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Table 4 Major historical events in end-of-life care in Japan[19, 20]

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 2 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 2 weeks after the insult was too early without clinical evidence (e.g., electroencephalogram) A physician was sentenced 1 1/2 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