Ethical Dilemmas and Advance Directives in Japan

Summary

Recently a number of studies on clinical practices in Japan have been carried out. Researchers have conducted several clinical studies about ethical issues including life-sustaining treatment and advance directives. In this paper, I would like to review the studies published about these issues and also refer to the outcomes of two recent studies using a group interview with Japanese physicians and a nationwide survey. These results indicate that the general public, patients, and physicians in Japan think that advance directives would help to make medical care at the end of life more satisfactory. However, it has also been suggested that the wishes of patients or their advance directives are not always respected and that ethical decision making by Japanese physicians may depend on the situation and thus be inconsistent. It was also suggested that attitudes of physicians and a patient’s family towards advance directives, life prolongation, and death with dignity can be possible barriers to implementing a competent patient’s wishes or advance directives. Some physicians and family regard withholding or withdrawing of life support from a patient, even if according to the patient’s wishes, as abandonment or killing. Furthermore, family’s wishes to be at the bedside at the time of a patient’s death seem to strongly affect the physician’s decision about whether to perform cardiopulmonary resuscitation. We need to determine the importance of advance directives fro the Japanese and to find the best way to utilize such directives in Japanese clinical settings.