Presentation Information
[SY-92-03]Between Autonomy and Interdependence: Ethical and Sociological Dimensions of End-of-Life Care in Japan
*Kae Ito (Tokyo Metropolitan Institute for Geriatrics and Gerontology(Japan))
Keywords:
End of life care,autonomy,interdependence,decision making,older persons
In Japan, end-of-life care has long been shaped by cultural values of familial obligation and emotional interdependence. Historically, it was customary for older persons to die at home, cared for by family members—a tradition rooted in centuries-old laws and social norms. However, since the mid-20th century, Japan has seen a marked shift toward hospital deaths, now accounting for approximately 75% of all deaths, despite many expressing a preference to die at home.Recent national surveys reveal a complex picture: while many older adults consider end-of-life care important, few discuss it with their families, and even fewer document their wishes. The predominant concern is not pain relief or dignity, but the fear of being a burden. Complicating this is the Japanese tendency to believe that mutual understanding can be achieved without explicit communication—a belief that leads to significant mismatches between older persons’ expectations and their families’ knowledge.As Japan grapples with global principles such as patient autonomy and advance care planning (ACP), tension arises between legal norms, clinical practices, and cultural realities. Although ACP is gaining attention, actual implementation remains low. Moreover, legal frameworks emphasizing individual autonomy often clash with the collectivist ethos that values family harmony over personal assertion.This presentation explores the ethical and sociological challenges Japan faces in aligning culturally embedded interdependence with evolving norms of autonomous decision-making. It also examines how these dynamics affect policy, clinical practice, and the well-being of older adults. Ultimately, it invites reflection on how culturally sensitive approaches to end-of-life care can be developed.