Tanaka Miho, Kodama Satoshi
Japan Medical Association Research Institute, Tokyo, Japan.
Medical Ethics & Patient Safety Laboratory, Keio Research Institute at SFC, Keio University, Kanagawa, Japan.
Asian Bioeth Rev. 2020 Jan 16;12(1):51-57. doi: 10.1007/s41649-020-00109-3. eCollection 2020 Mar.
In Japan, terminating life-sustaining treatment (LST) in non-terminal patients is legally and ethically problematic given the lack of legal regulations regarding the termination of LST, including dialysis treatment. This article describes an ethically problematic case that happened at a hospital in Tokyo in March 2019, in which a patient died after a physician withdrew kidney dialysis upon the patient's request. Most national newspapers in Japan reported the case extensively and raised the question of ethical and legal permissibility of withdrawing dialysis treatment from non-terminal patients. In this article, we first examine the case within the current policy framework in Japan and then discuss how Japan can improve its end-of-life practice, focusing specifically on the patient's right to self-determination and treatment refusal. We recommend that policymakers consider legalizing the termination of LST and the patient's right to refuse treatment based on the principle of respect for autonomy.
在日本，鉴于缺乏包括透析治疗在内的关于终止维持生命治疗（LST）的法律法规，在非终末期患者中终止维持生命治疗在法律和伦理上存在问题。本文描述了2019年3月发生在东京一家医院的一个伦理问题案例，一名患者在医生应其要求停止肾脏透析后死亡。日本大多数全国性报纸广泛报道了该案例，并提出了从非终末期患者身上撤下透析治疗在伦理和法律上是否允许的问题。在本文中，我们首先在日本当前的政策框架内审视该案例，然后讨论日本如何改进其临终实践，特别关注患者的自决权和拒绝治疗权。我们建议政策制定者基于尊重自主权的原则，考虑将终止维持生命治疗和患者拒绝治疗的权利合法化。
