Planned revision to end-of-life care guidelines include at-home treatment


Daisy Bernstein

Date: 15.01.2018

The health ministry has unveiled a plan to revise guidelines for end-of-life care to cover terminally ill patients who wish to die at their homes or nursing care facilities.

The Ministry of Health, Labor and Welfare referred the plan to a panel of experts on Jan. 17 for deliberations. The ministry will complete the revision plan by the end of the current fiscal year in March. This will be the first time for the guidelines to be amended since their introduction in 2007.

The will of terminally ill patients must be respected to the maximum extent in deciding whether to discontinue life-prolonging treatment, such as the use of artificial respirators and cardiac massage for the patients.

The ministry's guidelines explicitly provide for patients' decision-making procedures in the assumption that they would be used at medical facilities. As 10 years have passed since the guidelines were compiled, however, the aging of Japan's population has progressed and more than 1.3 million people now die each year. As an increasing number of terminally ill patients wish to die at home rather than at medical institutions, the ministry plans to revise the guidelines so that they can be used for end-of-life care at homes or nursing care facilities.

Specifically, a clause stipulating that medical professionals such as doctors and nurses should discuss patients' decisions on whether to discontinue life-prolonging treatment and how they want to take their last breath will be rewritten to involve care managers and care workers in the process.

Moreover, since the will of patients could change as time passes and their illnesses progress, the revision plan underscores the need to repeatedly talk to patients to confirm their decisions. The idea of "advance care planning," which takes into account patients' philosophy on life and values in such decision making, will also be incorporated in the guidelines. The plan also underscores the importance of recording the outcome of discussions on the matter in writing.

Under the planned revisions, policies on care when patients become unable to convey their intentions will also be reviewed.

The current guidelines stipulate that in such a case, medical staff should provide the best possible treatment while holding discussions with the patient's family. The amendment plan, in contrast, recommends that patients designate specified persons such as their family members as those who should presume the will of the patients regarding their end-of-life treatment in advance.

Keeping in mind the increase in the number of senior citizens living alone, the ministry assumes that there will be cases where elderly people will designate their close friends or guardians, appointed to manage their financial affairs or daily life due to their physical or mental limitations, as those who should presume the patients' will.

This material was created specially for WorldHealthNews project by Daisy Bernstein.

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