National / Science & Health

Ministry considers program to share end-of-life wishes of elderly with ER doctors, paramedics

Kyodo

Medical professionals are considering introducing a system in which a record of an individual’s wishes on whether to be revived in a medical emergency would be shared with medical personnel when needed.

Aging Japan has increasing numbers of elderly terminally ill patients, and doctors have no choice but to try to revive them following collapse when they aren’t sure whether the patients would want to be resuscitated.

The current system does, however, respect the requests of close relatives, such as the spouse of an incapacitated patient, to end life support.

The Health, Labor and Welfare Ministry recognizes that some people may not want to be put on life support. It will back a system starting next April that allows nurses, paramedics and doctors who provide home care for elderly patients to share information about their patients and, crucially, makes a record of their end-of-life wishes.

The Japanese Society for Emergency Medicine is considering drafting guidelines that would allow paramedics not to attempt resuscitation if requested by the patient or their doctor.

While many terminally ill patients do not want to be left on life support if there is no prospect of recovery, doctors cannot be sure of their wishes in dementia cases or when relatives cannot be reached.

The ministry plans a program that would encourage patients to tell their doctors and family members what kind of medical procedures they want to receive when the time comes. The details would then be shared with hospital staff and paramedics.

Figures from the Fire and Disaster Management Agency show that ambulances transported a record 5.47 million people to hospitals in 2015, with the proportion of elderly patients on the rise. In 2014, about 3 million of such people, or 55.5 percent of the total, were elderly, the agency said.

Hachioji in western Tokyo is one of the few municipalities experimenting with written affidavits. The fire department coordinates with hospitals and nursing facilities in handing out forms on which people can register their life support wishes and other medical requests.

At the end of September, a 77-year-old man who swallowed and suffocated on his saliva was rushed to a hospital in Kawasaki. Because his heart had already stopped, paramedics performed CPR and doctors put him on life support.

The patient did not regain consciousness. He had suffered several strokes previously, and if he or his family members had said so doctors could have ended his life support. But his wife didn’t know what his wishes were.

“In such a case, there is no choice other than to put him on life support,” said Ryota Konishi, who heads the emergency room at the hospital where the man was treated.

The man was later taken off life support with the consent of his wife after doctors explained that he would never recover.

Cancer patients and others who know they may die soon tend to inform family members of their will or to put it down in writing. But that is not the case for the vast majority of elderly people.

“Many family members ask us to do everything we can,” Konishi said. “But if they have been bedridden for a long time and have no prospect for recovery, we aren’t sure if life support is the best option.”

In 2015, the Japanese Society for Emergency Medicine set up a panel of doctors, paramedics and fire department officials to create guidelines on resuscitating patients who have stopped breathing and who are in cardiac arrest. It plans to come up with the guidelines by the end of March.

“Some fire department officials perform CPR regardless of the patients’ will. We need a guideline,” said Seishiro Marukawa, who heads the panel, adding that it’s best to respect the will of the patient and rely on their personal doctor rather than ER doctors and paramedics.

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