Medical Deregulation on Death

This can be a small deregulation in a country that bureaucrats are strictly controlling how ordinary people die. Mainichi Shimbun reported a governmental decision that medical doctor would be able to issue death certificate without direct diagnosis on patient. While it is for the cases in isolated small islands, the government is going to add strict conditions in order to avoid crime.

Article 20 of Medical Practitioners Law determines that a medical doctor must not issue death certificate without direct diagnosis after the death of patient, except the case of previous diagnosis within 24 hours. If a patient dies in her/his house or nursery facility without the doctor in charge, police will intervene in the case, regarding it as strange death.

Family of dead patient cannot bury her/him without death certificate. In isolated island, for example, such family has to keep the corpse for a certain period of time or send it to somewhere medical doctor is. It is harming human dignity to some extent.

Japan Nurse Association has been demanded deregulation of condition for issuing death certificate, followed by Deregulation Reform Convention that required Ministry of Health, Labor and Welfare. Not only in isolated island, the request assumed some cases in big cities where a few doctor was working. In the education for nurse, there is no course for determining cause of death or medical jurisprudence. It will be necessary for nursing school to have new curriculums, anyway.

The government set five conditions for mitigation: 1) the death is coming soon, 2) doctor and nurse keep close communication and there is consent of patient or family, 3) direct and immediate death diagnosis by doctor is difficult, 4) nurse with knowledge of medical jurisprudence can immediately report necessary information to doctor, and 5) doctor can realize facts of death or absence of criminal incident through information communication technology. While the doctor can confirm three phenomena of death, stop of heart, no respiration and dilated pupils, proving no incident of crime is not easy.

Total amount of deaths in Japan, 1.27 millions in 2014, is increasing up to 1.7 millions in 2040. Namely, there is a growing number of home deaths in Japan. Not only scarcity of doctors, insufficiency in home medical care affects. Even in a hospital that has 24-hour home medical care system, some patients had to use ambulance to have emergency medical treatment. To deal with those home deaths, deregulation of death certificate is indispensable for preserving human rights to die in a way anyone likes.