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Project Target & Outline

Japanese law does not allow a guardian of an adult to make any health-care decisions. Therefore if patients have impaired capacity to consent to treatment, their family conventionally has made decisions in their place. However, the recent growing trend of aging and nuclear families has caused the problem that some patients have no family to make such decision and eventually are forced to suspend treatment. We have launched this project in order to address this issue.

Target

  1. Assessment tool of capacity to consent for older patients with dementia, which is easily used by people who are not specialists
  2. Tools and guidelines to help older patients with impaired consent capacity to make health care decisions
  3. Decision making process model for patients with incapacity, which can be used in the area with limited medical resources

If your decision-making ability becomes impaired due to any disorder including dementia…etc., who/how do you want make a decision regarding your medical treatment? Currently the way to provide the treatment to impaired older patients is becoming an issue along with the increase of the aging population in our society. If a patient has no capacity to consent, conventionally his/her family has made a decision about treatment on behalf of the patient. However, the recent growing trend of aging and nuclear family has caused the problem that some patients have no family to make such decision and eventually are unable to receive the necessary treatment.

In order to solve this problem, we need to assess a patient’s capacity to consent to the treatment in the first place, and find out if we can proceed based on the patient’s wishes, or if we need people around the patient including his/her family for support in decision-making. In the case when the patient is incapable to determine, treatment we need to initiate a surrogate decision-making process , focusing on what is in the best interest of the patient. The objective of this project is to develop a user-friendly, pragmatic system enabling even people who are not specialists to assess the patients’ consent capacity and to make decisions in their places by using an assessment tool and process modeling based on the opinions of dementia patients, their family and the community.

The member of this project is consisted of specialists of medicine, welfare, and even legal experts who have been studying on the role of a guardian and improvement of the legal system in medical decision making. Looking at the systems in foreign countries, we aim at establishment of the system that decisionally impaired patients are able to receive the appropriate medical treatments with ease.

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With a rapidly growing dementia population, the issue of capacity assessment and the involvement of substitute decision makers for incapable older adults is now a major public health challenge. Our project attempts to address this unmet need in a thoughtful and systematic fashion.

Kenneth Shulman
Toronto University

China has introduced the system of medical informed consent since 1980’s, however, substitute decision-making and advance directives in relation to the elder patient’s medical treatment should be brought to the attention, which is an urgent problem for both Japan and China.

Tao Jiang
Shanghai University of Political Science and Law

Informed consent system was not officially required by the Chinese government until 2010. It has been regarded as a revolutionary institution to balance powers and rights of doctors and patients, moderate hostile relations between both sides. However, informed consent could not be always truly achieved, especially from patients suffering senile dementia who are more than 10 millions in China now. Therapeutic privilege or patient self-determination? Patients determination or family’s (guardian’s) determination? This research project will not only provide feasible measures for Japan society, but also will definitely enlighten other countries to confront the difficult problem in the aging era.

Wei Qian
Peking University Law School

Member
Project Member
Name Belong
Atsuko Aramaki The Kyoto Chapter of the Alzheimer’s Association Japan
Atsuko Nakano Judicial Scrivener, Legal-Support Adult Guardian Center
Chikao Sawada Acting Director, Kitayma Hospital
Hiroshi Fujimoto Graduate Student, Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
Hideko Kawaguchi Public Health Nurse, Kyoto Prefectural Tango Public Health Center
Hiroshi Kamimura Director, Department of Psychiatry, North Medical Center Kyoto Prefectural University Of Medicine
Hiroyuki Koumi Professor, Department of Psychology, Hanazono University
Hitomi Ishida Part-Time Lecturer, Faculty of Management,Otemon Gakuin University, Part-Time Lecturer, Faculty of Social Sciences,Hagoromo University of International Studies
Jin Narumoto Associate Professor, Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
Kayoko Okabe Clinical Psychologist, Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
Kiyoko Iiboshi Professor, Department of Clinical Psychology, Shigakukan University
Masaki Doi Director, Doi Hospital
Masaru Mimura Professor, Department of Neuropsychiatry, Keio University
School of Medicine
Masaki Horiguchi Director, Kyotango City Yasaka Hospital
Mayu Ogawa Clinical Psychologist, Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
Mie Urabe Associate Professor, Department of Nursing, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
Nobutaka Ayani Graduate Student, Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
Noriaki Kuwahara Associate Professor, Graduate School of Science and Technology, Kyoto Institute of Technology
Rika Kanbayashi Social Worker, Kyoto City Comprehensive Community Support Center Seiitsu
Riki Kitaoka Medical staff, Department of Internal Medicine, Kyotango City Yasaka Hospital
Shogo Taniguchi Graduate Student, Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
Shoichi Ogano Professor, Faculty of Law, Politics and Economics, Chiba University
Shutaro Nakaaki Associate Professor, Department of Neuropsychiatry, Keio University School of Medicine
Teruyuki Matsuoka Assistant Professor, Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
Toshiyuki Tominaga Assistant Professor, Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
Yoko Eguchi Researcher, Department of Neuropsychiatry, Keio University School of Medicine
Yuichiro Nagura Judicial Scrivener, Legal-Support Adult Guardian Center
Yuka Kato Assistant Professor, Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
Yutaka Hatano Assistant Professor, Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine

Project Cooperator
Name Belong
Katsumi Sakai Director of Nursing, Kitayama Hospital
Kenneth I. Shulman Professor, Department of Psychiatry, Toronto University
Ryuta Kamei Specially Appointed Lecturer, Faculty of Law, Daito Bunka University
Takeshi Morimoto Professor, Division of General Internal Medicine, Hyogo College of Medicine
Tao Jiang Director of the Sino-Japanese Comparative Law Research Center, Institute of Comparative Law, Lecturer, Faculty of Law, Shanghai University of Political Science and Law
Teruko Doi Representative Director, T M Medical Services, Inc.
Toshiaki Furukawa Professor, Health Promotion and Human Behavior, Kyoto University School of Public Health
Wei Qian Lecturer (Post-doctoral Research Fellow), Peking University Law School Researcher, Institute of Labour Law and Social Security Law, Peking University

Organizations
Kyoto Comprehensive Community Care Promotion Organization
Kyoto Prefectural Medical Association
Legal-Support Adult Guardian Center
NPO Universal Care, Kyoto Civic Center for Adult Guardianship
The Kyoto Chapter of the Alzheimer’s Association Japan

Community Center
Association of Care Provider in Kyotango City
Iwakura Area Comprehensive Support Center
Kamigyo Area Comprehensive Support Center
Kamigyo Welfare Office
Kyoto Prefectural Tango Health Center

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