Coronavirus: Japan debates one doctor's call for younger patients to be treated before older ones

A Japanese doctor's call for older people to carry a "consent card" that tells health workers to prioritise younger patients instead of treating them for the coronavirus disease has been met with some criticism, but Fuminobu Ishikura is convinced this is the right move.

"In Italy and Spain a month ago, we saw that there were too many patients and not enough respirators or even beds to treat them," said the 64-year-old cardiovascular specialist. "That meant that doctors had to make a decision on who they would treat."

In many cases, this effectively boiled down to a choice between treating an older person with Covid-19 who needed care more urgently, but had a lower likelihood of recovery, or prioritising a younger patient with a better chance of survival, Ishikura said.

"That is a very difficult decision," he said. "Twenty years ago, I worked in hospital emergency rooms and I know just what doctors have been facing. My colleagues and young doctors are making life-or-death decisions " and that can hurt them."

Japan is the world's oldest country. Photo: EPA-EFE

Ishikura came up with the idea of the consent cards, which he has made available for download from his personal website, shortly after being diagnosed with prostate cancer in February. He said he does not know how many people have downloaded the cards so far, but the webpage has been visited thousands of times.

There are critics aplenty though.

The association for parents with children with Down's syndrome on April 23 issued a statement claiming that Ishikura's proposal could lead to people with disabilities being discriminated against and not receiving the treatment they require.

The statement added that, "the lives of people with disabilities should not be underestimated", adding that the association fears that should the system gain traction, it will become easier for "the weak" in society to be discarded. Instead of prioritising treatment, it added, the government should improve and expand health care facilities.

Some people fear the social pressure to conform may influence elderly Japanese to carry the consent cards. Photo: Reuters

The proposal has also generated debate in online forums, with opinions divided.

"All life is precious and valuable. The decision on who to treat first should be based on objective triage procedures, not some subjective calculation based on whose life is worth more," said one message on the Japan Today website.

"I guess people could say this is voluntary, but social pressure to conform could mean that some older people feel obliged to carry a card like this, whether they really agree with it or not," added another poster.

With fewer than 17,000 confirmed cases and 744 deaths officially connected to Covid-19 as of Monday, Japan's health system has not yet been overwhelmed by the pandemic.

But experts warn of the dangers of a second wave of cases in a country with just five intensive care beds per 10,000 people. This compares with 13 in Italy, where the death toll is nearing 32,000 with almost a quarter of a million cases. Germany, which has recorded nearly 8,000 deaths from some 176,000 cases, has 29 intensive care beds per 10,000 people.

The coronavirus has also laid bare just how few protective equipment, artificial respirators and other medical equipment Japan has in stock.

These are examples Ishikura's supporters have highlighted in online forums.

"All resources, of any physical sort, are limited. There is no way to make them unlimited. The doctor in this story knows this," one user said. While medical experts will do everything in their care to help anyone admitted to a hospital, the reality is that some will die, the poster added.

"Not having this hard discussion is like the ostrich hiding its head in the sand. Adults need to address difficult situations when we know the ideal outcomes are not possible in every situation," the message said. "It is not despicable to have the discussion."

Japan has reported almost 17,000 coronavirus cases. Photo: Getty Images

Ishikura maintains his proposal is completely voluntary.

"I think " and I hope " that I will live for a few more years," he said. "But I decided that if I do contract the coronavirus, my life is likely to be shorter than many other people, so I thought that it would be better for a younger person to receive the care that I would have got."

"Also, look at the generation of people my age, in their 60s and 70s. We never knew the horrors of war. We lived in Japan's most prosperous economic period," Ishikura said. "We have had a very good life."

This article originally appeared on the South China Morning Post (SCMP).

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