70% of key hospitals halted, avoided life-prolonging care for some terminal patients: poll

OSAKA -- About 70 percent of key emergency hospitals that replied to a Mainichi Shimbun survey discontinued or decided not to provide life-prolonging treatment for some of their terminally ill patients last year.

Some of the other medical institutions answered that they do not stop life-prolonging treatment for fear of criminal prosecution.

The outcome of the survey sheds light on the difficult decisions medical institutions face amid the ballooning numbers of the elderly in Japanese society over whether to try to prolong the lives of patients who have no prospects of recovering.

The Mainichi Shimbun surveyed 288 hospitals that had emergency and critical care centers as of the end of January about whether there were cases last year in which they stopped life-prolonging treatment of their terminally ill patients or chose not to provide such treatment. Of the institutions, 113 responded to the survey.

Among these, 73 answered whether or not they had such cases, and 49 of the institutions, or 67 percent, replied in the affirmative. Some 24 hospitals said they did not have such cases, but 10 of them had at one point considered stopping or not providing life-prolonging treatment.

The remaining 40 institutions declined to answer the question because it is a delicate issue.

A total of 308 patients died after their life-prolonging treatment was aborted and 812 passed away because institutions decided not to provide such treatment, totaling 1,120. Of these, 92 percent were aged 65 or over.

However, the actual figures are likely to be higher because multiple respondents that had failed to tally the number of such cases replied that they had "many" such cases.

In a question about the types of treatment the 49 hospitals stopped or decided not to provide -- in which multiple answers were allowed -- over 80 percent said the administration of vasopressor drugs that raise blood pressure and some 70 percent, respectively, cited artificial respiration and artificial dialysis.

Illnesses suffered by these patients varied from terminal cancer and brain hemorrhages to natural causes as a result of old age.

In a question about the reason for discontinuing or deciding not to provide life-prolonging treatment in which multiple answers were permitted, an overwhelming majority -- 89 percent -- cited the desire of the patients and their families. Some 34 percent replied that they did so out of consideration for the burden of the patients' illnesses on their families.

With regard to how the medical institutions confirmed the patients' or their families' will, 80 percent answered that the patients' families made the decision or the families assumed the patients' will. Only 20 percent replied that the institutions confirmed their decisions with the patients themselves.

The survey results also show that hospitals' decisions on life-prolonging treatment were divided. Multiple hospitals answered that they never call off such treatment. As to the reasons, they cited their inability to confirm whether discontinuation of or decisions not to provide life-prolonging treatment reflect the consensus of all of the patients' family members, while others said consensus could not be reached among medical staff.

Between 2004 and 2006, it came to light that elderly and other patients died at hospitals in Hokkaido and Toyama Prefecture after doctors removed artificial respirators from them. The doctors and others were reported to prosecutors on suspicion of murder, but none of them was indicted.

In 2007, the Health, Labor and Welfare Ministry drew up guidelines for conditions and procedures for stopping or deciding not to provide life-prolonging treatment. The ministry revised the guidelines in March this year requiring patients, their families and doctors to repeatedly discuss medical treatment and care plans.

The guidelines attach particular importance to the confirmation of the patients' will. However, cases in which the will of the patients could not be confirmed accounted for a majority of the cases covered by the Mainichi survey, suggesting that doctors often waver over life-prolonging treatment before making final decisions.

(Japanese original by Daisuke Kondo and Kentaro Mikami, City News Department)