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Should a patient without a terminal illness be allowed to choose death?

In this Nov. 30, 2017 file photo, a patient is seen receiving a dialysis treatment in Nagasaki. (Mainichi/Eriko Hori)

TOKYO -- Stopping a kidney patient's dialysis is tantamount to a death sentence. Sometimes called "artificial kidneys," dialysis machines clean waste products and poisons out of the blood of patients who cannot produce urine because their own kidneys no longer function. Dialysis gives decades of life to people who would otherwise have died of kidney failure.

By the same token, withdrawing dialysis means poisons build up in the body. If the patient is relatively young, like the 44-year-old woman who passed away in August 2018 at the public Fussa Hospital in the city of Fussa, western Tokyo, death is certain in about a week.

That is why it is so surprising that the woman was apparently presented this "death option" in the context of her medical choices. Medical institutions are supposed to be places for treatment of illness. But in this case it was not treatment that was chosen, but death, and this death was carried out within the walls of the hospital. It is also shocking to learn that it was criticism of dialysis that apparently led the woman's doctor to give her the option to end her own life.

One very important point in this case was the memorandum the woman wrote confirming she understood her choice, and this document's connection to her eventual death. Patients have won the right to make their own treatment choices, after movements pressing for informed consent and the right to self-determination. However, does self-determination extend to the right to die? There is as yet no clear legal answer.

The death of the woman at Fussa Hospital is the first documented case in Japan of a doctor giving a patient the option to die even though the patient is not nearing the end of their life, medically speaking. Will the doctor's actions be ruled unethical and thus unacceptable? Or do we suddenly find ourselves in an era when a patient who has given up on living can choose to forgo dialysis? This question is as weighty as it is sharp, and it is demanding a response.

(Japanese original by Yoshihiko Saito, Lifestyle News Department)

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