The acceptability of advance directives in japanese society : A questionnaire study for healthy people in the physical check-up settings

An advance directive, in an American context, is understood to be a declaration by a person that stipulates the forms of medical treatment to be provided by caregivers and/or designates someone to act as a proxy should the person at some future date lose decision making capacity. In written form, an advance directive is often referred to as a"Living Will."In order to investigate the acceptability of advance directives in Japanese society, a questionnaire study for healthy people was conducted, asking their knowledge, experiences, and attitudes related to advance directives. Two hundred and ten male subjects who visited 2 urban general hospitals for their physical checkups were asked to fill out a self-administered questionnaire. More than 80% of the respondents knew the term"Living Will"and they wanted to express their preferences on their medical care they will get in the future. Regarding contents, more than 70% of them wanted to leave their preferences on treatment plan for incurable diseases such as terminal cancer, brain-death, persistent vegetative state as well as pain control. More than 80% answered they would give a lot of leeway to surrogates to override their preferences, and did not feel necessity for detailed, concrete directives such as preference for cardiopulmonary resuscitation and respirator. More than 60% answered oral statements were enough, while about 30% recognized the necessity for written documents. As for a surrogate decision maker, 80% answered they would designate"family or relatives", in most cases, a spouse. On the other hand, those who do not want to express their preferences in advance (18.1%) listed reasons against it. These include, psychological resistance to talk about death and dying ; difficulty in imagining the future situation, which represents the theoretical limitation of advance directives ; and entrusting to their family (omakase), etc. Written advance directives might be useful in the Japanese settings when 1) a person do not want to give surrogates and/or caregivers a lot of leeway ; 2) there exists uncertainty and caregivers feel the necessity to ascertain the preference by written documents.