Aging & Social Change: Thirteenth Interdisciplinary Conference

Abstract

Japan constitutes the most aged society in the world. The ratio of older people aged 65 and over in the national population was 29.1% in September 2021, which is projected to reach 38.4% in 2055. The arrangements to prepare end-of life is however not so advanced that most older people rely on relatives or nursing-home managers with their health/aged care. It is a serious concern on how older people will have a quality of life with satisfaction until the final moment. In theory, the values of autonomy and self-determination of older people must be respected in end-of-life care. Advance Care Planning (ACP) is a common method enables these people to realize their wishes in the process of end-of-life. In practice, the story is not so simple because statistics indicate that ACP is underutilized among people, namely, 37% in the US, 8-10% in the UK, the Netherland, Germany, 3% in Taiwan, and nearly zero in Japan. Even if ACP were created, no guarantee was available that ACP would be respected by medical professionals subject to their judgement. Opinions of relatives are sometimes more respected than ACP. Why does it so happen? Healthcare treatments are conducted between medical professionals and patients based on the foundation of the national healthcare policy and medical law. ACP exists within such framework and needs some adjustment. To clarify what adjustments are essential, two different ACP systems in theory and practice are comparatively examined between the 2018 guidelines in Japan and 2016 legislation in State of Victoria (Australia).