Background In current Western medical ethics, patient-centered medicine is considered the norm. However, the cultural background of collectivism in East Asia often leads to family-centered decision-making. In Japan, prior studies have reported that family-centered decision-making is more likely to be preferred in situations of disease notification and end-of-life decision-making. Nonetheless, there has been a recent shift from collectivism to individualism due to changes in the social structure. Various personal factors have also been reported to influence moral decision-making. Therefore, this study (...) examined whether the current trend in attitudes of healthcare decision-making in Japan is family-centered or patient-centered among the general public and physicians. In addition, the personal factors that influence this tendency were examined.Methods Three vignettes on disease notification and two vignettes on decision-making during end-of-life care were created, and 457 members of the public and 284 physicians were asked about their attitudes (behavioral intentions) regarding these vignettes.Results Approximately, 95% of physicians were patient-centered in explaining the patient’s severe medical condition. However, approximately 80% of physicians emphasized the wishes of the family over patient wishes when making life-sustaining decisions. Nearly half the general public emphasized the patient’s wishes in the explanation of a severe medical condition and in life-sustaining decisions. In both the public and physician groups, personal factors, particularly the presence or absence of a disease under treatment and prior caregiving experience, influenced ethical attitudes toward medical treatment decisions.Conclusions In relatively low-conflict situations, such as the announcement of a patient’s medical condition, physicians tended to be patient-centered, while they tended to be family-centered in situations of strong conflict in withholding life-sustaining treatment. The fact that personal factors influenced the family-centered response in situations of strong conflict highlights the importance of not only acquiring knowledge of medical ethics but also learning to fairly apply this knowledge in practice. (shrink)

Background According to some medical ethicists and professional guidelines, there is no ethical difference between withholding and withdrawing life-sustaining treatment. However, medical professionals do not always agree with this notion. Patients and their families may also not regard these decisions as equivalent. Perspectives on life-sustaining treatment potentially differ between cultures and countries. This study compares Japanese physicians’ and citizens’ attitudes toward hypothetical cases of withholding and withdrawing life-sustaining treatment.Methods Ten vignette cases were developed. A web-based questionnaire was administered to 457 (...) citizens and 284 physicians to determine whether they supported withholding or withdrawing treatment.Results In a case where a patient had an advance directive refusing ventilation, 77% of the physicians and 68% of the citizens chose to withhold treatment. In a case where there was an advance directive but the patient’s family requested treatment, 55% of the physicians and 45% of the citizens chose to withhold the ventilator. When a family requested withdrawal of the ventilator but patient wishes were unknown, 19% of the physicians and 48% of the citizens chose to withdraw the ventilator. However, when the patient had also indicated their wishes in writing, 49% of the physicians and 66% of the citizens chose to withdraw treatment. More physicians were prepared to withdraw dialysis (84%) and artificial nutrition (81%) at a patient’s request than mechanical ventilation (49%).Conclusions A significant proportion of Japanese physicians and citizens were reluctant to withhold or withdraw life-sustaining treatment, even in cases where the patient had indicated their wishes in writing. They were more likely to withhold than withdraw treatment, and more likely to withdraw artificial nutrition than mechanical ventilation. Japanese physicians gave significant weight to family views about treatment but were less likely to agree to withdraw treatment than citizens, indicating a potential source of conflict in clinical settings. (shrink)

Vivre et mourir sans se départir de son courage et perdre son honneur est au coeur du Hagakure, une série de textes écrits par un samouraï du XVIIIe siècle, Yamamoto Tsunetomo. Ce livre est une fenêtre ouverte sur l'esprit du samouraï, éclairant le concept de bushido (la Voie du guerrier), qui précise la manière dont les samouraïs devaient se comporter, se discipliner, vivre et mourir. Alors que pendant de nombreuses années, le Hagakure demeura un texte secret, connu uniquement des samouraïs (...) au service du clan Nabeshima auquel appartenait l'auteur, il fut plus tard reconnu comme un grand classique de la pensée du samouraï. A l'origine, le Hagakure était composé de plus de 1300 textes courts que Tsunetomo dicta à un jeune samouraï sur une période de sept années. William Scott Wilson a sélectionné et traduit ici 300 des textes les plus représentatifs pour créer un ouvrage plus accessible, un guide du samouraï. Aucun autre traducteur n'a su rendre ce texte avec autant de profondeur et d'érudition. Wilson éclaire le Hagakure sous un jour différent : Tsunetomo fait référence au bushido comme à " la voie de la mort, " une description qui a engendré une fascination morbide chez ses lecteurs, particulièrement pendant la Seconde Guerre mondiale. Mais à l'époque de Tsunetomo, le bushido relevait d'un concept plus nuancé qui était étroitement lié au concept zen de muga, la " mort de l'ego ". L'introduction de Wilson fournit l'arrière-plan historique et philosophique pour une lecture plus métaphorique du Hagakure. (shrink)