Guidelines for Life-sustaining Treatment: What Should be Done to Respect Patients’ Wishes?

Editorial

14:24 JST, April 30, 2026

Whether to seek life-sustaining treatment, and when receiving it, how long to continue it — these are critical decisions for everyone.

As the population ages, it has now become necessary for each individual to routinely consider what kind of treatment they wish to receive at the end of their life and to share their wishes with those around them.

Four medical societies, including the Japanese Society of Intensive Care Medicine, are set to revise their guidelines on life-sustaining treatment in the near future. The revision is intended to provide detailed procedures for determining whether to discontinue life-sustaining treatment.

In the past, there were a number of cases in which doctors were investigated by the police on suspicion of murder in connection with the discontinuation of life-sustaining treatment. Against this background, the current guidelines were established in 2014 to make it easier for medical professionals to make such decisions.

These guidelines classified patients in the “terminal phase” of life as candidates for the discontinuation of life-sustaining treatment, citing as examples cases in which death is predicted to occur within two to three days.

However, medical advances since then have made it possible to sustain the lives of critically ill patients using medication and devices such as ventilators. Consequently, the current guidelines no longer reflect the reality.

According to the draft revision, respecting a patient’s wishes is the first principle when ending life-sustaining treatment. If the patient is unconscious and their wishes cannot be ascertained, the draft calls for doctors, family members and others to discuss the matter thoroughly and take the best course of action for the patient.

In medical settings, once life-sustaining treatment begins, there is often no option but to continue treatment. This is because discontinuing treatment would result in the loss of life.

It is undesirable for life-sustaining treatment that causes suffering to continue when the patient does not want it.

The draft revision also proposes as a new option a method in which the patient’s side and medical professionals discuss and decide the timing to discontinue life-sustaining treatment when initiating it. The idea is that treatment would continue if there is a prospect of recovery during the course of treatment, and if not, ending it would be considered.

This can be seen as an attempt to allow patients and their families to come to terms with their feelings and make a decision after carefully assessing the patient’s condition, without rushing to a conclusion. It is hoped that doctors will uphold the patient’s dignity and provide thorough explanations to their family.

In response to this revision, some people, mainly patients with intractable diseases who rely on ventilators and other medical devices on a daily basis, are worried that, even if they wish to continue living, treatment might be discontinued based on the decisions of others including their families or doctors.

A situation must be avoided in which necessary medical care is withheld from patients against their will. When making decisions regarding life-sustaining treatment, medical professionals should provide support to ensure that patients and their families can make decisions that are acceptable to them.

(From The Yomiuri Shimbun, April 30, 2026)