___² Yoshizawa, T., Shinia Raifu Hyakka (Senior Life Encyclopedia), Shakai Hoken Kôhosha, Tokyo, 1982, pp. 74-75.

___³ Ministry of Health and Welfare, Showa 59 Nen Kan'i Seimei Hyô (Simplified Table for Life Statistics, 1984), Government of Japan, 1985, p. 33.

___⁴ Nakamura, E., On the Death at Homes and Institutions, in "IRYÔ '85" (Medical Services '85) Vol. 1, No. 5, Sept. 1985, Medikaru Furendo Sha, Tokyo, 1983, pp. 118-119.

___⁵ Okayasu, M., ed., Sôgôenjo toshiteno Tâminaru Kea (The Terminal Care as an Integrated Support System), Chîmu Iryô, Tokyo, 1983, p. 259.

___⁶ Ministry of Health and Welfare, Analysis of Brain Death Cases, Kôseishô, Tokyo, 1985.

___⁷ Ministry of Health and Welfare, The Report of Study Group Concerning Brain Death, Kôseishô, Tokyo, 1985.

___⁸ General legal trends and court cases in Japan relating to malpractice suits affirm the physician's responsibility in giving information to the patients (Ishi no Setsumei Gimu which means physician's obligation for explanation in doing treatment) as well as to receive consent. However, in several cases the Japanese courts are still holding "prerogative right of medical discretion" to be given to physicians, which shows inconsistency in dealing with the medical malpractice suits. See cases, Osaka District Court (Nov. 15, 1979), Sapporo District Court (Dec. 22, 1978), Tokyo District Court (Dec. 21, 1981) and Hiroshima District Court (Dec. 22, 1982). In the court case in Hiroshima, the decision mentioned that there was no malfeasance in physician's "non-explanation" on side effects of "shock death" to be caused by injection of streptomycin as it would give unnecessary anxiety to the patient. Also, in a recent case the Tokyo High Court (April 22, 1985) gave the negative decision to allow the patient's autonomy for the medical treatment by having physician's explanation. This decision says "Medical treatment is solely the responsibility of physician because of highly professional character and the physicians are obligated to do medical treatment in having his/her own confidence according to medical standard - an appropriate medical treatment as a professional technique could hardly be done if physicians are always supposed to confirm the consent of the patient by following the patient's own choices" (Hanrei Jihô, No. 1159, p. 90, 1985).

___⁹ Kimura, R., Baioeshikkusu to Byôin no Kinô (Bioethics and the Function of Hospital), Japanese Journal of Hospital, Vol. 40, No. 1, pp. 50-53, 1981, and also recent development of the "Patients' Rights" in Japan should be mentioned here. See National Committee on Patients' Rights, Kanjya no Kenri Sengen (An) (The Draft of the Declaration of Patients' Rights). Suzuki, T., Kanja no Kenri Sengen (Declaration of Patients' Rights), in "Jurisuto" No. 826, Dec. 1, 1984, Yûhikaku, Tokyo, pp. 48-51.

___¹⁰ Okada, K., Sosei o shinai Kijun (A Standard for DNR) in "Saishin Iryô to Rinri" (The Recent Medical Service and Ethics) ed. by Aochi, O., Herusu Shuppan, Tokyo, 1985.

___¹¹ Hara, Y. and Chihara, S., Hosupisu Kea (Hospice Care), Medikaru Furendo Sha, Tokyo, 1983, p. 80.

___¹² Inagaki, T., The Cases of Physician's Rights (Prerogative) in the Medical Treatment, Iryôkago Soshô no Riron (A Theory of Malpractice Suits), Nippon Hyôron Sha, Tokyo, 1985, pp. 64-65.

___¹³ Nakai, Y. et al., Iryôkagohô Nyûmon (An Introduction to the Law Relating to Medical Malpractice), Seirinshoin Shinsha, Tokyo, 1979, pp. 3-26.

___¹⁴ According to the data by the Supreme Court, the medical malpractice suits now in pending are 1,329 cases in the year 1984 and since 1974, there have been around 250 cases in average in each year till 1984.

