Message from the President
Dr. Kunihiko Ishitani
President of The International Reserch Society of the SCPSC
President, Higashi Sapporo Hospital
Photographer: Dr. Camilla Zimmermann
This red cardinal lives in Dr. Zimmermann's backyard. It loves the dedicated bird feeder!
Greetings,
As the saying goes, "time flies like an arrow," and before we know it the 5th Sapporo Conference for Palliative and Supportive Care in Cancer (SCPSC) will be upon us (July of next year). In the previous issue of our Newsletter, we introduced its theme under the title "Toward a New Era in Palliative Care in Cancer." The program has already been published on the SCPSC website and has received numerous positive responses from readers worldwide.
In this issue, we would once again like to share the details of the program for those who may not have had the chance to view it yet. Additionally, starting this February, participant registration and abstract submissions for general presentations will open. We look forward to receiving many applications.
The SCPSC has addressed the issue of "euthanasia," which is considered to encompass many of the challenges facing palliative care. As part of our exploration of the underlying philosophy, we are examining Kant's concept of "human dignity."
Chapter 4: The Circular Structure Surrounding "Human Dignity"
-On the Dignity of the Deceased -
In October of last year, a public lecture on body donation, titled "A Gift That Connects Lives: The Future of Medicine Opened by Body Donation," was held at my alma mater, Sapporo Medical University. It was organized by Professor Kanna Nagaishi of the Department of Anatomy. As one of the speakers, I delivered a talk titled "The Significance of Body Donation: Exploring the Concept of Human Dignity." The motivation for this event stemmed from a growing concern that, following the COVID-19 pandemic, there has been a decline in the number of individuals willing to donate their bodies. This trend raises potential challenges for future medical education, research, and surgical training. Having personally participated in anatomical dissection practice using body donations during my time as a medical student at my alma mater, I felt deep gratitude and a strong sense of obligation to accept the invitation to speak at this meaningful event.
I have been contemplating the issue of "euthanasia," one of the critical challenges in palliative care, for many years. As a result, I have come to believe that Immanuel Kant's concept of "human dignity" is central to the discussion of euthanasia and that the act of willingly donating one's body symbolizes this profound significance. To conclude my lecture, I stated: "Kant teaches that 'humans have dignity because they possess the freedom to live self-disciplined lives and act morally not only for their own happiness but also for the happiness of others."
In Japan, there is a deeply ingrained cultural practice of solemnly respecting the remains following body donation. This is an accepted notion, observed not only within Buddhism but more broadly through all religious rituals broadly. The reverence for the deceased body and its symbolic power is a universally shared phenomenon.
This universal belief—that “the deceased must be treated with respect”—raises profound and complex questions in moral philosophy, encapsulated in the concept of "the dignity of the deceased." This discussion extends to various contexts, such as the dignity of fetuses, the ethics of organ trade, end-of-life care during the COVID-19 pandemic, and even to deaths caused by war and famine.
In his 2012 work, "Dignity: Its History and Meaning," 1)2) Professor Michael Rosen of Harvard University offers a positive account of Kant's interpretation concerning "the dignity of the deceased." His exploration provides a significant contribution to the discourse on the concept of dignity.
The concept of dignity, as previously mentioned, is a complex amalgamation of various diverse elements.3) After World War II, the concept of dignity expanded beyond the realm of everyday life to occupy a fundamental role in political and legal spheres. For example, the preamble to Article 1 of the Universal Declaration of Human Rights (1948) by the United Nations states, "All human beings are born free and equal in dignity and rights." Similarly, Article 1 of the Basic Law for the Federal Republic of Germany (1949) begins with the declaration, "Human dignity shall be inviolable." Nevertheless, it goes without saying that Kant’s ideas lie at the core of this discussion. In Grundlegung zur Metaphysik der Sitten(1785)4), Kant explicitly states that "the basis of human dignity lies in autonomy, and only morality, which possesses an unconditional and incomparable value, guarantees human dignity." Furthermore, he argues that because human beings have a moral law that embodies autonomy (human beings themselves are the source of law), dignity is always "human dignity." Law entails obligations, and Kant holds that we have obligations to ourselves and to others, and that we have an obligation to demonstrate respect for "human dignity." As we have seen, this is quite different from the modern understanding of autonomy as the individual’s ability to choose whatever way of life suits them.5)
Professor Michael Rosen, in Chapter 3, "Duty to Humanity (Human Dignity)," revisits the question, "Why do we have a duty to treat the deceased with dignity?" He highlights Kant's assertion that "the duty to respect human dignity is fundamentally a duty directed towards oneself." Based on this view, Rosen argues that one cannot truly be human without fulfilling this duty. He concludes that the preservation of dignity for the living—those left behind—becomes possible only by paying respect to the deceased. This creates a circular structure surrounding "human dignity" (the pursuit of the highest ideal, only to return to the point of origin). A recent report depicted the victims in Gaza burying the dead, piling rubble stones over the graves, and offering prayers. This act of showing respect to the deceased—fulfilling the duty to uphold the "dignity of the deceased"—also demonstrated how the dignity of the living is preserved through such actions.
