Japanese Version of POLST (DNAR) by Japan Association for Clinical Ethics : Ethics for End of Life Care

Abstract

The Japan Association for Clinical Ethics (JACE) organized a working group on DNAR order to discuss the ethics of the decision making process and issued a Japanese version of POLST (DNAR) in March, 2015.
Until recently, consensus regarding DNAR was lacking, with different interpretations among different individual physicians. As a result, various life-sustaining medical treatments other than CPR were withdrawn or withheld.
The Japanese version of POLST (DNAR) has 3 parts : 1. Basal Concept, 2. Guidance (with check sheets), and 3. Form.
Regarding ‘guidance’, the following six reference points are considered relevant : Chap.1. Communication with patient, family members and medical staffs ; Chap.2. Autonomy : respect for patient’s wishes and values ; Chap.3. Substituted judgment : respect for family member’s opinions and ethically adequate process of proxy consent ; Chap.4. Medical matters in consideration of POLST (DNAR) ; Chap.5. Procedual justice of decision making on POLST (DNAR) ; Chap.6. Consideration for the patient and family members after POLST (DNAR) is made.
To reduce and resolve ethical dilemmas relating to end-of-life care, Advance Care Planning is proposed as being of paramount importance. To this end, we advocate the implementation of ethically appropriate POLST (DNAR).