A draft of the bill of special measures in the medical treatment of terminally ill individuals

Article One (Purpose)

__Every human being has the right to decide whether to accept or refuse measures to maintain one's own life. In accordance with this right, the purpose of this law is to provide procedures for stopping life prolonging measures for patients who are terminally and incurably ill and have declared they do not want excessive life prolonging treatment.

Article Two (Definition)

__The patient must be deemed by medical authorities to be terminally and incurably ill where life prolonging treatment would merely prolong the time of death. Excessive life prolonging measures mean treatment from which a patient shows no signs of improving, but which only serves to prolong the time of death. This does not include treatment to lessen pain.

Article Three (Declaration by an Individual to Refuse Excessive Life Prolonging Measures)

__An Individual older than fifteen, possessing the ability to express intent, can indicate in advance a desire to refuse excessive life prolonging measures in the event he/she should become terminally and incurably ill, in any of the following ways:
__1) An individual, while of sound mind, can indicate on a written from his/her desire in advance to refuse excessive life prolonging measures should that individual become terminally and incurably ill. This form must be dated, and carry the individual's address and name in handwriting as well as his/her personal stamp. At least two others must bear witness by signing and putting their personal stamps on the above form to verify that the above individual did indeed sign in normal consciousness.
__2) If due to illness or other reasons, an individual is not able to sign the form, at least two doctors must sign and put their personal stamps on the form where the individual's signature would go. Furthermore, the form must be dated, in order to verify that these doctors were present when the individual indicated his/her desire and that this request was made while the individual was of sound mind.

(Middle section omitted)

__2. Article Number 964 of the civil code applies to the witnesses described in (1) above.
__3. The format of the written form to be used, mentioned in the first item of (1) above is shown in a separate table.

Article Four (Withdrawal of Form by an Individual)

__In order for an individual to change his/her mind about the written form mentioned in item one of the previous article, he/she must either destroy the form, or write in his/her own handwriting a request for the form to be withdrawn, with the date and the individual's signature.

Article Five (Measures for Individuals Who Do Not Possess the Ability to Decide)

__The individual's right to decide, as provided in Article One, cannot be taken on by others. However, in cases where an individual does not possess the ability to decide, the courts may be asked to decide for the individual.

Article Six (Verification that an Individual Is Terminally and Incurably Ill)

__At least two doctors need to verify that an individual is terminally and incurably ill. The doctors carrying out the verification must sign and put their personal stamps on the form certifying that an individual is terminally and incurably ill. This does not include the patient's doctor who will either decide to not start life prolonging measures or who will decide to stop them.

Article Seven (Doctors Not Legally Accountable for Carrying Out Request)

__The doctors who have decided to not start or to stop excessive life prolonging measures, in accordance with the regulations or law, are not to be held legally accountable under the penal and civil codes.

Article Eight (Duty of Keeping the Form)

__The forms mentioned in Articles Three, Four and Six, must be kept by the doctor who decided to not start or to stop the life prolonging measures of an individual for a period of five years.

Article Nine (Relation to Life Insurance Policies)

__An individual's refusal of excessive life prolonging measures must not be interpreted as suicide in life insurance policies.

Article Ten (Punishment)

__Those who destroy or hide the form in Article Three, Four or Six, falsify facts, or sign as a witness knowing the facts are false, or forge or adulterate the form, are punishable by imprisonment for a term no greater than "years or a fine no greater than" yen.

APPENDIX II

SURVEY FOR WASEDA UNIVERSITY STUDENTS
Bioethics - Prof. Rihito Kimura

R. Kielstein, H.M. Sass (1993), "Using Stories to Assess Values", Kennedy Institute of Ethics Journal 3 (3): 322f.

__WHICH VALUES AND WISHES SHALL GOVERN YOUR TREATMENT? ... Others might not make the correct proxy decisions when deciding for you. Therefore you should let them know about your preferences and give them directions. Tell them which values and wishes you would prefer to govern the last days and hours of your life story.

PRESENT SELF-ASSESSMENT	FUTURE SELF-DETERMINATION
1 - Yes, very important	A - Yes, very important
2 - Important	B - Important
3 - Not important	C - Depending on situation
4 - I cannot decide	D - I cannot decide
5 - No	E - No

1. I want to live as long as possible:
-if I am permanently unconscious	__1, 2, 3, 4, 5____A, B, C, D, E__
-if I am mentally incompetent	__1, 2, 3, 4, 5____A, B, C, D, E__
-if I am terminally ill	__1, 2, 3, 4, 5____A, B, C, D, E__
2. I want to be without pain.	__1, 2, 3, 4, 5____A, B, C, D, E__
3. I do not want to be dependent.	__1, 2, 3, 4, 5____A, B, C, D, E__
4. I do not want to die in the hospital.	__1, 2, 3, 4, 5____A, B, C, D, E__
5. I want a comfortable dying process.	__1, 2, 3, 4, 5____A, B, C, D, E__
6. I do not want to be left alone.	__1, 2, 3, 4, 5____A, B, C, D, E__
7. I do not want to be a burden.	__1, 2, 3, 4, 5____A, B, C, D, E__
8. I want my values to govern treatment.	__1, 2, 3, 4, 5____A, B, C, D, E__

__If you intend this to be a legally binding document, please sign it and have it witnessed according to the laws of your state. If you change your story, comments, or directives, do so in writing by dating and signing those changes. It is always a good idea to review stories, comments, and directives from time to time and to sign and date them again, even if you do not change anything, as this would indicate your repeated commitment to previous statements.
__If you wish, please include comments on these and other stories, wishes, or preferences on additional pages.

