Patients' terminal stage, incurability defined
The Yomiuri Shimbun

The Japan Society for Dying with Dignity has compiled a report stipulating definitions of the "terminal stage" of patients suffering certain diseases, aiming to provide a basis for judgment on whether to discontinue life-sustaining treatment, it has been learned.

Lawmakers are expected to use the report, which was released Saturday, as a basis for their discussions on legislation concerning the issue.

The report offers some guidelines for proceeding with a process toward "death with dignity." In its general statement, the report offers definitions of the terminal stage and incurability--which are not covered in the ministry's guidelines--and conditions for terminating life-sustaining treatment.

In the body of the report, diseases are divided into six categories, along with conditions for terminating treatment for patients in each category. The categories are: cancer; respiratory failure, cardiac failure and kidney failure; continuous vegetative state; amyotrophic lateral sclerosis (ALS); aging; and those in need of emergency treatment. The former four are major diseases that have been under discussion concerning life-sustaining treatment. ALS, for example, is a fatal neurodegenerative disease.

In its general statement, the report defines the terminal stage as "the period from the time the patient is determined to be incurable to the time of his or her death."

It also defines incurability as "the condition of a patient for whom no medical treatment is expected to be effective, and the progress toward death is unstoppable."

The report stipulates three conditions for discontinuing treatment: the patient is willing to stop the life-sustaining treatment; two or more doctors agree to stop the treatment; and the purpose of ending treatment is to ensure death with dignity and relieve the patient's suffering.

For cancer patients, the report defines the terminal stage as "a period from the time when all treatment ceases to have any effect until the time of death." The report says doctors can stop or withhold medical treatment--such as providing nutrition and water and the operation of the respirator--when harmful reactions are observed during the terminal-stage treatment.

For ALS patients, the report indicates that doctors can remove respirators after a patient has repeatedly clarified his or her wish for them to do so and when a test shows the patient does not breathe spontaneously.

It defines the terminal stage of ALS patients as a condition in which the man or woman is not able to stay alive without a respirator. However, experts are divided on this point, and as such, the report says the final decision on whether the respirator should be removed should be left up to the patient.

"On first glance, the report seems to put priority on the patient's decision," said Yumiko Kawaguchi, a director of the Japan Amyotrophic Lateral Sclerosis Association. "However, I think its suggestions are dangerous, as people surrounding the patient may possibly lead him or her [to terminate treatment]."

Nagoya University of Arts and Sciences President Akihiro Igata--who also is the director of the Japan Society for Dying with Dignity and head of the group that compiled the report--said his team wanted to provoke more debate on the issue of death with dignity. "We'd like to further discuss the issue and call for legislation [of necessary laws]," he said.

(Apr. 16, 2007)http://www.yomiuri.co.jp/dy/national...16TDY01002.htm