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Hospital didn't seek ethics panel's advice before ending patients' dialysis

Fussa Hospital is seen in Fussa, Tokyo, on March 6, 2019. (Mainichi/Yuki Miyatake)

TOKYO -- A public hospital here, where at least three patients died after a surgeon discontinued dialysis treatment on them, never convened an ethics committee meeting over the surgeon's offering of such an option to those and other patients, it has been learned.

The move at Fussa Hospital in the Tokyo suburban city of Fussa comes in spite of guidelines of the Japanese Society for Dialysis Therapy (JSDT) issued in 2014, which recommend seeking advice from an ethics committee or a third-party panel over ethical issues.

The surgeon, aged 50, had offered a choice of terminating dialysis to several patients since around 2014. One of them, a 44-year-old woman, died in August last year. In all of these cases, however, the hospital did not convene a meeting of its ethics panel -- a body including external experts. This was apparently based on a decision by hospital director Takeshi Matsuyama that such meetings were "unnecessary."

The Tokyo Metropolitan Government has conducted an on-site inspection on the public hospital and is investigating the cases as suspected violations of the JSDT guidelines.

According to the surgeon, the doctor first discontinued dialysis of a patient around 2014. When the doctor asked Matsuyama, who was then serving as deputy hospital head, over the necessity to hold an ethics panel meeting, Matsuyama replied, "Medically speaking, it is not necessary to convene an ethics panel. But please obtain a written document (a letter of confirmation) from the patient."

The surgeon accordingly received a letter of confirmation from the patient, without having to go through an ethics panel review. The doctor had since taken similar steps with the 44-year-old woman and several other patients in terminating their dialyses and did not ask Matsuyama to bring the cases before an ethical panel.

According to a source close to the hospital, there are no clear-cut in-house rules about when and under what circumstances such a panel should be called. "It is up to doctors whether to consult the ethics panel," the source said, adding, "Actually, an ethics panel meeting is rarely held."

According to Matsuyama, an ethics panel met about 10 years ago when the family of a patient called for terminating dialysis treatment on their loved one who remained unconscious. The panel concluded that the treatment could not be discontinued solely at the request of the family members. Yet dialysis was eventually terminated after the patient's condition deteriorated and it was deemed that the treatment itself posed a medical risk to the patient.

Regarding the fact that an ethics panel has never met since around 2014, Matsuyama said, "It is burdensome to hold a panel meeting as we have to call in external members and so on. It is unrealistic to hold such a meeting each time."

At Nagasaki Jin Group hospital in Nagasaki, southwestern Japan, there were 12 cases of dialysis treatment being suspended or never introduced due to reasons including the patient suffering from terminal cancer or advanced dementia. All such cases have been reported to an ethical committee, whose membership includes a psychiatrist from another hospital, to screen whether the patient or their family members are in a state of depression with suicidal thoughts.

Hospital director Takashi Harada said, "As suspension of dialysis treatment directly leads to a patient's death, it is only natural to refer each case to the ethics panel to make sure of the patient's intentions, even if their will had earlier been confirmed."

(Japanese original by Yoshihiko Saito, Lifestyle News Department)

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