JAPAN: First Terminal Care Guidelines Drafted

TOKYO (Japan Times - Kyodo News), April 10, 2007: The Health, Labor and Welfare Ministry on Monday formulated a basic terminal care guideline that puts priority on patients' wishes in deciding whether and when to begin and halt treatment to prolong their lives, ministry officials said. The first government-set guideline on terminal care stipulates that honoring the patients' wishes is the "most important principle" in dealing with such type of care. To prevent individual doctors from making single-handed decisions, the guideline asks hospitals to set up teams of doctors and nurses to care for such patients and calls for any agreements to be documented between them and the medical teams. If there is no way to know the patients' wishes, teams must "discuss with the family and treat the patient in a way deemed best for the patient," it says. The ministry's study panel on the matter, headed by Norio Higuchi, a professor at the University of Tokyo graduate school, endorsed the guideline in principle on Monday, ministry officials said. The ministry plans to formally approve the guideline and report it to local governments and hospitals, they said. The guideline marks the introduction of the first unified criteria on terminal care. But judgments on the appropriateness of specific acts, such as under what circumstances doctors should be allowed to remove a respirator, have been left for future discussions. The guideline, however, leaves one critical question unanswered: Under what circumstances would doctors not be charged with murder even if they were to halt treatment that prolongs the life of terminal-stage patients? The document, called "Guideline on the decision-making process for terminal care," does not present a concrete definition of the terminal stage and states that medical teams should appropriately judge the state of a patient and decide on whether the patient is in a terminal stage. The ministry decided to formulate the guideline after an incident came to light in March last year involving seven elderly patients who died at a hospital in Imizu, Toyama Prefecture. The guideline this time deals only with procedures, because the ministry has limited the scope to the points that most people would agree on, a ministry official said, adding the ministry plans to continue discussing the remaining points. The Japan Times. C) All rights reserved