Abstract
Five years have passed since the Japanese Long-Term Care Insurance Law was enforced. Since then, many ethical problems have become evident. They include: 1) Social welfare being viewed as a business opportunity; 2) Violation of the autonomy of the elderly, especially those with dementia; How to determine 'competence'? Who should be a surrogate or proxy? What is in the best interests of the elderly?; 3) Issues relating to the care of the dying in nursing homes; the definition of 'terminal'; what constitutes the futility of treatment; issues relating to unnecessary life-prolonging medical treatment (e.g. tube feeding); and 4) Other issues such as those of privacy, the keeping of official secrets, and abuse and risk management. There is a need to cultivate the ethical sensitivity of care-givers, and to explore ways to analyze and resolve these difficult ethical problems so as to respect the dignity of the elderly as human beings until the last moment of their life.
