Abstract
BackgroundRegulations on forgoing life-sustaining treatment (LST) have developed in Asian countries including Japan, Korea and Taiwan. However, other countries are relatively unaware of these due to the language barrier. This article aims to describe and compare the relevant regulatory frameworks, using the (more familiar) situation in England as a point of reference. We undertook literature reviews to ascertain the legal and regulatory positions on forgoing LST in Japan, Korea, Taiwan, and England.Main textFindings from a literature review are first presented to describe the development of the regulatory frameworks surrounding the option of forgoing LST in each country. Based on the findings from the four countries, we suggest five ethically important points, reflection on which should help to inform the further development of regulatory frameworks concerning end-of-life care in these countries and beyond. There should be reflection on: (1) the definition of – and reasons for defining – the ‘terminal stage’ and associated criteria for making such judgements; Korea and Taiwan limit forgoing LST to patients in this stage, but there are risks associated with defining this too narrowly or broadly; (2) foregoing LST for patients who are not in this stage, as is allowed in Japan and England, because here too there are areas of controversy, including (in England) whether the law in this area does enough to respect the autonomy of (now) incapacitated patients; (3) whether ‘foregoing’ LST should encompass withholding and withdrawing treatment; this is also an ethically disputed area, particularly in the Asian countries we examine; (4) the family’s role in end-of-life decision-making, particularly as, compared with England, the three Asian countries traditionally place a greater emphasis on families and communities than on individuals; and (5) decision-making with and for those incapacitated patients who lack families, surrogate decision-makers or ADs.ConclusionComparison of, and reflection on, the different legal positions that obtain in Japan, Korea, Taiwan, and England should prove informative and we particularly invite reflection on five areas, in the hope the ensuing discussions will help to establish better end-of-life regulatory frameworks in these countries and elsewhere.
Highlights
Findings from a literature review are first presented to describe the development of the regulatory frameworks surrounding the option of forgoing life-sustaining treatment (LST) in each country
Comparison of, and reflection on, the different legal positions that obtain in Japan, Korea, Taiwan, and England should prove informative and we invite reflection on five areas, in the hope the ensuing discussions will help to establish better end-of-life regulatory frameworks in these countries and elsewhere
The new law allows treatment withdrawal from terminally ill patients, and from any patient who is in an irreversible coma, in a vegetative state, has severe dementia, or otherwise suffers from unbearable pain
Summary
Development of regulatory frameworks with regard to forgoing LST in Japan, Korea, Taiwan, and England Japan In Japan, court cases and other incidents highlighting problems associated with LST withdrawal increased the momentum for legislation. The Hospice and Palliative Care Act allows withdrawing and withholding LST from a terminally ill patient who has a valid AD, which covers the relevant treatment options and designates healthcare proxies; if there is no AD, the patient’s family can submit a consent form on their behalf when patients cannot express their will. A qualitative survey of emergency physicians in Japan conducted between 2006 and 2007 found the following factors to be motivations for avoiding the withdrawal of artificial ventilators: 1) fear of criminal prosecution and concern about unwanted media exposure; 2) concern for the feelings of the patient’s family; 3) physicians’ psychological barriers to shortening patients’ lives by withdrawing LST because they regard withdrawing LST to be an act and not an omission; and 4) medical factors in the acute phase of a severe condition, including the uncertainty of treatment outcome (i.e., they cannot completely deny that the patient may recover) [77].
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