【Aging, safety net and fiscal crisis in Japan】No.71: Availability of Advance Care Planning (ACP)

In this column series, Yukihiro Matsuyama, Research Director at CIGS introduces the latest information about aging, safety net and fiscal crisis in Japan with data of international comparison.

In February 2018, the Ministry of Health, Labor, and Welfare announced the results of the "Survey of medical choice at the final stage of life." This is a questionnaire survey on how much Advance Care Planning (ACP), which has been popular in Europe and the United States since the 1990s, is being practiced by the Japanese public, doctors, nurses, nursing care staff, etc. ACP is a scheme by which a doctor talks with a patient and their family at the end of life and determines treatment.

Examples of answers that provide some insights into the circumstances of terminal medical care in Japan are as follows (Table 1).

①About 40% of the general public and about 50% of medical and welfare workers have talked with families about medical care at the final stage of life.

②In preparation for cases where you cannot make a judgement yourself, there is what is referred to as "Advance Instruction." This is a document stating what kind of treatment you want or do not want to receive. The proportion of respondents who agree with the concept of advance instruction is 69.7% for the public, 73.4% for doctors, 84.7% for nurses, and 83.8% for long-term care staff.

③However, few of those who agree have actually created their own Advance Instruction.

④There are many opponents regarding the legal provision of determining treatment policy based on the advance instruction.

The Ministry of Health, Labor, and Welfare plans to announce a revised version of the ACP guidelines in March 2018. In order to disseminate ACP, it seems necessary to make reforms that reflect the selection of end-of-life care in public health insurance premiums.

Table 1


(Source)Ministry of Health, Labor, and Welfare

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