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Hospital removed life support from woman though death was not imminent.

TOKYO, Dec. 23 Kyodo

A hospital in Akita Prefecture, northeastern Japan, removed in March last year life support from a female patient who was in a state of ''chronic brain death'' for about six months, although she did not face imminent death, hospital officials said Saturday.

The Akita Red Cross Hospital's move was a rare action by a healthcare institution in Japan. Doctors said the woman did not suffer cardiac arrest for a prolonged period even after being diagnosed as brain dead but said they could not say for sure that her ''death was imminent.''

Although the action to remove the artificial respirator and other means of life support was in line with the family's request, it could spark a new ethical debate on pros and cons of removing life support for a brain-dead patient.

The woman in her 40s was pronounced by the hospital in Akita City as clinically brain dead when her life support including artificial respirator was removed, following the approval of the hospital's ethics committee. The woman's heart and other organs stopped functioning shortly afterward.

Chronic brain death refers to a state in which the heart of the patient, even after being pronounced brain dead, does not stop beating for an extended period of time. Usually, brain-dead patients' hearts stop beating from a week to 10 days even after continued life support treatment.

The officials said the woman was hospitalized after suffering head injuries from an accidental fall in September 2005 and was placed in intensive care.

The woman was later pronounced clinically brain dead based on nearly similar standards used in judging if a patient is brain-dead before organ transplants.

The woman's family initially wanted to continue her treatment, prompting the hospital to attach a life support system to feed her with water and nutrients, but even after about two months, her situation remained unchanged. A CT scan also confirmed her brain was necrotic.

Her family finally decided in February last year to end the life support including her artificial respirator. There were no documents indicating the patient's desire regarding life support treatment.

To comply with the family's wish, the hospital convened in March an ethics committee comprising the hospital's director and senior hospital staff to deliberate on the matter. The committee then said the hospital will give the green light so long as the family fully understood the implications of such action.

The hospital's director ultimately approved it after the family submitted in writing their desire to end the life support system. The family was present when doctors removed the life support system and her heart stopped functioning some 20 minutes later.

After her heart stopped beating, her kidney and eyes were used for transplant, as per her wish.

In October this year, the Japanese Association for Acute Medicine adopted a guideline that sets conditions such as allowing physicians to remove respirators from brain-dead patients or patients who are diagnosed to die within a few days.

However, some civic groups are opposed to leaving the decision to continue or end life support to the family, fueling heated debate among those against and for it.
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Publication:Japan Weekly Monitor
Date:Dec 29, 2007
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