A Comparative Analysis of End-of-Life Care for Older Adults in East Asia, the U.S. and Europe : With a Particular Focus on Family Involvement, Advance Directives and ACP

Abstract

This article addresses the urgent challenges of an ageing population and rising dementia rates in East Asia, focusing on Japan, South Korea, Taiwan, and Singapore. It highlights the need for proactive measures due to increased deaths, declining birth rates, increasing single-living elderly, and weakening familial bonds. The question is how law and policy can respond to these challenges to ensure fulfilling end-of-life care for older adults. The article compares social characteristics and law and policy strategies from the U.S., Europe, and East Asia, noting the prevalence of family involvement in East Asia. It calls for a balance between respecting individual autonomy and societal values. Inspired by the European Law Institute, it proposes the project for “Advance Decision-Making for Future Disability in the East Asian Context" for comprehensive research. The article examines the social and legal influences on advance directives (ADs) and advance care planning (ACP). It suggests that each country should be respected in its unique traits. It argues for integrating healthcare and asset management, legal and practical approaches, and individual and relational autonomy. The proposed East Asian model for advance decision-making aims to promote a supportive approach to ADs and ACP, guided by principles of human rights, diversity, and mutual benefit.departmental bulletin pape