The debate over "body donation" prompted me to look into Professor Michael Rosen's book "Dignity: Its History and Meaning," in which he brilliantly expounds on the "dignity of the dead" based on Kant's "inviolable sanctity of human dignity." Professor Michael Rosen's philosophical thinking on "human dignity" is a great blessing for us, as he is also an outstanding scholar of Immanuel Kant.
References
1. Michael E. Rosen: Dignity: Its History and Meaning. Harvard University Press. 2012
2. Michael Rosen: Dignity: Its History and Meaning. (Translated by Taichi Uchio and Yoichi Mine) Iwanami Shinsho, 2021
3. Yukie Ishitani: IRS-SCPSC Newsletter New Year Special Issue (BMJSPCare Blog Feb.15.2024)
4. Immanuel Kant: Grundlegung zur Metaphysik der Sitten.1785. (The Fundamental Principles of the Metaphysic of Ethics. Translated by Yoshiyuki Mikoshiba, 2022)
5. Kunihiko Ishitani: Human dignity and Autonomy-The fallacy of Autonomy・Self-determination, and Right to Self-determination –
IRS-SCPSC/ News Letter January. 2024
Announcement: The 5th Sapporo Conference for Palliative and Supportive Care in Cancer
We are pleased to announce that the latest poster and flyer for the 5th SCPSC have been completed.
The PDF versions are available upon request. If you would like to receive a copy, please contact the Secretariat.
Thank you for your kind attention.
Below, we have provided an overview of the program for your reference.
For further details, please click the banner below to view them.
Here's an Overview of the SCPSC 2026 program
Genome-wide association studies of opioid response: implications for cancer pain management
Daisuke Nishizawa (Tokyo Metropolitan Institute of Medical Science, Japan)
Opioid therapy for cancer pain: impact of pharmacogenetic analysis
D.Max Smith (Georgetown University, USA)
Edoardo Arcuri (Regina Elena Cancer Institute of Rome, Italy)
Buprenorphine and methadone in the treatment of cancer pain
Russell Portenoy (Albert Einstein College of Medicine, USA)
Effects of opioids on immune response and endocrine function
Jason Boland (Hull York Medical School, UK)
Effects of opioids on reinforcement/reward: risk of abuse and mitigation strategies
Joseph A. Arthur (University of Texas MD Anderson Cancer Center, USA)
The Lancet Commission on medicine, Nazism, and Holocaust: historical evidence, implications for today, teaching for tomorrow
The Era of Personalized Palliative and Supportive Care for Patients with Cancer: Progress and Innovation
Shunichi Nakagawa (Columbia University, USA)
This session will discuss the appropriateness of palliative treatment including chemotherapy, radiation therapy, immunotherapy, targeted therapy, and palliative surgery at the End of Life.
The role of palliative care for patients with advanced cancer
Jennifer Temel (Massachusetts General Hospital, USA)
Palliative care in patients with hematologic malignancies: current trends and future directions
Areej El-Jawahri (Massachusetts General Hospital, USA)
Palliative care in the era of novel therapies and personalized medicine
Jessica Bauman (Fox Chase Cancer Center, USA)
Minding the gap: leveraging palliative care in surgical quality improvement
Ana Berlin(Columbia University, USA)
Future Care Planning-European perspective on better planning for palliative care patients
Psychodynamic Perspective on the Patient-Clinician Encounter in Palliative Care
Sarah Dauchy(APHP. Centre University of Paris, France)
An introduction to a psychodynamic perspective on the patient-clinician encounter in palliative care
Friedrich Stiefel (University of Lausanne, Switzerland)
Basic assumptions of psychoanalytic theory and their relevance for palliative care
Sarah Dauchy (APHP. Centre University of Paris, France)
How psychodynamic approaches contribute to medicine and palliative care?
