End-of-Life Care in ICUs in East Asia: A Comparison Among China, Korea, and Japan

Abstract

Despite similarities in cultures and a common emphasis on the role of family, differences exist in physician perceptions and practices of end-of-life ICU care in China, Korea, and Japan. These findings may be due to differences in the degree of Westernization, national healthcare systems, economic status, and legal climate.

The quality of dying and death for patients in intensive care units: a single center pilot study

“…This may hinder the essential advance care planning process for improving quality of dying and death. Many physicians feel uncomfortable in beginning and leading conversations regarding end-of-life care for multiple reasons, including personal attitudes [24,25]. These imply that education for healthcare professionals should be provided to enhance clinicians’ performance in caring for dying patients in the ICUs.…”

Reframing the meaning of life and professional values: A theoretical framework of facilitating professional care for terminally ill patients

“…Although some formal teaching about EOL care is currently evident in the basic curriculum of a minority of Chinese medical schools, formal nursing education in EOL care has not been established in mainland China (Su, 2013;Tang et al, 2014). Several studies have explored the effectiveness of structural education or training programs, but most teaching strategies have been developed in Western countries, which may not be appropriate for Chinese nurses due to the differences in culture, development of EOL care, and clinical demands (Park et al, 2018;Su, 2013). EOL education and ethical training have been found to influence the development of nursing professional values (Iranmanesh et al, 2011;Poorchangizi et al, 2017).…”

“…Although awareness of the importance of EOL care for terminally ill patients is increasing in China and other East Asian countries sharing a similar culture, separate hospice and palliative care units are not yet established in most Chinese hospitals. This situation may be related to several factors such as a lack of comprehensive understanding of EOL (Yin et al, 2017), and inadequate professional preparation for EOL care when compared to countries such as Korea and Japan (Park et al, 2018). While Chinese nurses may be concerned with patients' emotional and psychosocial comfort (Zheng et al, 2015), they are rarely involved in EOL decisionmaking and communication with dying patients (Dong et al, 2016;Su, 2013).…”

The role of policy and law in shaping the ethics and quality of end-of-life care in intensive care

“…In this issue of Intensive Care Medicine, Lee and colleagues describe changes in clinicians' perceptions of the quality of death in the intensive care unit following the implementation of South Korea's Hospice, Palliative Care, and Life-sustaining Treatment Decision-Making Act (the "well-dying law") in 2018, which legalized the ability for terminally ill patients to refuse cardiopulmonary resuscitation (CPR) and life-sustaining treatments [2]. South Korea is a traditionally Confucian country, whose social norms are governed by strong familial relationships, filial piety, and a focus on collective harmony rather than individualism and autonomy [3]. Discussing death is seen as inappropriate and filial piety often interpreted as doing one's best to ensure parents live as long as possible, even if treatments might not be beneficial [4,5].…”