care after death offers caregivers a role to be involved with the family. 4. Care after death helps in coping with death. 5. Caregivers must be engaged in care after death not as disposal workers, but as care workers.

背景 宗教的土壌が多種多様な日本の医療(看護)現場では、形而上的要素が強く影響してくる人間学的側面へのケアが黙止されがちである。そのため、人間学的側面への系統的ケア、いわゆるスピリチュアルケアが不明瞭なままとなっている。目的 宗教的基盤が明確な医療現場で実施されているスピリチュアルケアに参入して、日本の看護師が行っている「死後の処置」を相対化しその人間学的意義を顕在化させる。方法 イスラーム・ジャカルタ病院(Rumah Sakit Islam Jakarta)の宗教医療部準メンバーとなり、スピリチュアルケアに関して参与観察する。結果 日本の医療現場における「死後の処置」は、「医療業務(ルーチン)」「患者への最後の看護」「患者やその家族への礼節」「慣習(しきたり)」が主目的であり「現世(医療)と切り離す場」である。一方、インドネシアのムスリムにとっての「死後の処置」はスピリチュアル活動の一環であり、患者とその家族を含む関係者全員がひとつに結ばれているという「絆を再確認する場」であった。結論 日本での「死後の処置」の場面にスピリチュアルな看護ケアを求める場合、以下のような人間学的意義をもつ。1.「場」の共有2.「喪の作業」の促進3.「共同行為者」としての役割4.「死(という出来事)」への対処5.「片づけ(処理)ではなく手当て」としての処置