James Levenson (Virginia Commonwealth University, USA)
How can psychotherapeutic approaches and palliative care be integrated within oncology care?
Camilla Zimmermann (University of Toronto, Canada)
A view from “inside”: working as a psycho-oncologist in palliative care
Ken Shimizu (Cancer Institute Hospital of JFCR, Japan)
Spirituality, spiritual care in comparative cultural studies
Karen Steinhauser (Duke University, USA)
Assisted Dying (euthanasia, VAD, MAID) and Palliative Care: Two Sides of the Same Coin?
David Currow (University of Wollongong, Australia)
Empirical evidence on the relationship between palliative care and assisted dying (AD) in countries with a long standing jurisdiction with legal AD
James Downar (University of Ottawa, Canada)
How palliative care clinicians have adopted to the voluntary assisted dying legislations in the Australian states ever since legalization in Victoria?
David Currow (University of Wollongong, Australia)
Experiences of a palliative care doctor with assisted dying system in Switzerland
Claudia Gamondi (University of Lausanne, Switzerland)
“The Last Flight home” directed by Ondi Timoner
The trailer of the movie can be seen on You Tube. Luc Deliens has reviewed the full movie at a conference in the US and it is very well done showing the importance and complexities of palliative care within an assisted dying trajectory. The producer Mark Barger (New York city, USA) has agreed to shorten up the documentary of about 1h30 min towards a shorter version of 45min, including the provision of Japanese subtitles.
Panel members:
David Currow, James Downar, Claudia Gamondi, Mark Barger, Hideki Onishi
Topics
Introducing interesting medical research papers, for your reference
IL36G-producing neutrophil-like monocytes promote cachexia in cancer
Nature Communications 15 Article number: 7662 (2024)
doi:10.1038/s41467-024-51873-x
Ponsegromab for the Treatment of Cancer Cachexia
N Engl J Med 2024;391:2291-2303
DOI: 10.1056/NEJMoa2409515
Impacts of Immunotherapy on Patients With Aggressive Thyroid Carcinomas
JAMA Oncol. 2024;10(12):1617-1618.
doi:10.1001/jamaoncol.2024.4202
Predictive Biomarkers of Dyspnea Response to Dexamethasone and Placebo in Cancer Patients
J Pain Symptom Manage. 2024 Aug 6:S0885-3924(24)00852-2.
doi: 10.1016/j.jpainsymman.2024.07.003.
Differences in palliative care needs between cancer patients and non-cancer patients at the start of specialized palliative care: A nationwide register-based study
Palliat Med. 2024 Oct;38(9):1021-1032.
doi: 10.1177/02692163241269705.
Maybe for unbearable suffering: Diverse racial, ethnic and cultural perspectives of assisted dying. A scoping review
Palliat Med. 2024 Oct;38(9):968-980.
doi: 10.1177/02692163241268449.
Topics contimued
“It’s not a one-person show” E-learning course in neuropalliative care: A qualitative analysis of participants’ educational gains and self-reported outcomes
Published online by Cambridge University Press: 27 September 2024
DOI:10.1017/S147895152400124X
Intrinsic capacity and survival among older adults with gastrointestinal malignancies: The Cancer and Aging Resilience Evaluation registry
Cancer 15 October 2024 Pages 3530-3539
doi:10.1002/cncr.35427
The humanities in palliative medicine training: perspectives of academic palliative medicine physicians and trainees
BMC Medical Education volume 24, Article number: 1337 (2024)
DOI:10.1186/s12909-024-06295-0
Systemic Anticancer Therapy and Overall Survival in Patients With Very Advanced Solid Tumors
JAMA Oncol. 2024;10(7):887-895.
doi:10.1001/jamaoncol.2024.1129
Delivering High-Quality Cancer Care: Charting a New Couse for a System in Crisis: One Decade Later J Clin Oncol Vol.42,No.36 Oct.02,2024
https://doi.org/10.1200/JCO-24-01243
Thrilling News: A Joyous Announcement!
November15, 2024. The Autumn issue of the SCPSC Newsletter was published on the BMJSPCare Forum.