___¹⁵ Nakai, Y., op. cit., pp. 180-181, and Kawashima, T., Dispute Resolution in Contemporary Japan, in Law in Japan, A. von Mehren ed., Harvard Univ. Press, 1963, pp. 41-72. See also Kojima, T. and Taniguchi, Y., Japanese National Report on Access to Justice, in Access to Justice, M. Cappelleti ed., Vol. I, Book 2, Sijthoff, 1978, pp. 717-734.
___As of 1970, the medical malpractice troubles were 1,986 cases and 1,038 cases were solved by the arrangement of "conflicts resolution committee of each local prefectural medical association" (Journal of Japan Medical Association, Vol. 68, No. 2, 1970, p. 183). This data shows the general trends of Japanese approach in conflicts resolution outside courts.
___Even the malpractice suit would have been brought to the court, the final decisions were not made by court ruling but "Saiban jô no Wakai" (the settlement of the conflicts by the initiative of the court by having mutual agreement between the defendant and the plaintiff). This "Wakai" settlement has various reasons to be adopted by the parties as follows: 1. Tendency to avoid the losing of the case in the physician's side for keeping their credit, reputation and honor, 2. The defendant's wishes for expeditious settlement than normal court procedure, and 3. Judge's inclination to avoid court ruling because of the highly professional character of the cases.

___¹⁶ Suzuki, T., Shujutsu Shôdakusho to Kanja no Kenri (The Consent Form for Surgical Operation and Patients' Rights) in Iatorosu, No. 4, pp. 70-71.
___There are three types of "Consent Form" presently used in the public hospital in Japan. Patients or their proxies are requested to sign with seal in the document stated as 1. no-complaint whatsoever about anything that happens during or after operation and causing no trouble to the hospital, 2. understood and gave consent in having full explanation on surgery (operation, anesthesia and treatment), and 3. asking all kinds of treatment to the physicians in charge based on the explanation and understanding in present situation of sickness, necessity for operation, prognosis and possible complications.

___¹⁷ Suzuki, op. cit., p. 70.

___¹⁸ Fujita, K., Songenshi Rippôka no Dôkô to Mondaiten (The Trends and Some Points of Problems Relating to the Legislation for the Dignity of Death) in Rippô to Chôsa (Legislation and Research), No. 98, June 1980, pp. 10-13.

___¹⁹ Fujita, K., op. cit., p. 12.

___²⁰ Fujita, K., op. cit., p. 16.

___²¹ Nishida, H., Seimeisôsateki Handan to Sôgôteki Iryô no Jûyôsei nitsuite (Life-Manipulative Judgment and the Importance of Integrated Medical Services) in Symposium Report II on the Hereditary Malformity and Its Treatment, Tokyo, 1982, p. 70.

___²² Nishida, H., Sakamoto, S., and Sakanoue, M., Shussanki no Rinri (Ethics of Perinatal Period), in Sanfujinka no Sekai (The World of Obstetrics and Gynecology), Vol. 37, special issue, 1983.

___²³ Hara, Y., op. cit., pp. 76-80.

___²⁴ Kaibara, E., Yôjôkun (The Teaching for Keeping Health), 1714 (English translation by Kunihiro, M., Tokuma Shoten, Tokyo, 1974, pp. 199-233) and also Fujikawa, Y., Nihon Igaku Shi (The History of Japanese Medicine), Nissinshoin, Tokyo, 1941, pp. 5-22.

___²⁵ Lock, M. M., East Asian Medicine in Urban Japan. Varieties of Medical Experience, California Univ. Press, pp. 111-178.

___²⁶ Anma Massâgi Shiatsushi, Harishi, Kyûshitô ni kansuru Hôritsu (The Law Relating to Anma Mass Agist, Shiatsushi, Acupuncurist and Moxibustionist, etc.), 1947, Dec. 20th, The Law No. 217, Government of Japan.

___²⁷ Kimura, R., Health Care for the Elderly in Japan in "Health Policy, Ethics and Human Values, An International Dialogue", ed. by Bankowski. Z. and Bryant, J. H., Council for International Organizations of Medical Sciences, Geneva, 1985, pp. 184-193.

___²⁸ Kimura, op. cit., p. 187.

___²⁹ Hino, S. et al. ed., Nihon no Hoken'iryô (The Japanese Health and Medical Services), Rôdôjunpôsha, Tokyo, 1984, pp. 24-25.

___³⁰ Kikuchi, T., Jibuntachi de Inochi o Mamotta Mura (The Village Where People Themselves Had an Initiative to Maintain and Promote Their Health and Life), Iwanami Shoten, Tokyo, 1968, pp. 82-151; also Hino, S. et al., op. cit., p. 182.

___³¹ Hino, S. et al., op. cit., p. 183.

___³² Hino, S., Gendai Nihon no Iryôseisaku (The Policy for Medical Services in Contemporary Japan), Rôdôjunpôsha, 1984, pp. 70-88.

