The current status of ethics committees and decision making procedures in general hospitals in Japan

Ethics committees could be established in the following 6 settings in Japan : 1) university hospitals ; 2) medical research institutes ; 3) general hospitals ; 4) academic societies ; 5) government administrative offices ; 6) health professional organizations such as The Japan Medical Association. Understanding the present situation in all these 6 dimensions is necessary for further discussion. The purpose of this study is to investigate the current status of ethics committees and decision making procedures in general hospitals in Japan. A self-administered questionnaire was sent to directors of 3098 general hospitals, asking about the presence of ethics committees, attitudes toward ethical problems, and their experiences. A complete survey for hospitals with more than 300 beds [group A] ; 20% random sampling for hospitals with 100-299 beds [group B], and 20-99 beds [group C]. The recovery rate was 44.3% (51.0% in group A, 42.5% in group B, 34.6% in group C, respectively). Ethics committees have been established in 24.4% of group A, 5.7% of group B, and 2.0% of group C. 13.2% of the total respondents answered that they had certain guidelines for the patients who refuse blood transfusion because of their religious beliefs such as Jehovah's Witness. The necessity of ethics consultation for individual cases as well as education was highly recognized in all groups. Certain guidelines indicating how to set up and manage an ethics committee in a general hospital setting is badly needed. On the other hand, for those hospitals with smaller numbers of beds where an ethics committee is difficult to be set up, certain systems other than an ethics committee should be established to deal with ethical problems in the daily clinical settings. The roles and responsibilities of ethics committees at each level should be further explored and clarified in order to legitimately formulate an ethics committee system for ethical decision making in the clinical setting.