End-of-life care and advance directives in Japan.

This paper examines the ethical issues concerning Advance Directives (ADs) and surveys the current Japanese situation. ADs were devised as a means of expressing the refusal to live in deep unconsciousness. This is validated as the patient's self-determined right to end his/her life in America. This trend affects Japan as well, where the move toward legislation for ADs is seen at present. Many Japanese people think that ADs should be respected because wishes in advance comprise the patient's autonomous decision concerning life-sustaining treatment and death with dignity. However, there are some ethical issues with ADs. The situation surrounding ADs is very uncertain. We cannot prove that a wish in deep unconsciousness and wish in advance are the same. In addition, medical prognoses are not always right. Such uncertainty gives rise to the ethical issue of consistency of advance autonomous decisions. It appears that many people are not aware of the ethical issues, and that there is little public discussion on ADs. Therefore, this paper explores why the Japanese have not argued the ethical issues concerning ADs. Finally, I speculate on the major problems and asks of ADs, and provide materials for the future examination of ADs.