This paper examines the evolving landscape of healthcare decision-making in Japan’s rapidly ageing society, with a focus on the legal, policy, and ethical challenges it entails. It analyzes the limitations of the adult guardianship system, the risks associated with family-dependent decision-making, and the underutilization of advance care planning (ACP). The study further considers how demographic shifts, advances in medical technology, and socio-legal inertia affect end-of-life care, particularly for individuals with diminished capacity. A central theme is the inherent ethical dilemma in balancing individual autonomy with Japan's cultural context, where explicit self-assertion can be challenging, especially for older adults. Cultural dimensions influencing decision-making practices are also explored. Drawing on legal, policy, and academic sources in both English and Japanese, the paper identifies key areas for systemic reform, emphasizing the need to enhance patient autonomy, establish legal clarity, and promote intergenerational inclusion. It argues for a culturally sensitive approach to legal and policy changes, particularly concerning the healthcare decisions of older adults, to mitigate risks such as social isolation and familial estrangement. It proposes a culturally informed yet future-oriented framework to strengthen healthcare decision-making in response to Japan’s demographic and ethical imperatives.
Yukio Sakurai (Fri,) studied this question.