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Three East Asian countries, Korea, China, and Japan, have shared a similar cultural background throughout history. This is the basis of the assumption of Asian values in the field of bioethics. However, different processes of modernization and healthcare systems have resulted in considerable differences. Along with the aging process, end-of-life care issues have been increasing in importance in these three countries. We conducted a study of 899 lay persons in 3 countries regarding their perspectives about end-of-life decisions; favorable ways of decision-making in end-of-life care; institutional and legal devices; withdrawal of life-sustaining treatment; and euthanasia. We confirmed several similarities and noted some differences among the three countries. Tres países del Este Asiático, Corea, China y Japón, han compartido una cultura bioética similar. Sin embargo, los procesos diferentes de modernización y los sistemas de cuidado de la salud han resultado en diferencias considerables. Junto con los procesos de envejecimiento, los temas del cuidado al final de la vida han ido creciendo en importancia en estos tres países. Realizamos un estudio con 899 personas legas en los tres países respecto a sus perspectivas sobre decisiones al final de la vida; formas favorables de toma de decisiones en el cuidado al final de la vida; disposiciones institucionales y legales; retirada de tratamiento de sostenimiento vital; y eutanasia. Confirmamos varias similitudes y notamos algunas diferencias entre los tres países. Três países asiáticos, Coreia, China, e Japão, têm compartilhado uma semelhante formação cultural através da história. Esta é a base da aceitação de valores asiáticos no campo da bioética. Contudo, diferentes processos de modernização e sistemas de cuidado à saúde resultaram em consideráveis diferenças. Ao logo do processo de envelhecimento, temas sobre cuidados no final-de-vida incrementaram em importância nestes três países. Nós conduzimos um estudo em 899 pessoas leigas nos 3 países considerando as suas perspectivas sobre decisões a cerca do final-de-vida; modos favoráveis de tomada de decisão em cuidados de final-de-vida; dispositivos institutionais e legais; suspensão de tratamento de sustentação da vida; e eutanasia. Nós confirmamos inúmeras semelhanças e notamos algumas diferenças entre os três países.

Purpose The debate about the end-of-life care decision is becoming a serious ethical and legal concern in the Far-Eastern countries of Korea, China and Japan. However, the issues regarding end-of-life care will reflect the cultural background, current medical practices and socioeconomic conditions of the countries, which are different from Western countries and between each other. Understanding the genuine thoughts of patients who are critically ill is the first step in confronting the issues, and a comparative descriptive study of these perspectives was conducted by collaboration between researchers in all three countries. Methods Surveys using self-reporting paper questionnaire forms were conducted from December 2008 to April 2009 in Korea (six hospitals in two regions), China (five hospitals in four regions) and Japan (nine hospitals in one region). The subjects were patients who were critically ill who had been diagnosed as having cancer. A total of 235 participants (Korea, 91; China, 62; Japan, 52) were eventually recruited and statistically analysed. Results Most respondents had sometimes or often thought of their own death, mostly fear of ‘separation from loved ones’. They wanted to hear the news regarding their own condition directly and frankly from the physician. A quarter of them preferred making end-of-life care decisions by themselves, while many respondents favoured a ‘joint decision’ with their family members. The most favoured proxy decision maker was the spouse, followed by the children. Most admitted the necessity of ‘advance directives’ and agreed with artificial ventilation withdrawal in irreversible conditions. The most common reason was ‘artificial prolongation of life is unnecessary’. Most respondents agreed with the concept of active euthanasia; however, significant differences were sometimes observed in the responses according to variables such as patient9s country of origin, age, gender and education level. Conclusion Patients in Far-Eastern countries gave various responses regarding end-of-life care decisions. Although familial input is still influential, most patients think of themselves as the major decision maker and accept the necessity of advance directives with Westernization of the society. Artificial ventilation withdrawal and even active euthanasia may be acceptable to them.