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LDP looks to submit bill on end-of-life care with emphasis on patients' will

TOKYO -- The ruling Liberal Democratic Party (LDP) is considering drafting a bill on end-of-life care, including procedures for confirming the patient's thoughts on terminating life-prolonging treatment, amid concerns over the risk of such treatment being ended against the patient's will.

The LDP aims to submit the bill to next year's ordinary Diet session at the earliest if the measure wins approval from both ruling and opposition parties. While a bill on death with dignity was drawn up by a suprapartisan group of lawmakers in 2012, the LDP is set to fundamentally review the previous bill to give more weight to procedures for continually checking on a patient's intentions for end-of-life care.

The move comes amid controversy over such treatment. Some argue that prolonging the lives of those with no prospects of recovery, such as terminal cancer patients or elderly experiencing senile deterioration, by way of artificial respirators or dialysis would not necessarily benefit the patients themselves considering their pain as well as the burden on their families for nursing care. Meanwhile, there are risks that doctors could be held criminally liable for terminating life-prolonging therapies under current laws. Therefore, medical workers and others have been calling for development of relevant legislation.

The 2012 bill defines "end of life" as a phase when a patient has no chance of recovery even with proper treatment and is diagnosed as nearing their end, and allows for the termination of life-prolonging treatment for the patient if they had indicated their intention in writing or by other means. The bill, however, also enables putting an end to such treatment without following those rules.

Medical data shows that 70 percent of terminal patients cannot express their own intentions due to unconsciousness or dementia. Groups of people with disabilities have shown concerns that patients without the ability to display their own intentions could be left to die. The bill has yet to be submitted to the Diet. During a meeting on Aug. 29 this year, an LDP project team on end-of-life care decided to review the bill from scratch.

Behind the move lies a recent trend for Advance Care Planning (ACP), wherein the patient, family and doctor continue to discuss the way the patient ends their life. Through discussion, those around can observe changes in the patient's mindset and reflect their will in end-of-life care.

The LDP intends to incorporate the concept of ACP into the new bill in order to urge medical staff to make the patient's decision-making processes more transparent, thereby winning the public's understanding.

As Japanese society grays rapidly, the LDP faces the urgent need to develop a medical environment where patients' intentions are respected in end-of-life care. According to an estimate by the National Institute of Population and Social Security Research, the annual number of deaths in Japan would reach 1.68 million in 2040, nearly 400,000 more from 2015. Meanwhile, surveys by the Ministry of Health, Labor and Welfare and the Cabinet Office have indicated that a majority of respondents wished to die at their homes, while in reality about 80 percent died at hospitals.

In March this year, the health ministry updated its guidelines for end-of-life care for the first time since they were formulated in 2007, adding the need to confirm the patient's intentions on multiple occasions.

In South Korea, death with dignity became legal in February this year. However, as there is no clear definition for this, some people confuse it with euthanasia, which is permitted in the Netherlands and Belgium. Therefore, some in the LDP insist that the terminology of "death with dignity" itself should be avoided.

(Japanese original by Masahiro Sakai, Medical Welfare News Department)

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