In Japan, terminating life-sustaining treatment (LST) in non-terminal patients is legally and ethically problematic given the lack of legal regulations regarding the termination of LST, including dialysis treatment. This article describes an ethically problematic case that happened at a hospital in Tokyo in March 2019, in which a patient died after a physician withdrew kidney dialysis upon the patient’s request. Most national newspapers in Japan reported the case extensively and raised the question of ethical and legal permissibility of withdrawing dialysis treatment from non-terminal patients. In this article, we first examine the case within the current policy framework in Japan and then discuss how Japan can improve its end-of-life practice, focusing specifically on the patient’s right to self-determination and treatment refusal. We recommend that policymakers consider legalizing the termination of LST and the patient’s right to refuse treatment based on the principle of respect for autonomy.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Airedale NHS Trust v Bland  1 All ER 821 at page 860 per Lord Keith and page 866 per Lord Goff.
Nitta, Kosaku, et al. 2018. 2017 annual dialysis data report, JSDT renal data registry. Nihon Toseki Igakkai Zasshi 51 (12): 699–766 [in Japanese]. https://doi.org/10.4009/jsdt.51.699.
Re JT (Adult: Refusal of Medical Treatment)  1 FLR 48.
Re AK (Medical Treatment: Consent)  1 FLR 129.
The American Bar Association. 2013. Law for Older Americans. https://www.americanbar.org/groups/public_education/resources/law_issues_for_consumers/patient_self_determination_act/ Accessed 7 Aug 2019.
The Asahi Shimbun. 2019. Twenty-four people died with dialysis-related, TMG instructed Fussa Hospital to improve. 10 April 2019 [in Japanese].
The Decision of the Supreme Court. 2009. Case No. a-585.Hanrei-Times No. 1316, p. 147 [in Japanese].
The General Medical Council. 2010. Treatment and care towards the end of life: good practice in decision making. https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/treatment-and-care-towards-the-end-of-life (accessed 7 August 2019).
The JSDT. 2019. The statement of the JSDT. https://www.jsdt.or.jp/info/2565.html [in Japanese] (accessed 7 August 2019).
The Japan Society for Transplantation. 2019. Fact book 2018 of organ transplantation in Japan [in Japanese]. http://www.asas.or.jp/jst/pdf/factbook/factbook2018.pdf (accessed 7 August 2019).
The judgement of the Yokohama District Court. 1995. Case No. wa-1172. [in Japanese].
The Judgement of the Yokohama District Court. 2005. Case No. wa-3802. [in Japanese].
The Judgement of the Tokyo High Court. 2007. Case No. u-1419. [in Japanese].
The Mainichi. 2019. The bereaved sued the Fussa hospital for not resuming dialysis treatment. 18 October 2019. [in Japanese].
The Ministry of Health, Labour and Welfare (MHLW). 2018. The process guideline for the medical decision-making at the last stage of life. https://www.mhlw.go.jp/stf/houdou/0000197665.html [in Japanese] (accessed 7 August 2019).
The MHLW. 2018. The report on the survey of attitude toward medical and nursing care in the last stage of life. https://www.mhlw.go.jp/toukei/list/dl/saisyuiryo_a_h29.pdf [in Japanese] Accessed 7 Aug 2019.
Watanabe, Yuzo, Hirakata Hideki, Okada Kazuyoshi, Yamamoto Hiroyasu, Tsuruya Kazuhiko, Sakai Ken, Mori Noriko, Itami Noritomo, Inaguma Daijo, Iseki Kunitoshi, Uchida Akiko, Kawaguchi Yoshindo, Ohira Seiji, Tomo Masashi, Masakane Ikuto, Akizawa Tadao, Minakuchi Jun, and the Japanese Society for Hemodialysis Therapy Guideline Commission of Maintenance Hemodialysis Investigation Subgroup Commission on Withholding and Withdrawal from Dialysis. 2015. Recommendations for the Shared Decision-Making Process Regarding Initiation and Continuation of Maintenance Hemodialysis. Therapeutic Apheresis and Dialysis 19 (Supplement 1): 108–117. https://doi.org/10.1111/1744-9987.12295.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Tanaka, M., Kodama, S. Ethical Issues Around the Withdrawal of Dialysis Treatment in Japan. ABR (2020). https://doi.org/10.1007/s41649-020-00109-3
- Moral dilemma
- Withdrawal of life-sustaining treatment
- Patient’s right to refuse treatment
- Respect for autonomy