BMJ SPCare (Please click)
Photographer: Dr. Camilla Zimmermann
This photo was taken in the Muskoka region near Toronto, Canada, capturing the quiet beauty of a snow-covered forest. It evokes the serene atmosphere of winter.
Member's News
📖 Medical Book Recommendation: Dignity in Care: The Human Side of Medicine
How can we preserve "dignity" in healthcare? Dignity in Care: The Human Side of Medicine (by Dr. Harvey Max Chochinov, 2022) explores this crucial topic and provides practical insights.
Author: Dr. Harvey Max Chochinov
🏢 Oxford University Press (2022)
🌐 DOI: 10.1093/med/9780199380428.001.0001
🛒 Available on Amazon
History
Contributor：Dr.Joseph Clark
Lecturer in Global Palliative Care
Wolfson Palliative Care Research Center, University of Hull, UK
Member of The Lancet Commission on The Humanitarian Crisis in Cancer: Palliative Care in Low Resource Settings
Reflections on Dame Cicely Saunders’ Dichotomies: Lessons for the Global Future of Palliative Care
In 1981, Dame Cicely Saunders – the Founder of the Modern Hospice Movement – edited In Hospice: the Living Idea a book reporting the proceedings of a five-day conference held at St Christopher’s Hospice in the United Kingdom. Saunders’ contribution focused on Theme 1: The Hospice Concept, where she reflected on the founding philosophy of hospice care and introduced two dichotomies central to its further development. Together, these two dichotomies continue to frame some of the key challenges for providing appropriate care to patients and families worldwide. Here, I reflect on each dichotomy, to consider what lessons we may learn for the global development of palliative care, by re-visiting Saunders’ writings.
Dame Cicely Sanders (1918-2005)
Dichotomy 1 – how do we balance the sophisticated science of our treatments with the art of our caring?
Saunders’ first dichotomy concerns a risk that increasing use of evidence-based approaches risks palliative care becoming overly technical, at the expense of a compassionate approach to caring.
Although Saunders’ hospice approach arose partly as a response to the over- technologisation of medicine, Saunders was an ardent scientist – focused on developing an evidence-based approach to the implementation of hospice care. Since 1981, the scientific, peer-reviewed evidence for palliative care – and palliative medicine in particular – has increased beyond recognition. Scientific palliative care conferences take place in all world regions, palliative care scientific articles now arise from (almost) every world country. Collectively, they provide a clear evidence-base for a range of palliative interventions – and delineate gaps in knowledge. Plentiful studies are also clear that regardless of effectiveness, interventions may fail if they are not implemented in accordance to context, of health beliefs, preferences and resources.
Within Saunders’ dichotomy, there is a clear warning that hospice care should not become overly technical, at the expense of a compassionate approach to care. But a reimagining of what Saunders may also have meant by describing this dichotomy strikes at the heart of key global challenges; how do we ensure that the care we deliver, incorporates our increasingly ‘sophisticated science,’ for the benefit patients and families worldwide?
In global health, the failure to translate what is known to work into the care that patients receive is called the “know-do gap”—and it may be the biggest hurdle to achieving health equity around the world.1An example of this in palliative care can be seen in the treatment of pain worldwide. We know that morphine is an effective and relatively low-cost medicine for relieving strong pain. Despite this there is a 5- to 63-fold difference in the estimated median consumption of morphine between high-income countries and lower income countries indicating a clear gap between the science and the care being delivered.
Saunders’ dichotomy may warn that palliative care delivery should not become overly technical. However, she would surely consider failure to implement what we know to be helpful for patients and families an imbalance in this dichotomy. Ensuring that the science for addressing the medical symptoms of patients gets into practice, remains a key challenge for all providers worldwide.
Photographer: Dr. Camilla Zimmermann
This photo was taken in the Muskoka region near Toronto, Canada, capturing footprints in the snow that lead off into the distance. The footprints evoke a sense of a researcher moving forward in search of new discoveries, creating a quiet yet powerful impression.
Dichotomy 2 – how do we balance a total focus on the needs of the individual with one’s responsibility to the whole community?
