The Japanese Association for Acute Medicine has adopted a guideline for the termination of life support of emergency patients in the terminal stage. The guideline is the first of its kind to be authorized by a national association of medical professionals, although some hospitals and universities have worked out their own guidelines. The association should be praised for taking on a difficult issue. The guideline will be helpful for doctors working in emergency wards. It will also effectively prevent termination of life support on the basis of arbitrary decisions made by doctors.
But even with the guideline, doctors cannot know how law-enforcement authorities will handle individual cases of life-support termination and cannot rule out the possibility that they may be targeted in a criminal investigation. It is hoped that the adoption of the guideline will deepen public discussion of medical treatment for terminal-stage patients and whether the state should write a guideline to deter law-enforcement authorities from launching criminal investigations against doctors.
In March 2007, the health ministry formulated a guideline on terminal care. To prevent unilateral decisions by doctors, it stipulated that respect for patients' wishes is "the most important principle" when medically treating those in the terminal stage. But it mention issues such as the specific circumstances under which doctors can end treatment designed to prolong a patient's life or the conditions under which doctors may remove respirators. The health ministry's guideline followed the launch of a criminal investigation into the deaths of seven patients at the municipal hospital in Imizu, Toyama Prefecture. Reports of the deaths, which resulted from the removal of respirators, surfaced in March 2006. Law-enforcement authorities have not yet decided whether to prosecute anyone in the Imizu incident.