The Legitimacy of Forgoing Life-Sustaining Treatment: A Comparative Analysis of Japan and Taiwan

This article examines the legal frameworks governing end-of-life (EOL) care in Japan and Taiwan, focusing on how the legitimacy of forgoing life-sustaining treatment (LST) is constructed and applied clinically. Tracing the historical development of EOL care regulation in both societies, the article analyzes how different approaches shape professional discretion and patient autonomy. Japan utilizes a guideline-based framework emphasizing procedural legitimacy through communication, collective deliberation, and advance care planning over the explicit recognition of individual statutory rights. Conversely, Taiwan’s legislation-based framework provides formal legal criteria for forgoing LST and grants legal force to advance directives as expressions of patient autonomy. While Japan’s approach allows flexibility in clinical decision-making, it leaves uncertainties regarding legal liability, particularly in cases involving patients without family support. Taiwan’s legislation offers greater legal clarity but may constrain clinical discretion during ambiguous medical trajectories. Despite these regulatory differences, both societies struggle to ensure the clinical realization of patient autonomy. Ultimately, this comparison suggests that neither procedural consensus nor legal codification alone is sufficient to address the ethical and practical complexities of EOL care.