Abstract
Recently in Japan, several guidelines regarding terminal care issues have been published and all of them refer to respect for individual autonomy. Similarly, the preference of patients requiring maintenance hemodialysis (MHD) should be respected so that they may spend the rest of their lives peacefully. This study utilized a virtual scenario in which a patient decides to withdraw from MHD in a broadly- defined terminal state, and discusses the implications of both MHD cessation based on self-determination and medical care in and after the decision-making process, based on the “Proposal for the Shared Decision-Making Process Regarding Initiation and Continuation of Maintenance Hemodialysis” (The Japanese Society for Dialysis Therapy, 2014). The results of the study suggest that it is ethically permissible and proper to allow MHD cessation if patients properly discuss and adequately understand their medical conditions and treatments and are permitted to make decisions without external pressures when in a broadly- defined terminal state. However, the decision-making process must be reviewed carefully while considering contextual features. In Japan, health professionals also require continual awareness of the inconvenient fact that there is no law providing immunity. This study suggests agendas that will supplement the proposal. In conclusion, it is necessary to comprehensively develop education about palliative care, consultation systems and subsequent grief care.