___³³ Hino, s. et al., op. cit., p. 178.

___³⁴ Hino, S., op. cit., p. 70.

___³⁵ Ogishima, H., et al., Rôjin Hoken Hô to Rôjin Iryô no Shinten (Law for the Health of Elderly and the Development of Medical Services for the Elderly), Japanese Journal of Nursing, Vol. 48, No. 7, Aug. 1984.

___³⁶ Ministry of Health and Welfare (Kôseishô), Government of Japan, Health and Welfare Services in Japan, 1984, p. 23.

___³⁷ Jinkô Tôseki Kenkyû Kai (The Society for the Study of Artificial Dialysis), Kodaka, M., Chiba Univ. Medical School, Wagakuni no Tôseki Ryôhô no Genkyô (Present Situation of the Chronical Dialysis Treatment in Japan), Chiba, 1983, pp. 34-35.

___³⁸ Sakai, T., CAPD Ryôhô o meguru Shomondai (Several Problems Relating to CAPD Treatment) in Annual Report, Kidney Center, Kitasato University Hospital, Part 3, 1984, pp. 2-6.

___³⁹ Sakai, T., op. cit., p. 2.

___⁴⁰ Medical Service Section's Notice, No. 7, 13th Feb. 1984.

___⁴¹ Sato, A., Ikiru soshite Shinu to yûkoto (On Living and Dying), Keizaiôraisha, 1985, pp. 225-226.

___⁴² Niki, R., Iryôkeizaigaku (Medical Economics), Igakushoin, 1985, pp. 212-214.

___⁴³ Otani, M., Nôshi - Hôritsu no Tachiba yori (Brain Death - From the Legal Perspective) in Chiryôgaku (Biomedicine and Therapeutics), Vol. 14, No. 4, pp. 499-502, 1985.

___⁴⁴ Yokoyama, T., Shitaijin'ishoku to sono Sisutemu (Cadaveric Renal Transplantation and Renal Transplantation Information Systems) in Chiryôgaku (Biomedicine and Therapeutics), Vol. 13, No. 3, pp. 375-378, 1984.

___⁴⁵ Yokoyama, T., op. cit., pp. 377-378.

___⁴⁶ Sasaki, T., et al., Kûyu Beikoku Shitaijin'ishoku no Genkyô (Current Status of Cadaver Transplants Using Kidneys Shipped from the United States) in Chiryôgaku (Biomedicine and Therapeutics), Vol. 13, No. 3, pp. 403-407, 1984.

___⁴⁷ Iwasaki, Y., Zôkiteikyôsha o meguru Shomondai (Some Problems Concerning Organ Donors) in Chiryôgaku (Biomedicine and Therapeutics), Vol. 13, No. 3, pp. 396-400, 1984.

___⁴⁸ Ishikawa, S., Yoriyoi Shi towa (Better Death - ?), Iryô (The Medical Services), Vol. 1, No. 5, pp. 20-21, 1985.

___⁴⁹ Hara, Y., op. cit., p. 80.

___⁵⁰ Aochi, O., Saishin Iryô to Rinri (The Recent Medical Services and Ethics), Herusu Shuppan, 1985, p. 130.

___⁵¹ Kakikawa, F., Kango no Tachiba kara - Kyûkyû Iryô niokeru Seimei to Rinri nikansuru furî tôkingu (The Nursing Point of View - Free Talking on Life and Ethics in Emergency Medical Services) in Aochi, O., op. cit., p. 149.

___⁵² Ministry of Health and Welfare, Medical Service Section's Notice, No. 11, 18th Feb. 1985.

___⁵³ Health and Welfare Statistics Association, Health and Welfare Statistics in Japan, 1985, pp. 49-50.

___⁵⁴ Health and Welfare Statistics Association, op. cit., p. 51.

___⁵⁵ Amano, H., Kôseizai no Rôjin eno Kajôtôyo wa Kinmotsu (The Overdose of the Antibiotics to the Elderly Is Hazardous) in Nikkei Medical, No. 187, Oct. 1985, pp. 65-68.

___⁵⁶ Mizuguchi, K., and Hiraga, I., Makkikanjya no Nîzu to Taiô (The Needs of the Terminal Patients and the Response to Them) in Sei to Shi no Iryô (Medical Service for Life and Death), Asakurashoten, 1985, pp. 136-140.

___⁵⁷ Mizuguchi, K., op. cit., p. 138.

___⁵⁸ Kenkôhokenhô (Health Insurance Law) amended and enforced from 1st Oct. 1984.

___⁵⁹ Hino. S., op. cit., pp. 90-151.

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