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Living wills created by terminally ill patients need to gain greater legal recognition in order to ensure their effectiveness, participants at the opening of an international conference on the right to die said Friday.

A living will is a document usually prepared by a person when they are terminally ill, stating at what point they wish medical treatment to be terminated.

The World Federation of Right to Die Societies is a nongovernmental organization with 38 member societies in 23 countries that holds biennial meetings under the banner of “respect self-determination at the time of one’s death.”

Its 15th world conference opened in Tokyo on Thursday with living wills as its theme.

Japan is on the leading edge of terminal care because of its aging population.

“But while advances in medical technology make it possible to save more lives, the application of such technology to incurable and terminal cases creates situations in which patients’ suffering is prolonged and the dignity of their lives is violated,” said Akihiro Igata, chairman of the Japan Society for Dying with Dignity.

His group and the Legislators’ Organization for Legal Recognition of Dying with Dignity are working to have Japanese courts recognize the concept of dying with dignity, or the right to refuse the prolongation of one’s own life.

But for the law to recognize such a right, individuals need a way to clearly express their wishes for care when they are dying, he said.

Soichiro Iwao, director general of the health ministry’s Health Policy Bureau, said the courts have ruled that it is a patient’s constitutional right to refuse certain treatments. But by allowing living wills, medical professionals will be more confident and have greater peace of mind when caring for terminal patients, he said.

He said that procedures clearly defining when and how to end specific treatments are also necessary.

In Japan, it is the refusal of medical treatment — not euthanasia — that is being discussed.

Euthanasia is when death is induced, such as by injection, in a terminally ill person or when assistance is given in the suicide of a person already facing death.

The medical inducement of death and assisted suicide are both legal in the Netherlands and Belgium, while only helping someone to commit suicide is allowed in Switzerland and the U.S. state of Oregon.

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