Yumi Naito on end of life decision making in Japan


I am a Master of Science student at the College of Nursing Health Sciences. I’m a registered nurse in Japan and Australia. Japanese teacher, education agent for international students, medical interpreter for Japanese patients, academic tutor, and mother for two sons.

I love traveling and meeting new people and environments. I want to be an author in the future, but my present goal is to be a PhD. student.

My research topic is End of life decision making with the ethnographic study. I have a passion for this study, I feel so fortunate by supporting people at Flinders University.

Since I was a nursing student in Tokyo, Japan, I have been always interested how people live well and how they end their life. Observing various death and dying process in different places throughout my nursing career, has motivated me to investigate end of life care decision making within Japanese culture. I have worked and lived in Japan, India, the United States of America and Australia. I experienced a particular difference when I was working as a registered nurse and witnessed the patient dying process in Australia. The difference in patient care in Australia related to the patient having the opportunity of choices. The choice around what happened at the end of life could be made by the patient. This difference prompted me to become involved in advance care planning, because these policies support a good death by valuing the patient’s preferences.

Advance care planning is a relatively new concept in Japan. There is some guidance on medical decision making at the end of life developed by the Ministry of Health, Labour and Welfare. However, unlike Australia, Japan does not have a legal framework to support advance care planning.

Advance care planning in Japan has followed from these government guidelines for medical decision making discussion processes in the terminal stages of an illness. They recommend individualised self-determination by patients as long as people are competent, but there is no legal documentation yet. The impact of this lack of clarity means patients and health professionals struggle to consider the most suitable way to utilise ACP.

Like other countries, Japan is rapidly ageing. However, the speed and extent of the ageing in Japanese society is unmatched anywhere in the world. This increase in ageing is accompanied by an increase in the number of deaths in this country as our older people reach the end of their life. Despite Japan being a modern country, existing customs and traditions make it difficult to adopt the concept and practice of advance care planning. My master thesis “How do community registered nurses use Advance care planning in Japan” found barriers include the customs and traditions in the Japanese cultural background along with a lack of understanding of individual decision making. Most patients rely on the family or the doctors to make decisions about care and treatments. This is a common understanding among Japanese people. “Omakase” is the Japanese tradition of letting a chef choose your menu order in the restaurant. The word means “I will leave it to you.” This is also the traditional Japanese approach to medical decision making. It implies that some patients want to leave decisions to their family and doctors.

The decision making is the key for the individual choice and the patient centred care. The future investigation relating what is the problems for end of life patient centred care and I will continue my research focus on Japanese culture with decision making. Through ethnographic study, deeper understanding death and dying with qualitative data and analysing with interviews. My project investigates what really matters for the patients and how health professionals support patient centred care.

Thank you for reading and your support.


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