[Withholding and withdrawing life-prolonging treatment--from the bioethical and legal viewpoints].

In Japan we have not reached an agreement on 'Withholding and Withdrawing Life-prolonging Treatment' among medical, bioethical and legal views. To achieve consensus on this issue, we should take several problems into consideration. They include: (1) Medical judgment; 'Is the patient in the end-stage of illness?' 'Is the futility of the treatment evident?' (2) Autonomy of the patient; 'Is the patient competent?' 'Is the Advanced Directive effective?' 'Is this the decision for the patient's best interest?' (3) Decision making by the family; 'Who is the most appropriate surrogate?' 'Does the decision reflect the patient's values?' or 'Is it for the patient's best interest?' (4) Procedural Justice; Enough communication, enough visibility and respecting the opinions by the third party are important to realize procedural justice. (5) To deliberate the difference between ethical and legal judgment, an interdisciplinary approach should be carried out. (6) To achieve consensus among the people, the importance of an Advanced-Directive should prevail widely.