Ethical attitudes of Japanese physicians regarding life-sustaining treatment for children with severe neurological disabilities

Ethical attitudes of Japanese physicians regarding life-sustaining treatmen t for children with severe neurological disabilities (SND) were investigate d by mailing a translated questionnaire which the Child Neurology Society ( CNS) of the United States used for their survey. The questionnaire was sent to 202 council members of the Japanese Society of Child Neurology (JSCN), and the answers of 147 respondents (72.8%) were analyzed. It was found that the majority (85.0%) of respondents believed that the same level of care s hould be provided to children with SND as those without it. However, fewer respondents (15.6%) believed that cardiopulmonary resuscitation was indicat ed for children with progressive or degenerative brain disorders. With resp ect to the authoritative role of medical indications and family/guardian's wishes in clinical decision-making for children with SND, about 30% of resp ondents believed that medical indications should override family/guardian's wishes. However, almost as many respondents (29.9%) chose an ambivalent an swer. If compared with the results of the preceding CNS survey, considerabl y more respondents gave ambivalent answers (average 26.6%) than in the CNS survey (5.8%). About half of the respondents (49.0%) acknowledged the need for ethical guidelines to help physicians make ethically difficult decision s. Although statistical comparison was not possible, there were considerabl e differences between the results of the current study and those of the CNS survey. (C) 2000 Elsevier Science B.V. All rights reserved.