Nippon Medical School drafts euthanasia guide

Kyodo News

The ethics panel of Nippon Medical School in Tokyo has compiled interim guidelines for ending life support for hopelessly sick or injured patients under certain conditions, including patient consent, panel members said Saturday.

The school, based in Bunkyo Ward, will begin using the guideline at its four affiliated hospitals from April.

The guidelines contain provisions allowing ethics boards at each hospital to determine whether removal of artificial respirators is warranted on a case-by-case basis.

In May, the Health, Labor and Welfare Ministry compiled the government’s first guideline for end-of-life care, emphasizing the importance of administering treatment based on patient intent.

But the government’s guideline did not touch on where to draw the line between discontinuing life-sustaining medical treatment, such as respirators, and the criminality of such measures.

It is rare for hospitals to draft their own guidelines on discontinuing life support.

None of the four hospitals in question — Nippon Medical School Hospital and its three branch hospitals in Tokyo, Kanagawa and Chiba prefectures — has come across a case in which such a decision was brought to their ethics boards, the members said.

“If it can be confirmed that the conditions are met, it is entirely possible that a go-ahead sign can be issued for removing the respirator,” said Shoji Kudo, head of Nippon Medical School’s ethics panel.

Kudo said the medical school wants to heighten the objectivity of such decision-making by getting the ethics boards involved and by avoiding situations in which the doctors involved become subject to criminal liability.

The school’s guideline defines “end-of-life” as a condition in which a patient is bound to die from illness or injury “within two weeks or within a month at longest” or that wherein a patient’s condition is determined to be medically incurable and any life-sustaining treatment will serve only as a means for delaying the time of death.

Under the guideline, the determination of whether a patient has entered the “end-of-life” period must be made by a team of doctors and not by a single attending doctor. In addition, the will of the patient not to receive life-support treatment should be confirmed in writing or through family, and doctors must receive the family’s consent.

When the three conditions are met, the doctors would consider which types of treatment — such as administration of medication, chemotherapy, blood transfusion, dialysis and artificial respiration — to terminate in consultation with the patient’s family.

If the consideration involves steps that would directly lead to death, such as removal of an artificial respirator, the matter would be brought to the ethics board, the guideline says.