____________________	___________
SIGNED	DATE
_
____________________	___________
WITNESSED	DATE

REFERENCES

Arai, Tatsuru; Namiki, Akiyoshi; Amaha, Keisuke; Shigematsu, Akio; et al: 1994, 'Shuumatsuki kanjyani taisuru DNR wa douarubekika (What Should be Done to Terminal Care Patient Relating to DNR?)', Journal Masui (Anesthesia) 43, No. 4, 600-611.

Bai, Koichi: 1990, Seimei iji Chiryou no Hori to Rinri (Legal Reasoning and Ethics of Life-sustaining Therapy), Yuhikaku, Tokyo.

Doi, Takeo: 1971, Amae no Kozo (Anatomy of Dependence), Kodansha, Tokyo.

Fujii, Masao: 1991, 'Gendai no Shi to Bukkyosha (Contemporary Death and Buddhists)' in Bukkyo no Ningengaku (Anthropology of Buddhism), Suzuki Shuppan, Tokyo.

Hoffmann, Yoel: 1986, Japanese Death Poems, Charles E. Tuttles, Tokyo.

Japan Medical Association: 1992, 'Makki Iryo ninozomu Ishino arikata (How Physicians Should Handle the Treatment of Terminal Patients in the Final Stage)', Japan Medical Association.

Japan Science Council: 1994, 'Shi to Iryo Tokubetsuiinkai Hokoku - Songenshi ni tsuite (Report of Special Committee on Death and Medical Services - On Dying with Dignity)', Japan Science Council.

The Japan Society for Dying with Dignity: 1990 & 1992, 'The Development of the Movement for Dying with Dignity in Japan', part one, Japan Society for Dying with Dignity.

Kimura, Rihito: 1987, Inochi o Kangaeru (Thinking of Life), Nippon Hyoron Sha.

Kimura, Rihito: 1991a, 'The Right to be Informed: An Aspect of Dignity', in World Health Forum 12, 391-392, World Health Organization, Geneva.

Kimura, Rihito: 1991b, 'Fiduciary Relationship and Medical Profession: A Japanese Point of View', in Ethics, Trust, and the Profession, Edmund Pallegrino et al., eds., Georgetown University Press, Washington.

Kimura, Rihito: 1991c, 'Japan's Dilemma with the Definition of Death', Kennedy Institute of Ethics Journal 1 (2), 123-131.

Kimura, Rihito: 1994, 'Bioethics and Japanese Health Care' in Washington-Japan Journal Vol. II, No. 4, 1-7.

Kobe District Court__Showa 50 nen: Oct. 29, 1975, No. 484.

Kochi District Court__Heisei 2 nen (Wa): Sep. 17, 1990, No. 94.

Lebra, T.S.: 1976, Japanese Patterns of Behavior, University Press of Hawaii, Honolulu.

MHWJ (Ministry of Health and Welfare, Japanese Government): 1995, Kosei Hakusho (Annual Report on Health and Welfare), Gyosei, Tokyo.

Mizuguchi, Kimonobu: 1987, 'Shumatsukiiryo no Genkyo (Present Situation of Terminal Medical Services)', Nippon Iji Shinpo (Japan Medical Journal), No. 3290, 14-18.

Morikawa, I.: 1994, 'Patients' Rights in Japan - Progress and Resistance', Kennedy Institute of Ethics Journal 4 (4), 337-343.

Nagoya High Court__Showa 37 nen (U): Dec. 22, 1962, No. 496.

Ohi, Gen: 1988, Terminal Care (in Japanese), Kobundo.

Osaka District Court__Showa 52 nen (Wa): Nov. 30, 1977, No. 3083.

Pinguet, Maurice: 1993, Voluntary Death in Japan, Polity Press, Cambridge.

Takeda, F. and Uki, J.: 1994, 'Recent Progress in Cancer Pain Management and Palliative Care in Japan', Annals Academy of Medicine 23 (2), 296-299.

Tokyo District Court__Showa 55 nen (Wa): Feb. 17, 1982, No. 2812.

Waseda University (Center for Advanced Study of Human Sciences): 1992, Kanjyanitotte Iryo towa nanika (The Meaning of Medical Service for Patients), Bioethics Project, Waseda University.

Yokohama District Court__Heisei 4 nen (Wa): Mar. 28, 1995, No. 1172.

Yamaori, Tetsuo: 1994, Omukae no Toki - Nipponjin no Shiseikan (When Time Comes - Japanese View of Death and Life) (in Japanese), Shodensha.

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