Wataru Sakurado: The Challenge of Self-Dialysis to Improve QOL

Throughout its long history, Japanese medicine has established a clear division of roles between doctors and patients. Medical professionals provide guidance as the primary agents of treatment, while patients are the recipients who follow that guidance. While this structure has supported the safety and uniformity of medical care, it cannot be denied that it has also suppressed patients' proactive decision-making and fixed medical care as something "given from above." This is the influence of so-called paternalism.

Within a hierarchy with doctors at the top, medical professionals bore the "responsibility to cure," and patients were seen as the beneficiaries of that care. While this structure achieved certain results in ensuring the quality of medical care, it simultaneously narrowed the scope for patient decision-making and fixed medicine as a one-way service. If medicine is an endeavor that supports human dignity, we must once again ask the fundamental question: who is the subject of the treatment?

Dialysis medicine is one of the areas where this structure remains most prominent. The form of treatment—attending a medical institution at fixed times for four-hour dialysis sessions three times a week—has not changed for over half a century. For reasons of safety, patients have been forced to comply with the framework of the medical system, sacrificing their lives, work, and family time. If life-sustaining treatment robs one of the "power to live," then the purpose of medicine has been lost. Medical safety should not mean sacrificing the patient's freedom.

The "self-dialysis" we promote is a response to that structure. Under the supervision of medical professionals, patients perform their own punctures and operate the machines, carrying out the treatment themselves. What is important is for patients to regain the "circuit of independence"—understanding their own bodies, making judgments, and taking action. The act of performing medical care with one's own hands is an experience of reclaiming life as "one's own" rather than being passive. Within that act resides the courage to challenge fear and the will to believe in oneself.

This practice also aligns with the concept of "Self-management support," which is gaining international attention. The Chronic Care Model (Ed Wagner, Univ. of Washington), which structured chronic disease care, placed the support of knowledge and confidence by medical professionals at its core so that patients can manage their own health and lives. Self-dialysis can be described as a pioneering model from Japan that embodies this philosophy in the field.

In fact, in a survey of patients practicing self-dialysis, the top responses were "comfort and freedom" (60%), "satisfaction and peace of mind" (55%), "weight management" (50%), "reduction of dietary restrictions" (35%), and "feeling physically well" (30%) (multiple answers allowed). These responses indicate a sense of affirmation toward life itself rather than just satisfaction with treatment technology. In particular, the alignment of terms like "comfort," "freedom," "satisfaction," and "peace of mind" suggests that self-dialysis contributes not only to improved QOL but also to the recovery of psychological well-being. Behind the numbers lies a certain realization that patients "have become able to control their own lives again."

When facing patients in the field, these changes appear in their expressions and words. A look of confidence not seen when they were entrusting their treatment to others, the sight of them reading work materials during dialysis, or a gentle smile as they say, "I've become able to do it myself."

Patients say things like, "I'm happy that I can do normal things normally now," "I'm happy to have reclaimed my life as a woman through improvements in beauty and health," "I'm happy to be able to work sufficiently and be entrusted with tasks on equal footing with other employees," and "I'm happy that I can now walk after recovering the physical strength I had lost." In every voice, the joy of reclaiming the initiative in one's life shines through.

This shows that medicine is not merely the act of healing the body, but a "place where people begin to tell the story of their own lives again." All of this tells the story of medicine as an endeavor that allows people to grow. Medicine should inherently not only compensate for human weakness but also draw out human potential.

Through self-dialysis, many patients are undergoing dialysis while working and reclaiming their roles within their families and local communities. As dialysis rooms transform from "places of treatment" to "places of independence," the role of medical professionals is also changing. From managers to companions, from commanders to co-creators. Patient independence brings new freedom and learning to medical professionals. Medicine is quietly shifting from a relationship of dominance and subordination to one of trust and collaboration.

Improving QOL is not simply about seeking comfort. It is about people regaining the power to understand their own lives, give them meaning, and step forward into the future. When medicine becomes the catalyst for this, treatment returns from "management" to "culture." The challenge of self-dialysis is both a technological innovation in medicine and a cultural movement to reclaim human dignity.

From medicine "to keep alive" to medicine "to live." This shift encourages the maturity of not only patients but also medical professionals and society as a whole. Beyond that, we see a new horizon of medicine centered on human dignity.