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Living Wills and Advance Directives in the World: Current State and Outlook

Taken from the World Right-to-Die Newsletter issue no. 46, Januray 2005.

By Dr. Michio Arakawa, Executive Director, Japan Society for Dying with Dignity

I surveyed the Living Wills (LWs) in the world by questionnaire and also received more than 50 documents from different countries for this Conference. LWs have legal recognition in Australia, the Netherlands, Norway, Spain, Switzerland and the United States; they have common law recognition in many other countries like England. There are ­different kinds of LWs; some are mostly directives to withhold or withdraw any kind of artificial life-prolonging to request reasonable measures to be taken in addition to refusal; most provide the option of requesting pain relief even if it unintentionally hastens death (palliation prioritization).

The end-of-life period can result in different circumstances: a person could be in an imminently life-threatening state where life-prolonging measures do nothing but delay the moment of death; or in a persistent vegetative state with no prospect of recovery from several months to more than one year; or in the terminal stage of a progressive illness. Providing clear wishes about desired care at these points could prevent tragedy for the individual and the family.

Usually two witnesses are required, neither of whom can be a relative, health care proxy, or personal physician. Provision for a Health Care Proxy is made in most countries; one person is named as the primary decision-maker but up to two alternates can be also named. An increasing number of studies place greater emphasis on health care proxies than LWs during the end-of-life process.

In a national survey (2002) conducted every five years by the Japanese government, the national consensus in favor of LWs increased to 59%, but for legalization decreased to 37%. However, it is imperative that LWs be granted legal recognition to promote their widespread use, and to guarantee the right of self-determination for those who are dying. Thanks to this survey, we clarified our purpose and goal in Japan. I personally hope this information will convey some messages to the member societies that will aid in a peaceful end-of-life.

(Dr. Arakawa summarized his data in Living Wills in the World, a 9-page document available from JSDD.)