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Policy & Legislations
Advance Directives
Life-Sustaining Treatment Plans
Withholding/Withdrawing
Personalized Information
by User
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Verification of Patient’s Intention
The decision to withdraw or withhold LST can be implemented only if the patient’s decision to withdraw or withhold LST is verified by any of the following.
- Verification with Life-sustaining Treatment Plan
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- The doctor in charge verifies the intention of the patient with the life-sustaining treatment plan(Appendix Form No. 1) (Refer to the preparation of Life-sustaining Treatment Plan above for the relevant part)
- Verification with Advance Directive on Life-sustaining Treatment
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- The doctor in charge verifies the intention of the patient with the advance directive on life-sustaining treatment prepared in advance (Appendix Form No. 10)
This is a case where the legitimacy of advance directive on life-sustaining treatment prepared after the medical assessment of the doctor in charge and the medical specialist in the relevant field stating that the patient does not have mental capacity has been verified(Appendix Form No. 10)
- The doctor in charge verifies the intention of the patient with the advance directive on life-sustaining treatment prepared in advance (Appendix Form No. 10)
- Verification with Statements of Two Patient Family Members
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- The doctor in charge and the medical specialist in the relevant field verify the intention of the patient through the statements of patient family(Appendix Form No. 11)
- Verification with Decision of Patient Family
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- The doctor in charge and the medical specialist in the relevant field verify the unanimous consensus of the patient family(if the patient is a minor, the intention of the person with parental rights) (Appendix Form No. 12)
Significance
- Advance Directive on Life-sustaining Treatment means a written statement prepared by a person above the age of 19 on his or her own decision to withdraw or withhold LST and hospice care(Article 2(9) of the Act)
- Advance directive on life-sustaining treatment is directly prepared by the patient himself or herself after receiving and understanding sufficient explanation through the Registry Agencies designated by the Ministry of Health and Welfare, and should be registered to the life-sustaining treatment information processing system to be recognized as a legally valid form.
- STEP 1
- Confirmation
of Eligibility
- STEP 2
- Search of Advance
Directive on
Life-sustaining
Treatment
- STEP 3
- Confirmation of
Patient’s Mental
Capacity
- STEP 4
- Writing and Safekeeping
the Verification
(Doctor in Charge and
Medical Specialist in
the Relevant Field)
Search
- The doctor in charge can search the patient’s advance directive on life-sustaining treatment via the life-sustaining treatment information processing system to verify the decision to withdraw or withhold LST.
- As a result of search, it is recognized as the decision to withdraw or withhold LST of the patient by going through the verification process determined by laws for the advance directive on life-sustaining treatment.
Verification
- When the patient has mental capacity
-
- Since the patient prepared the searched advance directive on life-sustaining treatment without being sufficiently aware of his or her current disease condition and methods of treatment, it should be verified that the opinion of the preparer who became a patient at the end stage of life is the same as the one in the document
- The doctor should have the patient verify the content and if the opinions are consistent, consider it as the decision to withdraw or withhold LST. If different, the life-sustaining treatment plan can be newly prepared.
- When the patient does not have mental capacity
-
- If the patient does not have mental capacity at the time of assessment as a patient at the end stage of life, the doctor in charge and one medical specialist in the relevant field should verify the following together in order to consider it as the intention of the patient.
- Medical assessment that the patient does not have sufficient mental capacity to verify the content of the advance directive
- The fact that the advance directive has been prepared legitimately(The Advance directive on Life-sustaining Treatment that can be searched through the life-sustaining treatment information processing system is considered as legitimately prepared)
Record of verified Results
- The doctor in charge and the medical specialist in the relevant field, who verified the patient’s intention for the decision to withdraw or withhold LST through advance directive on life-sustaining treatment, must record the result in [Appendix Form 10]
Significance
- If there is no way to check the patient's explicit intention such as by Life-sustaining Treatment Plan or Advance Directive on Life-sustaining Treatment, and if the patient is in a medical condition where the patient cannot express his or her intention, the decision to withdraw or withhold LST for the patient can be verified through the statements of two or more patient family members.
