Author:
Okada Kazuyoshi,Tsuchiya Ken,Sakai Ken,Kuragano Takahiro,Uchida Akiko,Tsuruya Kazuhiko,Tomo Tadashi,Hamada Chieko,Fukagawa Masafumi,Kawaguchi Yoshindo,Watanabe Yuzo,Aita Kaoruko,Ogawa Yoshitatsu,Uchino Junji,Okada Hirokazu,Koda Yutaka,Komatsu Yasuhiro,Sato Hisamitsu,Hattori Motoshi,Baba Toru,Matsumura Mamiko,Miura Hisayuki,Minakuchi Jun,Nakamoto Hidetomo,Okada Kazuyoshi,Tsuchiya Ken,Sakai Ken,Kuragano Takahiro,Uchida Akiko,Tsuruya Kazuhiko,Tomo Tadashi,Hamada Chieko,Fukagawa Masafumi,Kawaguchi Yoshindo,Watanabe Yuzo,Aita Kaoruko,Ogawa Yoshitatsu,Uchino Junji,Okada Hirokazu,Koda Yutaka,Komatsu Yasuhiro,Sato Hisamitsu,Hattori Motoshi,Baba Toru,Matsumura Mamiko,Miura Hisayuki,Minakuchi Jun,Nakamoto Hidetomo,
Abstract
Abstract
Background
In Japan, forgoing life-sustaining treatment to respect the will of patients at the terminal stage is not stipulated by law. According to the Guidelines for the Decision-Making Process in Terminal-Stage Healthcare published by the Ministry of Health, Labor and Welfare in 2007, the Japanese Society for Dialysis Therapy (JSDT) developed a proposal that was limited to patients at the terminal stage and did not explicitly cover patients with dementia. This proposal for the shared decision-making process regarding the initiation and continuation of maintenance hemodialysis was published in 2014.
Methods and results
In response to changes in social conditions, the JSDT revised the proposal in 2020 to provide guidance for the process by which the healthcare team can provide the best healthcare management and care with respect to the patient's will through advance care planning and shared decision making. For all patients with end-stage kidney disease, including those at the nonterminal stage and those with dementia, the decision-making process includes conservative kidney management.
Conclusions
The proposal is based on consensus rather than evidence-based clinical practice guidelines. The healthcare team is therefore not guaranteed to be legally exempt if the patient dies after the policies in the proposal are implemented and must respond appropriately at the discretion of each institution.
Publisher
Springer Science and Business Media LLC
Subject
Transplantation,Urology,Nephrology
Reference49 articles.
1. Ministry of Health, Labour and Welfare. Guidelines for the decision-making process in terminal-stage healthcare. http://www.mhlw.go.jp/shingi/2007/05/dl/s0521-11a.pdf. Accessed 12 May 2021.
2. Ministry of Health, Labour and Welfare. Guidelines for the decision-making process in end-of-life healthcare. https://www.mhlw.go.jp/file/04-Houdouhappyou-10802000-Iseikyoku-Shidouka/0000079906.pdf. Accessed 12 May 2021.
3. Ministry of Health, Labour and Welfare. Guidelines for the decision-making process in end-of-life healthcare management and care. https://www.mhlw.go.jp/file/04-Houdouhappyou-10802000-Iseikyoku-Shidouka/0000197701.pdf. Accessed 12 May 2021.
4. Japanese Society for Dialysis Therapy. Proposal for the shared decision-making process regarding initiation and continuation of maintenance hemodialysis. J Jpn Soc Dial Ther. 2014;47:269–85.
5. Okada K, Japanese Society for Dialysis Therapy. Proposal for the shared decision-making process for initiation and continuation of maintenance hemodialysis: survey after introduction. J Jpn Ass Dial Physician. 2019;34:1106.