Attitudes towards terminal care among the general population and medical practitioners in Japan

OBJECTIVES: Assessment of attitudes held by the general population and medical practitioners in Japan regarding medical interventions in cases of painful terminal illness or a prolonged vegetative state. METHOD: A mail survey was conducted in 1998. The subjects were 5,000 persons randomly sampled members of the general population age 20 years or more, and 3,104 doctors and 6,059 nurses in hospitals, clinics, palliative units, and visiting nursing service stations randomly sampled. The response rates were 48% among general population, 51% among doctors, 56% among nurses. RESULTS: 1. 68-76% of the general population and medical practitioners expressed disapproval of life-extending medical treatment of terminal patients suffering pain. The application of euthanasia in certain cases was acceptable to 13% of the general population but only 1% of the medical practitioners. 2. Respondents in almost groups favored a home care setting for terminal patient in pain, and regarded relocation to a palliative unit as acceptable if necessary. 3. 46% of doctors and 22% of nurses indicated knowledge of the WHO method for cancer pain relief, and 45% of doctors and 25% of nurses showed that they were able to explain appropriate opioid administration. 4. 74-79% of general population and medical practitioners opposed life-extending medical intervention for patients in a vegetable state. 26% of the general population favored termination of all means of life support, while about 10% of the medical practitioners held this view. 5. Most medical practitioners felt that some medical treatments, such as bedsore care, should be continued in lieu of life support, but there were differences in opinion between practitioners at various types of medical facilities regarding the necessity of such specific measures as, for example, blood pressure monitoring by automatic sphygmomanometer among the medical facilities. CONCLUSION: Both the general population and the medical practitioners in Japan tended to oppose life-extending medical treatment for painful terminal cases and patients in a prolonged vegetable state. There are some differences in opinion between the general population and practitioners at various types of medical facilities regarding the extent of desirable medical care in such circumstances.