Starting Monday, the Tokyo Fire Department (TFD) will allow its ambulance staff to halt cardiopulmonary resuscitation and transportation to hospitals if a terminally ill patient does not want to receive life-sustaining treatment.

 The change is aimed at respecting such patient’s will to spend their final moments at home. Ambulance staff will be allowed to stop CPR and transportation on the condition that family members of the patient agree and a doctor confirms that doing so reflects the patient’s wishes.

 As the nation is currently facing a graying population and a large number of elderly people are reaching the end of their lives, similar new operations by ambulance staff and emergency medical care services are likely to spread across the nation.

 According to the TFD, the new operation is allowed if several conditions are fulfilled. For example, the patient must be an adult in cardiopulmonary arrest; the patient themself must have discussed the issue with family members and their primary care doctor in advance, with all of them having agreed to forgo life-sustaining treatment; and, ambulance staff on the scene must contact the patient’s primary care doctor and confirm whether prior consent has been given, and whether the patient’s condition meets the criteria for halting treatment.

 If all of the conditions are met, ambulance staff will be allowed to halt resuscitation measures, and hand over the patient to family members without transporting the patient to a hospital. After that, a primary care doctor will confirm the patient’s death on the scene.

 Attention should be paid to the fact that the patient’s feelings about the issue could change depending on the symptoms. It is an important precondition for the new procedure that a terminally ill patient has clearly decided what they want.

 Under the current rules, ambulance staff must take action, even if a patient does not want to receive life-sustaining treatments, except in a case where the patient is clearly dead. If family members or acquaintances make emergency calls in a panic, ambulance staff have had no other choice but to transport these patients to a hospital while conducting CPR.

 The emergency transportation of elderly people to hospitals has been steadily rising.

 According to the Internal Affairs and Communications Ministry’s Fire and Disaster Management Agency (FDMA), of the almost 127,000 people in cardiac arrest who were transported by ambulances to hospitals in 2017, more than 70% were in their 70s or older.

 In many cases, family members or others made emergency calls in a panic, but later would ask the ambulance staff to halt resuscitation as the patient did not want life-sustaining treatment.

 In these cases, the ambulance staff were caught in a dilemma between their mission to save lives and the will of the patients. Such cases have continued to occur.

 In response to the situation, the TFD has reviewed its operations since spring last year.

 During monthlong research in the summer of last year, of the 816 cases of ambulance transportation in which staff conducted CPR, there were 11 cases where the patients did not want to receive life-sustaining treatment.

 There are no central government-made rules over the halting of resuscitation. Thus responses in these kind of cases differ among fire departments and stations.

 According to the FDMA, among the about 700 firefighting entities nationwide, 100 in prefectures including Saitama and Hiroshima discontinue resuscitation based on a doctor’s instruction.  

 Takeshi Ogata, an official of the TFD, said, “Because the change affects people’s lives, we made the decision after repeatedly holding very careful debates. From now on, we will aim for further improved operations while examining implementation in the field.”