Observing various death and dying process in different places throughout my nursing career, has motivated me to investigate advance care planning (ACP) in Japan. I have worked and lived in Japan, India, the United States of America and Australia. I experienced a particular difference when I was working as a registered nurse and witnessed the patient dying process in Australia. The difference in patient care in Australia related to the patient having the opportunity of choices. The choice around what happened at the end of life could be made by the patient. This difference prompted me to become involved in ACP, because ACP policies support a good death by valuing the patient’s preferences.
Advance care planning is a new concept in Japan. There is some guidance on medical decision making at the end of life developed by the Ministry of Health, Labour and Welfare (Shimizu, 2015). However, unlike Australia, Japan does not have a legal framework to support ACP.
Advance care planning in Japan has followed from these government guidelines for medical decision making discussion processes in the terminal stages of an illness. They recommend individualised self-determination by patients as long as people are competent, but there is no legal documentation yet. The impact of this lack of clarity means patients and health professionals struggle to consider the most suitable way to utilise ACP.
Like other countries, Japan is rapidly ageing. However, the speed and extent of the ageing in Japanese society is unmatched anywhere in the world (National Institute of Population and Social Security Research, 2017). This increase in ageing is accompanied by an increase in the number of deaths in this country as our older people reach the end of their life.
Despite Japan being a modern country, existing customs and traditions make it difficult to adopt the concept and practice of ACP. Barriers include the customs and traditions in the Japanese cultural background along with a lack of understanding of individual decision making. Most patients rely on the family or the doctors to make decisions about care and treatments. This is a common understanding among Japanese people. “Omakase” is the Japanese tradition of letting a chef choose your order. The word means "I will leave it to you." This is also the traditional Japanese approach to medical decision making (Sullivan, 2017). It implies that some patients want to leave decisions to their family and doctors.
I recently presented at the End of Life Care conference in Japan. My presentation was about the choices of life: the driver licence, marriage certificate, and decision making and advance care planning. The presentation was a huge success and had a big impact. Health professionals and media and public were interested in ACP in Australia. They had active questions and discussions.
As a researcher, I will go back to Japan again to talk in public about advance care planning in Australia to build community support for this issue. I believe this will contribute positively to the ageing issue as well. This work highlights that globalisation is having an influence on laws and policy. I will continue work with health professionals and assist public awareness with people in Japan.
- Shimizu T. Supporting Patients and their Families to Make Informed Decisions. Iryo To Shakai. 2015 May;25(1):35-48. doi:10.4091/iken.25.35
- National Institute of Population and Social Security Research. Population Projections for Japan (2017): 2016 to 2065 (1.79MB pdf). Tokyo: National Institute of Population and Social Security Research; 2017.
- Specker Sullivan L. Dynamic axes of informed consent in Japan. Soc Sci Med. 2017 Feb;174:159-168. doi: 10.1016/j.socscimed.2016.12.031. Epub 2016 Dec 23.
Yumi Naito, Registered Nurse and Masters Student, Flinders University