title: Medical decisions concerning the end of life: a discussion with Japanese physicians.
abstract: OBJECTIVE
  Life-sustaining treatment at the end of life gives rise to many ethical problems in Japan. Recent surveys of Japanese physicians suggested that they tend to treat terminally ill patients aggressively. We studied why Japanese physicians were reluctant to withhold or withdraw life-support from terminally ill patients and what affected their decisions.
  
  
  METHODS
  A qualitative study design was employed, using a focus group interview with seven physicians, to gain an in-depth understanding of attitudes and rationales in Japan regarding medical care at the end of life.
  
  
  RESULTS
  Analysis revealed that physicians and patients' family members usually make decisions about life-sustaining treatment, while the patients' wishes are unavailable or not taken into account. Both physicians and family members tend to consider withholding or withdrawing life-sustaining treatment as abandonment or even killing. The strongest reason to start cardiopulmonary resuscitation- and to continue it until patients' family members arrive-seems to be the family members' desire to be at the bedside at the time of death. All physicians participating in our study regarded advance directives that provide information as to patients' wishes about life-sustaining treatment desirable. All expressed concern, however, that it would be difficult to forego or discontinue life-support based on a patient's advance directive, particularly when the patient's family opposed the directive.
  
  
  CONCLUSIONS
  Our group interview suggested several possible barriers to death with dignity and the appropriate use of advance directives in Japan. Further qualitative and quantitative research in this regard is needed.
authors.affiliation: Department of General Medicine and Clinical Epidemiology, Kyoto University School of Medicine.
authors.forename: A
authors.initials: A
authors.lastname: Asai
authors.forename: S
authors.initials: S
authors.lastname: Fukuhara
authors.forename: O
authors.initials: O
authors.lastname: Inoshita
authors.forename: Y
authors.initials: Y
authors.lastname: Miura
authors.forename: N
authors.initials: N
authors.lastname: Tanabe
authors.forename: K
authors.initials: K
authors.lastname: Kurokawa
mesh_terms: D000328:Adult; D016223:Advance Directives; D000368:Aged; D001291:Attitude of Health Personnel; D003657:Decision Making; D004992:Ethics, Medical; D017144:Focus Groups; D006801:Humans; D007564:Japan; D008020:Life Support Care; D008297:Male; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D012106:Research; D013727:Terminal Care; D028761:Withholding Treatment