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J Intensive Care. 2014 Feb 18;2(1):9. doi: 10.1186/2052-0492-2-9. eCollection 2014.

End-of-life considerations in the ICU in Japan: ethical and legal perspectives.

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Department of Critical Care Medicine, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1264, New York, NY 10029 USA.
Clinical Professor of Emergency/Critical Care Medicine Department, St. Marianna Medical School, 2-16-1 Sugao Miyamae-ku, 216-8511 Kawasaki City, Kanagawa, Prefecture, Japan.


In Japan, the continuation of critical care at the end of life is a common practice due to the threat of legal action against physicians that may choose a palliative care approach. This is beginning to change due to public debate related to a series of controversial incidents concerning end-of-life care over the last decade. In this review we contrast and compare the history and evolution of end-of-life care in Japan vs. the USA and other Asian countries. Efforts by the Japanese Society of Intensive Care Medicine (JSICM) to establish better end-of-life care systems, as well as future directions in palliative care in Japan, are discussed.


Advance directive; Asian countries; East; End-of-life; ICU; Japan; Living will; Palliative care; USA

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