Medical Wishes: Writing Down What Matters to You
A guide to thinking through, and sharing with your family, your wishes about medical and nursing care later in life. Known in Japan as 人生会議 (advance care planning), it is a conversation before it is a document.
Notes on Your Care Preferences
Put Your Values Into Words
When someone cannot speak for themselves, families and doctors are left to guess. A page of notes, written while you are well, can make that guessing less painful. It does not need medical language. “I would like to stay at home as long as possible” is a perfectly usable sentence.
Our part is to help you take the questions one at a time: what kinds of treatment you may have an opinion about, what a good day looks like for you, and who should hear about all this. Your doctor, not us, is the right person to explain what a treatment would mean in your own case.
Topics to Think About
Treatments You May Want to Think About
Resuscitation (心肺蘇生), a breathing machine, tube feeding (経管栄養, 胃ろう), dialysis, antibiotics near the end of life. Your doctor can explain what each involves in your case; we help you decide which questions to ask.
Comfort and Pain Relief
Some people put comfort first, others want every option. There is no correct answer, only the one that fits you.
Where You Would Like to Be Cared For
At home, in hospital, in a care facility or hospice. Practical limits apply, and it helps to know which places are realistic where you live.
Who You Would Want Involved
Who should be told early, who you would want at your side and who you would rather not burden.
Beliefs and Customs
Religious or personal practices you want respected, and anything you do not want.
Review From Time to Time
Wishes change with health and circumstances. Date your notes, and revisit them after any major illness, move or loss.
Later-Life Preferences: Clarifying What Matters
Some people have never said aloud how they would want to be cared for when they are very ill. Putting it into words is not morbid; it is a courtesy to the people who will otherwise have to decide for you.
We find it helps to start from ordinary things: Where would you like to be? Who should be there? What would you not want to miss? How much would you want to know about your condition? Answers to these questions are often more helpful to a family than an opinion on a particular medical procedure.
Ways to Frame Your Preferences
Intensive Treatment or Comfort First
Many people want full treatment when recovery is likely and a gentler approach when it is not. Writing down what “likely” means to you is more useful than a single yes or no.
What a Good Day Looks Like
Being able to recognise family, eat a favourite meal, sit in the garden. These small pictures help the people who speak for you.
Rituals and Company
Music, a particular room, someone reading to you, a priest or monk you wish to see.
Uncertainty
Doctors often cannot say how an illness will go. It helps to think ahead about how you would want to decide when the picture is unclear.
Choosing Someone to Speak for You
In many countries there is a formal healthcare proxy with legal powers. Japan has no general statute of that kind, and in practice hospitals tend to involve the family. That makes it all the more useful to choose, in advance, the person you would want the doctors to talk to, and to make sure they know your mind.
This is not a casual role. The person you choose may have to speak up in a stressful setting, possibly alongside relatives who see things differently. The work you do together now, before anything happens, is what makes that possible.
Preparing the Person You Choose
We suggest an unhurried conversation, with concrete situations, and a short written note afterwards. A good question to put to the person you are considering is simply: “Would you be willing to do this, and is there anything you would find hard?”
We can help you plan that conversation and the note. We cannot act as your representative, take part in medical decisions on your behalf or give an opinion on whether a document is legally effective.
Preparing for the Role
Think About Who Knows You Best
Someone who can stay calm, who will carry out your wishes and not their own, and who is willing to take the role. Ask them before you name them.
Have the Conversation
Tell them, in plain words and concrete situations, what you would and would not want. Vague phrases such as “I do not want to be a burden” leave room for doubt.
Name a Second Person
Someone to step in if the first is unavailable, so that the family is not left without a point of contact.
Write a One-Page Note
Your values, your main wishes, the doctors you see and where your papers are kept. It is a communication tool for your family and medical team.
Understand the Limits
In Japan, a written statement of wishes is usually treated as an important guide, not as a binding legal order, and hospitals commonly ask a family member to take part in decisions.
Talk to a Licensed Professional About Legal Documents
A 任意後見 (voluntary guardianship) contract is made at a notary’s office and can cover managing money and arranging care. It does not by itself give anyone the power to consent to medical treatment. A lawyer or notary can explain what applies.
Sharing Your Wishes With Your Doctors
A page of notes that nobody has seen can only help if someone finds it in time. The most effective step is also the simplest: tell the people involved, including your family and your doctor, and make sure they know where the note is.
Some people find it helpful to practise a little with their family first, then raise it at a routine appointment. Doctors are used to hearing these questions, and many are glad to be asked early. If your doctor does not wish to discuss it, you can ask someone else at the clinic or at the hospital’s patient support desk.
Questions to Take to Your Appointment
What does this mean for someone with my condition, in plain terms? What are the realistic options later on? Where could I be cared for if I could not manage at home? Who would you speak to in my family if I could not take part?
We cannot attend appointments or give an opinion on treatment. If it helps, we will go over your list of questions with you beforehand so that you leave the appointment with the answers you wanted.
Practical Steps
Start With Your Regular Doctor
Tell your family doctor (かかりつけ医) that you have been thinking about this. Ask whether they are willing to talk it through and note it in your record.
Bring Your One-Page Note
A short summary is easier for a busy clinic to use than a long document. Ask where it will be kept.
Know Who Can Help Locally
City and ward offices run community support centres (地域包括支援センター) that advise older residents and their families on care and services. Many hospitals have a patient support desk.
Medical Orders Come From Doctors
Whether a do-not-resuscitate instruction is appropriate is a medical decision made with your doctors. We cannot arrange or recommend one.
Share With the Family
Give a copy to your family contact person and your second person, and tell them where the original is kept.
Update When You Change Doctors or Hospitals
Notes do not move with you by themselves. Hand a fresh copy to each new clinic.
The aim is modest: that when a decision has to be made, the people making it have a good idea of what you would have wanted, and have heard it from you. The images on this page are stock photographs used to illustrate the topic. They show neither our staff nor our clients.
Would You Like to Talk It Over First?
If you would like help turning these topics into a page of notes and a plan for talking to your family and doctor, write to us. We will not give medical advice, and we will not hurry you.
Write to Us