- STEP 1
- Confirmation
of Eligibility
- STEP 2
- Counseling (Patient
Family Statement
Acceptable)
- STEP 3
- Verification
(Statements of Two
or More Patient
Family Members
- STEP 4
- Writing and Safekeeping
the Verification
(Doctor in Charge and
Medical Specialist in
the Relevant Field)
Verification of Statements
- If two or more family members of the patient state the opinion that can be considered as the patient’s usual opinion on life-sustaining treatment consistently for sufficiently long period of time, and if the doctor in charge and the medical specialist in the relevant field verify it, it can be regarded as the intention of the patient.
- Here, patient’s family members include 1The spouse, 2lineal descendants, 3lineal ancestors, and if there is no one falling under the category, 4siblings are included.
- Only patient family members ages 19 years and above can be involved in the statement, and if there is only one applicable family member, the statement of the person is accepted.
- However, if there is another family member’s statement opposite to the statement or objective evidence such as document written by the patient himself or herself, voice records, videotapes, or equivalent documentaries, in which the patient directly expresses his or her intention to receive life-sustaining treatment, the statement cannot be regarded as the intention of the patient.
- The doctor in charge and medical specialist in the relevant field can verify the patient family’s statement or direct records from which the patient’s usual opinion on life-sustaining treatment can be guessed.
Record of Verified Results
- The doctor in charge and the medical specialist in the relevant field, who verified the patient’s intention for the decision to withdraw or withhold LST through statements of two or more patient family members, must record the result in [Appendix Form 11]
Significance
- If the patient is in the medical condition where the patient cannot express his or her intention and if the patient's intention cannot be verified or guessed, decision to withdraw or withhold LST can be made based on the decision through consensus of the patient's entire family.
- STEP 1
- Confirmation
of Eligibility
- STEP 2
- Counseling
- STEP 3
- Verification
(Unanimous Consensus
of Patient’s Family
Members. For a minor,
decided by the person
with parental rights)
- STEP 4
- Writing and Safekeeping
the Verification
(Doctor in Charge and
Medical Specialist in
the Relevant Field)
Verification of decision to withdraw or withhold LST based on the decision of the family for adult Patients
- If the decision to withdraw or withhold LST for the patient is expressed based on the consensus of the patient’s entire family and if the doctor in charge and one medical specialist in the relevant field verify it, it is considered that there is a decision to withdraw or withhold LST for the patient.
- However, if the doctor in charge or the medical specialist in the relevant field verified that the patient did not have the decision to withdraw or withhold LST, the decision to withdraw or withhold LST cannot be made.
- The scope of the patient’s family is 1 Spouse, parents/children, 2 If there is no one falling under 1, grandparents/grandchildren, 3 If there is no one falling under 1 and 2, siblings are included, but the following persons are excluded(enforced on March 28, 2019).
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- ① A person in whose case at least three years have passed since his/her disappearance was reported to a police office
- ② A person judicially declared as missing
- ③ A person whose medical condition has been diagnosed and confirmed by at least one specialist, as a person whose medical
condition prevents him/her from expressing his/her own intention due to unconsciousness or similar reasons
- If you wish to exclude a person from the scope of the patient’s family subject to agreement, you must submit a document proving the fact to the doctor.
Verification of decision to withdraw or withhold LST based on the decision of the family for minors
- If the legal representative, who is a person with parental rights of the patient, expresses the intention for the decision to withdraw or withhold LST for the patient and if the doctor in charge and the medical specialist in the relevant field verify it, it is considered that there is a decision to withdraw or withhold LST for the patient.
- However, if the doctor in charge or the medical specialist in the relevant field verified that the patient did not have the decision to withdraw or withhold LST, the decision to withdraw or withhold LST cannot be made.
Record of Verified Results
- The doctor in charge and the medical specialist, who verified that there was a decision to withdraw or withhold LST for the patient based on the unanimous consensus of the patient’s family, must record the result in [Appendix Form 12].