Consideration of patient autonomy and dignity of life, in cases refusing resuscitation or useless medical care at the terminally ill stage

In Japan, there is no legal assurance for living wills or advanced directives, therefore, it is always a matter of argument in stopping medically useless life-supporting interventions or adopting a DNR-order when it is strongly requested by the patient through his/her autonomy. Since individualism is not the prevailing attitude but totalitarianism is still a voice in Japanese society, the paternalistic attitude of seniors to juniors becomes the keynote in families and society at large even when a judgment is required for a medical decision. Surrogate opinion cannot always represent the thoughts of the patient. In Japan, even dying with dignity is hard to guarantee, and moreover, choosing euthanasia with autonomy and its legal endorsement will be too difficult. We physicians should consider more deeply the autonomy and preference of the last terminally ill patients when they come to stages.