Decision-Making in Social and Medical Services for Patients with Dementia in Japan

Abstract

There is no one likely in Japanese society today who objects to the assertion that it is society’s duty to assist individuals with physical disabilities to achieve the lifestyle that they have chosen for themselves. However, these ideals do not easily translate into action. When elderly people, living on their own or living in a nuclear family, suffer a functional disability, they may strongly desire to continue living at home. When such circumstances arise, the family and those people living nearby must make sacrifices for this to be realized. The problem becomes more complicated when the ability of the elderly person to construct a reasonable wish is adversely affected by mental disorders, such as dementia. An individual suffering from dementia has not necessarily lost the ability to determine his or her lifestyle. However, we must take care not to simply accept the volition expressed by an elderly person with dementia as his/her true volition, as it may instead reflect his/her reduced ability due to the disease to think while adequately recognizing the impact on society. We also cannot hold such a person responsible for the outcome of their actions. There is a risk of endangering others by blindly accepting the wish of elderly individuals who suffer from dementia, live by themselves, and refuse to enter an old age home or receive assistance from home based care services. People living near an affected individual may be exposed to dangers, such as accidental fires because they have a neighbor who cannot follow simple safety measures Similarly, elderly individuals suffering from dementia who live alone represent a potential danger to themselves if society respects their wishes and allows them to stay at home.