Issues concerning life-prolonging treatment in Japan, as considered from attitudes among the legal and medical professions

In this paper, the author explores the clinical ethical issue of the withdrawal and withholding of life-prolonging treatment, surveying 2,848 lawyers and 2,469 doctors as medical and legal professionals in Japan on a variety of points for discussion. The main survey items are: (1) systems that should be used in the withdrawal and withholding of life-prolonging treatment at the end of life; (2) problems in determining treatment strategy at the end of life; (3) assessment of suspension of life support systems (extubation); and (4) strategies for better end-of-life care. While 42.2% of lawyers cited legislature and judiciary and 54.9% cited academic society guidelines as the system that should respond to the withdrawal and withholding of life-prolonging treatment, 23.3% of doctors cited the legislature and the judiciary, and 65.4% academic society guidelines. In relation to current end-of-life care, 81.3% of lawyers and 69.3% of doctors responded that there was room for improvement. Strategies for doing so included ensuring the transparency of and publishing decision procedures, and notification to government. It is important for medical institutions to normalize end-of-life care by making decisions with reference to guidelines and the like, ensuring the transparency of decision-making procedures, and being managed by a public institution.