title: A survey of the perspectives of patients who are seriously ill regarding end-of-life decisions in some medical institutions of Korea, China and Japan.
abstract: OBJECTIVE
  The debate about the end-of-life care decision is becoming a serious ethical and legal concern in the Far-Eastern countries of Korea, China and Japan. However, the issues regarding end-of-life care will reflect the cultural background, current medical practices and socioeconomic conditions of the countries, which are different from Western countries and between each other. Understanding the genuine thoughts of patients who are critically ill is the first step in confronting the issues, and a comparative descriptive study of these perspectives was conducted by collaboration between researchers in all three countries.
  
  
  METHODS
  Surveys using self-reporting paper questionnaire forms were conducted from December 2008 to April 2009 in Korea (six hospitals in two regions), China (five hospitals in four regions) and Japan (nine hospitals in one region). The subjects were patients who were critically ill who had been diagnosed as having cancer. A total of 235 participants (Korea, 91; China, 62; Japan, 52) were eventually recruited and statistically analysed.
  
  
  RESULTS
  Most respondents had sometimes or often thought of their own death, mostly fear of 'separation from loved ones'. They wanted to hear the news regarding their own condition directly and frankly from the physician. A quarter of them preferred making end-of-life care decisions by themselves, while many respondents favoured a 'joint decision' with their family members. The most favoured proxy decision maker was the spouse, followed by the children. Most admitted the necessity of 'advance directives' and agreed with artificial ventilation withdrawal in irreversible conditions. The most common reason was 'artificial prolongation of life is unnecessary'. Most respondents agreed with the concept of active euthanasia; however, significant differences were sometimes observed in the responses according to variables such as patient's country of origin, age, gender and education level.
  
  
  CONCLUSIONS
  Patients in Far-Eastern countries gave various responses regarding end-of-life care decisions. Although familial input is still influential, most patients think of themselves as the major decision maker and accept the necessity of advance directives with Westernization of the society. Artificial ventilation withdrawal and even active euthanasia may be acceptable to them.
authors.affiliation: Department of Medical Education, School of Medicine, Ewha Woman's University, 911-1, Mok-6-dong, Yangchon-gu, 158-710 Seoul, Korea. kivo@ewha.ac.kr
authors.forename: Kwon
authors.initials: K
authors.lastname: Ivo
authors.forename: Koh
authors.initials: K
authors.lastname: Younsuck
authors.forename: Yun Young
authors.initials: YY
authors.lastname: Ho
authors.forename: Suh
authors.initials: S
authors.lastname: Sang-Yeon
authors.forename: Heo Dae
authors.initials: HD
authors.lastname: Seog
authors.forename: Bae
authors.initials: B
authors.lastname: Hyunah
authors.forename: Hattori
authors.initials: H
authors.lastname: Kenji
authors.forename: Zhai
authors.initials: Z
authors.lastname: Xiaomei
mesh_terms: D000328:Adult; D016223:Advance Directives / Q000941:ethics / Q000639:trends*; D000368:Aged; D001293:Attitude to Death; D002681:China; D002755:Choice Behavior; D016638:Critical Illness / Q000523:psychology; D003657:Decision Making; D028601:Euthanasia, Active / Q000639:trends; D005260:Female; D006801:Humans; D038622:Internationality; D007564:Japan; D007802:Language; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D010361:Patients / Q000523:psychology / Q000706:statistics & numerical data*; D056910:Republic of Korea; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000941:ethics / Q000379:methods / Q000639:trends; D014177:Translations; D028761:Withholding Treatment / Q000941:ethics / Q000639:trends