| Research Abstract |
An advance directive, is understood to be a declaration by a person that stipulates the forms of medical treatment to be provided by caregivers and/or designates someone to act as a proxy should the person at some future date lose decision making capacity. In order to investigate the acceptability of advance directives in Japanese society, questionnaire studies were conducted on healthy subjects and health professionals asking about their knowledge, experiences, and attitudes.
Two hundred and ten male subjects who visited two urban general hospitals for their physical check-ups were asked to fill out a self-administered questionnaire. The majority of the respondents wanted to express their preferences about future medical care and wanted to designate their preferences for treatment for incurable diseases such as terminal cancer, brain-death, and persistent vegetative state. More than 80% answered they would give a lot of leeway to surrogates to override their preferences, and did not fe
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el it was necessary for detailed, concrete directives. More than 60% answered that oral statements were enough. As for a surrogate decision maker, 80% answered they would designate "family or relatives", in most cases, a spouse. On the other hand, those who do not want to express their preferences listed reasons against it : psychological resistance to talk about death ; difficulty in imagining the future situation ; and entrusting their family (omakase), etc.
A questionnaire administered to 72 medical doctors in one university hospital revealed that majority of them wanted their patients to leave their preference in advance. They preferred to written documents (not an oral one), however, they did not feel necessity for detailed, concrete directives.
Possible disease-specific advance directives in the palliative care and chronic neurological disease such as ALS were also explored. Written advance directives might be useful in the Japanese settings when 1) a person does not want to give surrogates and/or caregivers a lot of leeway ; 2) where there exists uncertainty and caregivers feel the necessity to ascertain the preference by written documents. Less
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