2025 Volume 13 Pages 5-20
This study examined the ethical issues in supporting patients with dementia including a legal perspective. An online survey conducted with 1,588 members of the Japanese Association of Social Workers in Health Services assessed their awareness of respect for the wishes of patients with dementia, understanding of the inherent autonomy of the patients in decision-making, and practices surrounding Artificial Hydration and Nutrition (AHN). Responses were obtained from 264 participants (response rate : 16.6％). Medical Social Workers (MSWs) generally understood the personal nature of patients’ autonomy in decision-making. However, ＞50％ mistakenly believed that “a key person,” i.e., the closest family member or individual most closely related to the patient, held a proxy decision-making right. Many MSWs recognize the decision-making capacity of patients with dementia and aim to respect their wishes. However, the findings showed that family preferences, conditions set by receiving facilities, such as long-term care hospitals or nursing homes, and physician decisions often led to AHN choices, such as gastrostomy or central venous nutrition, which contradicted the patients’ wishes. To address this, promoting Advance Care Planning and developing systems that honor the wishes of patients with dementia are needed alongside balancing healthcare limitations and Japan’s cultural emphasis on family preferences.
