Role for family urged in deciding euthanasia

More legal options needed, group says

A group promoting the right of terminally ill patients to a “dignified death” is seeking legislation that would allow relatives to choose euthanasia if the patient’s will is not clear, group members said Saturday.

By advocating that a family should be able to make decisions based on the assumed will of a patient, the Japan Society for Dying with Dignity is endorsing for the first time the idea that euthanasia can be decided by someone other than the patient.

The euthanasia issue has returned to the spotlight due to recent revelations that a surgeon in Imizu, Toyama Prefecture, took a number of terminal patients off life support.

The society has submitted an opinion to a multiparty group of lawmakers considering euthanasia legislation that it is “desirable to specify by law” that family members can make decisions for the patients, the members said.

The opinion reiterates the society’s principle that the decision should not be made by people unrelated to the patient.

The group also lists options that can be taken in the event a terminal patient has not indicated his or her will in writing.

These include a judicial decision based on sufficient material that suggest the patient’s will, a decision by the ethics committee of a medical institution and consensual decision-making by the patients’ immediate family members, other relatives and friends.

Another alternative is to stipulate the order among family members that can make the decision, including spouse, children, parents, and brothers and sisters.

Akihiro Igata, chairman of the society and head of the Nagoya University of Arts and Sciences, said that his group’s position that the patient’s will is the premise for deciding euthanasia remains unchanged.

“But when (the will) is not clear, we thought it was appropriate for the family members to decide by deducing the patient’s will such as from conversations they had” in the past, Igata said.

“We are not saying this is the method that must be taken. We want to continue further discussions,” he said.

The group of lawmakers is working on a bill based on a draft outline which calls for recognizing the right of patients to decide whether to undergo life-sustaining treatment and allowing those aged 15 and above to indicate their will beforehand.

The issue of what to do when a patient’s will cannot be confirmed is among the items yet to be discussed by the group.

The Japan Society for Dying with Dignity, established in 1976 by doctors, lawyers and academics, conducts activities to promote the right of terminally ill patients to choose to die naturally.

In the cases at the Toyama hospital, police are investigating the deaths of seven patients from 2000 to 2005 as possible murders, as the patients died after the hospital’s surgery department head took them off life support.

The surgeon has said he obtained consent from the families of six of the patients, but not consent from the patients themselves, and that another surgeon was in charge of the remaining patient.

Based on a 1995 Yokohama District Court ruling, euthanasia via dosing or other acts by doctors is deemed legal only if four conditions are met — the patient’s death is imminent, there is unendurable pain, there is no other way to remove or alleviate the pain, and the patient wishes to be euthanized.