From: End-of-life considerations in the ICU in Japan: ethical and legal perspectives
Year | Name of hospital | Issues | Importance |
---|---|---|---|
1991 | Tokai University Hospital | Administration of potassium chloride to ease a patient's respiratory discomfort at the request of the patient's family | Withholding or withdrawal of care is applied when the following condition fits: |
1. A patient is terminally ill and death is inevitable | |||
2. Living will or advance directive exists at the time of end-of-life decision | |||
3. Mechanical ventilation, dialysis, medication, blood transfusion, medication, and artificial nutrition are targets of withholding or withdrawal of care | |||
A living will or an advance directive by the patient did not exist and the surrogate decision in the setting of poor understanding of the patient's condition was not appropriate to determine the patient's end-of-life care | Euthanasia was established to be illegal. A physician was sentenced 2Â years in prison | ||
1998 | Kawasaki Kyodo Hospital | Withdrawal of endotracheal tube and administration of neuromuscular blockade for respiratory discomfort | Withdrawal of care in this situation was not legally indicated; however, the Supreme Court did not cite a specific norm when withholding or withdrawal of care is applied |
Confirming poor recovery or prognosis 2Â weeks after the insult was too early without clinical evidence (e.g., electroencephalogram) | A physician was sentenced 1 1/2Â years in prison | ||
Withdrawal of care requested by the patient's family was performed without providing appropriate information about the patient's prognosis | |||
2004 | Hokkaido Haboro Hospital | Withdrawal of mechanical ventilation without confirmation of brain death or informed consent | The physician was not prosecuted because subsequent investigation concluded that the patient would have died shortly even with ventilator support |
2006 | Imizu Civil Hospital | Seven deaths after withdrawal of mechanical ventilation was investigated | The physician was not prosecuted because of insufficient evidence to prove the relationship between ventilator withdrawal and the patients' deaths |
2006 | Wakayama Medical University Hospital | Withdrawal of mechanical ventilation from a brain-dead patient at the request of the patient's family | Physicians and the hospital were exempted from prosecution |
2006-2009 | - | - | End-of-life care guidelines were developed by a variety of societies |
2009 | Fukuoka University Hospital | Withdrawal of percutaneous cardiopulmonary support (PCPS) as requested by the patient's family | The treatment team withdrew PCPS according to the 2007 end-of-life guideline and the team was not prosecuted |