2023 Volume 72 Issue 1 Pages 22-30
With the world's aging population and the advent of a “super-aged, multi-death society” in which approximately 1.3 million people die each year, interest in end-of-life care is growing. Many academic societies have developed guidelines on how end-of-life care should be provided. In 2018, the Ministry of Health, Labour and Welfare revised its guidelines on end-of-life care for the first time in 11 years. The public has become increasingly interested in how to end one's own life, as in “end-of-life” activities, and there is a growing discussion about “desirable ways to die” and the corresponding medical treatment. Considerations regarding the kind of end-of-life care required and how medical and welfare professionals should approach patients and their families have emerged. Advances in medical technology have made it possible to prolong patients' lives; however, it is necessary to determine how we should respond when patients do not wish to prolong their lives. In such cases, options such as “euthanasia,” “death with dignity,” and “physician-assisted suicide” are available. However, there is conflict between the patient's preferred choice of dying (patient decision-making) and the medical professionals required to treat the patient.
Therefore, this paper summarizes the decisions made by medical professionals in cases in which ventilators and life-prolonging treatments were withheld or discontinued to respect the decisions of terminally ill patients and considers them in the context of legal arguments.
Japan is less advanced than other countries with regard to Voluntary Stopping of Eating and Drinking (VSED) at the end-of-life. Therefore, we will analyze these issues according to ethics, medical practice, and legislation and discuss how to advance knowledge about VSED in Japan, develop laws and guidelines, and formulate a code of ethics.
