Background. Medical decisions concerning the end of life (MDEL) have recently been the subject of sustained ethical debate in Japan. However, no study has been undertaken to provide a picture of the kinds of ethical dilemmas Japanese physicians encounter in their care of the terminally ill. We therefore conducted a national survey of Japanese physicians involved in medical care for the terminally ill in their everyday practice. Methods. A postal questionnaire was sent to 500 physician members of the Japan Society of Cancer Therapy for an inquiry into their experience on ethical dilemmas in MDEL. Results. A total of 339 physicians (68%) responded, of whom 11% answered that they were always, 26% often, and 39% sometimes perplexed by ethical dilemmas in MDEL. A total of 386 dilemmas were reported by 267 respondents as the most perplexing, including those related to decisions about life-sustaining treatment, patients' families' demands or requests for medical care, patients' refusal of or demand for medical care, and truth- telling to a terminal cancer patient. Many respondents wondered whether cardiopulmonary resuscitation should be performed for a terminally ill patient, in what situation life-sustaining treatment should be withheld, and whose wishes for medical care should be prioritized in the face of disagreement between patients and their families. Conclusion. Our study suggests that Japanese physicians are faced with various perplexing ethical dilemmas. Serious efforts to resolve these problems in research, education, and physician-patient communication are imperative.
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