End-Of-Life Decision Making: A Cross-National Study (Basic Bioethics)

This examination of end-of-life decision making offers a broader perspective than that found in the extensive existing literature on this topic by offering a cross-national comparison. Experts from twelve countries analyze death-related issues and policies in their respective nations, discussing such topics as health care costs, advance directives or wills, pain management, and cultural, social, and religious factors. The countries selected for study—Brazil, China, Germany, India, Israel, Japan, Kenya, the Netherlands, Taiwan, Turkey, the United Kingdom, and the United States—represent a mix of East and West, developed and developing nations seldom considered together in analyses of these issues. This is the first systematic attempt to analyze end-of-life issues in many of these countries; the chapters on China, Kenya (of special significance because of the HIV/AIDS epidemic in sub-Saharan Africa) and Turkey break new ground.

Each author reports on various factors in end-of-life decisions: estimated costs of dying, including health care costs; the proportion of deaths occurring in hospitals, in hospices, and at home; the prevalence and variety of advance directives; the mix of high technology and palliative care; the cut-off point for aggressive care and the legal definition of death; government policies on end-of-life decisions, assisted suicide, and euthanasia; and cultural, social, and religious influences. The findings show that there are great differences among countries even in the way these issues are framed. Scholars, policymakers, and medical practitioners can all benefit from the extensive information in these essays on how different nations are dealing with death-related issues.

Janna C. Merrick is Professor in the Department of Government and International Affairs at the University of South Florida.