Saunders’ second dichotomy concerns a perceived risk, that a concentrated focus on the needs of the individual, may have unintended negative consequences for communities. In Hospice: the Living Idea 2 , Saunders doesn’t detail her specific thoughts regarding the need to balance the needs of the individual, with the needs of the community. However, the dichotomy expresses Saunders’ concerns about issues of equity in palliative care. In relation to the global development of palliative care, we can consider a number of ways Saunders’ dichotomy is prescient.
First, looking back to 1981, when most hospice patients had a diagnosis of cancer, one way to examine Saunders’ dichotomy is to consider the feasibility of extending the hospice approach to people with non-cancer diagnoses. With a limited hospice workforce – how could a holistic, often time-heavy, approach to care be extended to a larger population? Understood like this, Saunders’ dichotomy warns of the ethical challenges of implementing palliative care equitably worldwide. Why should people who die from cancer receive better care at the end-of-life than people with a non-cancer diagnosis? Extending access to palliative care to non-cancer patients remains a key challenge for global development.
A second interpretation of individual in relation to community needs, is to consider the equity between the palliative care population and wider healthcare population. In all healthcare systems worldwide, difficult decisions on human – and financial - resource allocation take place. The Lancet Commission on the Value of Death highlighted how treatment in the last months of life is costly and a cause of families falling into poverty in countries without universal health coverage.3 Additionally, they highlighted how in high-income countries between 8% and 11·2% of annual health expenditure for the entire population is spent on the less than 1% who die in that year. Is this what patients and families want? Some of this high expenditure is justified, but there is evidence that patients and health professionals hope for better outcomes than are likely. Although Saunders’ dichotomy clear warns of the opportunity costs of providing a total focus on the needs of the individual. In healthcare systems worldwide it is evident that a greater – not lesser – focus on individual need that is still required.
Finally, a global perspective on Saunders’ dichotomy is warranted that takes into account the needs of individual countries in relation to the needs of the global community. Whilst the majority of palliative care services are concentrated is in High Income Countries, the greatest need is in Low and Middle-income Countries. Equity describes the just and fair allocation of resources according to need and improving global health equity is one of the key challenges of the 21st Century. To improve health outcomes in LMICs, richer countries provide Official Development Assistance (ODA), to promote international development. However, although governments committed to providing 0.7% of their Gross National Income (GNI) as ODA, few consistently meet this benchmark. Despite ongoing health challenges in individual HICs, a rebalance of global resources is still required to meet responsibilities of richer countries to the global community.
Conclusion
In 1981, Dame Cicely Saunders articulated two dichotomies, framing challenges for the future development of palliative care which continue to resonate today. In 2025, there is a significant – and increasing – imbalance between need for palliative care and supply. As the practice of palliative care spreads worldwide, Saunders’ two dichotomies remind us that no single blueprint for development is appropriate for any context. Instead, service development must continue amidst ongoing balancing of implementation of evidence and compassionate approaches – and continual balancing between the relative needs of individuals and communities. Reflecting on just how distant feel the dangers of an overly scientific approach to care and total focus on the individual – is a reminder to us all that despite ongoing development - we still have a much to do, to meet the palliative care needs of people worldwide.
1 Donohue F, Elborn JS and Lansberg P et al. Bridging the “Know-Do” Gaps in Five Non-Communicable Diseases Using a Common Framework Driven by Implementation Science. J Healthc Leadersh, 2023;3(15). doi: 10.2147/JHL.S394088.
2 Saunders C, Summers D and Teller N (eds). Hospice: The Living Idea 1981. London: Edward Arnold.
3 Sallnow L, Smith R, Ahmedzai SH, et al. Lancet Commission on the Value of Death. Report of the Lancet Commission on the Value of Death: bringing death back into life. Lancet. 2022 Feb 26;399(10327):837-884. doi: 10.1016/S0140-6736(21)02314-X. Epub 2022 Feb 1. PMID: 35114146; PMCID: PMC8803389.
Please click on the site to view the slideshow, as it is a wonderful slideshow.
Announcement from the SCPSC Team
Season’s greetings
We would like to extend our heartfelt gratitude to Dr. Camilla Zimmermann for generously sharing his beautiful winter landscape photos from Canada as a gift for this issue. Each of these images is imbued with artistry and thoughtfulness, and we are honored to have the opportunity to feature them in several sections. We look forward to sharing the stories behind these photos in a future issue.
Registration for the 5th SCPSC is now open. We would be truly honored if you would consider participating. We eagerly await your involvement.
With best wishes
The SCPSC Team
