Ethical Issues Around the Withdrawal of Dialysis Treatment in Japan

Miho Tanaka; Satoshi Kodama

doi:10.1007/s41649-020-00109-3

Ethical Issues Around the Withdrawal of Dialysis Treatment in Japan

Asian Bioeth Rev. 2020 Jan 16;12(1):51-57. doi: 10.1007/s41649-020-00109-3. eCollection 2020 Mar.

Authors

Miho Tanaka^{1

2}, Satoshi Kodama³

Affiliations

¹ Japan Medical Association Research Institute, Tokyo, Japan.
² Medical Ethics & Patient Safety Laboratory, Keio Research Institute at SFC, Keio University, Kanagawa, Japan.
³ Graduate School of Letters, Kyoto University, Kyoto, Japan.

Abstract

In Japan, terminating life-sustaining treatment (LST) in non-terminal patients is legally and ethically problematic given the lack of legal regulations regarding the termination of LST, including dialysis treatment. This article describes an ethically problematic case that happened at a hospital in Tokyo in March 2019, in which a patient died after a physician withdrew kidney dialysis upon the patient's request. Most national newspapers in Japan reported the case extensively and raised the question of ethical and legal permissibility of withdrawing dialysis treatment from non-terminal patients. In this article, we first examine the case within the current policy framework in Japan and then discuss how Japan can improve its end-of-life practice, focusing specifically on the patient's right to self-determination and treatment refusal. We recommend that policymakers consider legalizing the termination of LST and the patient's right to refuse treatment based on the principle of respect for autonomy.

Keywords: Dialysis; Moral dilemma; Patient’s right to refuse treatment; Respect for autonomy; Withdrawal of life-sustaining treatment.

Publication types

Editorial