[Terminal care at home of aged]

Between my return from a visit to hospices in England in 1977 and April 1996, our home care program has included 219 patients. Those aged at least 65 years have accounted for 94% and those aged at least 75 years 82%. Almost all (96.8%) live within 2 kilometers of the clinic. My experience has led me to the following conclusions. 1. We should not regard death as taboo, but should learn how to accept death in pace. 2. We should not discriminate by age, and should emphasize humane treatment, particularly in the elderly. 3. We should respect the patient's will and try to improve his or her quality of life. 4. We should see patients helistically, and should not attend to their diseased organs alone. 5. Terminal care must be based on communication. 6. Physicians should not only prescribe medicine but should also devote themselves to the care of patients. 7. Physicians should teach patients and their family members about death. 8. An organic community network for care at home should be established. 9. Access to care should be a community priority. 10. Elderly persons should be allowed to die at home if caregivers are available. Lastly, I should like to quote a poem by Saigyo, a poet-priest of the 12th century. We should remember that many people share his wish of dying naturally under a flowering tree. How I long to die in spring under cherry blossoms Looking up at a full moon in February.