2015 Volume 25 Issue 1 Pages 35-48
As important participants in a shared decision-making process, patients and their families are expected to form informed intentions, on the basis of which they build consensus with other participants to make shared decisions. Not only decision-aids, but also actual support by medical workers is needed via communication with patients and families. Concerning this support, the following points are discussed in the present paper.
First, there are two guidelines published in Japan regarding the medical decisionmaking process. On the surface, the guidelines for the medical decision-making process in terminal stages created by the Ministry of Health, Labor and Welfare (2007) might seem to recommend individualistic self-determination by patients so far as they are competent. However, with careful word-by-word analysis, they actually recommend respect for patient self-determination based on the consensus reached by deliberation between the participants. The guidelines for the decision-making process concerning artificial hydration and nutrition for elderly people by the Japan Geriatrics Society (2012) explicitly recommend the preceding points of the MHLW guidelines and add more detailed explanations.
Second, the latter guidelines demonstrate the “information-sharing and consensusseeking model,” a type of shared decision-making including a process of communication, wherein the patient and other participants share information and seek consensus on the basis of the patient's way of life. Through such a process, the participants support the patient (and the family) to reach an informed decision.
Third, ACP, the process of making a care-plan in advance, is best understood on the basis of the information-sharing and consensus-seeking model. Not only the advance directive for the end of life, but also many other decisions before the end should be deliberated in advance. Sharing the patients' way of living and values should be the basis for the advance shared care planning.
