<i>Analysis of legal exegeses regarding the Kawasaki Kyodo Hospital case </i>

<p>    The proposed “draft Advance directive (AD) law” holds that, given that certain physicians who withdrew life-sustaining treatments (LSTs) have been prosecuted, there is a need to provide legal protection to physicians who carry out such acts. We discuss this in the context of a major court case, the “Kawasaki Kyodo Hospital case,” in which a physician withdrew LSTs and ordered the injection of a muscle relaxant to a patient in a coma. Generally, the Kawasaki Kyodo Hospital case, which was heard by the Supreme Court, is understood by the public without a full grasp of the legal implications. Here, we analyze the legal exegeses of the court decisions surrounding this case.<BR>    The following three issues were identified from our analysis: <BR>1. Ambiguous relationship between “respecting patient self-determination” and “limits of treatment obligations,” which were indicated as a set of conditions within which withdrawing LSTs could be judged legal by the court: some commentators made a point that these two arguments should be used separately, while others believe they should be used together;<BR>2. Need for family proxy or presumed consent: some say this leads to respect for patient self-determination, whereas others suggest it leads to familial determination (decision-making by the family); and<BR>3. Whether or not withdrawing and withholding LSTs are equivalent: in Western countries, there may not be a legal or moral difference between the two; however, clinical settings in Japan are more hesitant about withdrawing LSTs than withholding it.<BR>    Our findings suggest that a number of factors regarding physicians’ hesitancy of withdrawing LSTs should be addressed. Moreover, legalization and formulation of relevant guidelines should be considered by the government. Proxy consent by the family and support for patient’s decision-making must also be kept in mind when considering the draft law.</p>