Abstract
Paternalism is a predominant pattern in the social and behavioural climate of medical practice in Japan. Recognition of the sanctity of life is the first principle guiding medical ethics. This principle is an important factor in considering the management of patients with ALS in Japan. Following discussion of these principles in the application of ventilatory support to patients with ALS among the Ministry of Health and Welfare of Japan (MHWJ), the Japan ALS Association (JALSA) and ALS patients and families in the Tokyo Metropolitan Neurological Hospital (TMNH), I have concluded that the development of ventilatory failure in ALS in the Japanese context should not be regarded as the endpoint of the disease but merely one of its impairments. Ventilatory support, considered in this context, can extend the life of an ALS patient.
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