Evaluation of Do-Not-Resuscitate Policy in Japan

Summary

The use of cardiopulmonary resuscitation (CPR) must be carefully considered, especially for terminally ill and elderly patients. The use of DNR orders is relatively new to Japan and there has been little discussion of DNR policy. In 1994, we introduced standardized DNR order forms and guidelines at our university hospital. This study found that CPR was performed much less often after the introduction of the DNR order forms than before in patients who died of lung cancer. This finding might reflect both educational efforts and greater awareness of DNR due to the introduction and use of DNR orders and guidelines. Although few competent patients participated in DNR decisions, surrogates or proxies were consulted in all cases. Because advance directives for medical care have not yet been advocated in Japan, we surveyed inpatients and found that they preferred to participate in decisions about life-sustaining treatment if they could discuss their decision with physicians. Therefore, we introduced an original advance directive called the Personal Medical Directive which can serve as a tool for discussion. Medical opinions on the appropriateness of CPR for certain patients should now be openly discussed. Further efforts to improve both patient participation in decision-making and DNR practice are recommended. We continue to strive for concrete measures, such as the introduction of DNR order forms and the Personal Medical Directive, to improve terminal care and to give all patients an equal opportunity to benefit from medical care.