Survey of Japanese physicians' attitudes towards the care of adult patients in persistent vegetative state.

Abstract

Objectives-Ethical issues have recently been raised regarding the appropriate care ofpatients in persistent vegetative state (PVS) in Japan. The purpose of our study is to study the attitudes and beliefs ofJapanese physicians who have experience caringfor patients in PVS. Design and setting-A postal questionnaire was sent to all 317 representative members of the J7apan Society ofApoplexy working at university hospitals or designated teaching hospitals by the Ministry of Health and Welfare. The questionnaire asked subjects what they would recommend for three hypothetical vignettes that varied with respect to a PVS patient's previous wishes and the wishes of the family. Results-The response rate was 65%. In the case of a PVS patient who had no previous expressed wishes and no family, 3% of the respondents would withdraw artificial nutrition and hydration (ANH) when the patient did not require any other life-sustaining treatments, 4% would discontinue ANH, and 30% would withhold antibiotics when the patient developed pneumonia. Significantly more respondents (17%) would withdraw ANH in the case of a PVS patient whose previous wishes and family agreed that all life support be discontinued. Most respondents thought that a patient's written advance directives would influence their decisions. Forty per cent of the respondents would want to have ANH stopped and 31 % would not want antibiotics administered if they were in PVS.Conclusions-Japanese physicians tend not to withdraw ANHfrom PVS patients. Patients' written advance directives, however, would affect their decisions. (7ournal ofMedical Ethics 1999;25:302-308)

Knowledge, acceptance and perception towards brainstem death among medical students in Hong Kong: a questionnaire survey on brainstem death

“…This is a commonly observed phenomenon in other end-of-life situations such as the provision of basic needs to patients in the PVS. Asai et al (1990) found that fewer individuals would agree to withdraw artificial nutrition, hydration and antibiotics in the event of pneumonia developing in a stranger than in themselves (3% vs. 40% and 30% vs. 31%). The family decision-making about withdrawing life-support from a patient with BSD is complex and involves three interrelated processes (Swigart et al 1996).…”

Withdrawing life‐sustaining medical treatment—A physician's personal reflection

“…If the same patient developed pneumonia, only 4% would withhold AHN but 30% would withhold antibiotics. Interestingly, 40% of the practitioners responding to the survey would withhold AHN if they themselves were in PVS [Asai et al, 1999]. Lacking data on the reasons, the authors speculate that the dramatic difference between Japanese and American attitudes may be due to different religious views on the meaning of death, or of possibility of a patient with PVS sharing a meaningful life with friends and family [Asai et al, 1999].…”

“…Interestingly, 40% of the practitioners responding to the survey would withhold AHN if they themselves were in PVS [Asai et al, 1999]. Lacking data on the reasons, the authors speculate that the dramatic difference between Japanese and American attitudes may be due to different religious views on the meaning of death, or of possibility of a patient with PVS sharing a meaningful life with friends and family [Asai et al, 1999]. In an analysis of the Halacha (the Judaic legal-ethical system) and the ethics of limiting AHN in the elderly who are terminally ill, Schostak points out that the overall guiding principle is the sanctity of life and the subsequent obligation to restore health since the patient's body is the "property" of God.…”

Vorausverfügter Behandlungsverzicht bei Verlust der Selbstbestimmbarkeit infolge persistierender Hirnerkrankung

“…Eine Umfrage unter japanischen Ärzten ergab, dass der Abbruch künstlicher Ernährung bei einem "apallischen Syndrom" auch im Fall einer vorauslaufenden Willenserklärung nur von 17 der Befragten befürwortet wurde und dass sie mehrheitlich unter den gleichen Umständen auch für sich selbst einen Nahrungsentzug ablehnten [3]. In unserem eigenen Kulturkreis gilt dagegen die Selbstbestimmung am Lebensende als ein hohes Gut und hat in der letzten Dekade stark an Bedeutung gewonnen [4].…”