Deeply humane and reliable medical care

1. Medical care based on informed consent*
   Taking informed consent as a basis, we provide medical care in good faith to build positive relationships of trust with our patients.
2. Medical care that is open to the regional and local community
   In full recognition of our public character as a hospital, we are committed to providing medical care that is open to the regional and local community.
3. Medical care on the highest level
   We actively pursue our studies, and make every effort so that we will be able to provide medical care on the highest level and at the very forefront of the times.
4. Training creative health care practitioners who possess a strict ethical sense
   Constantly holding to a strict ethical position, we aim to foster creative health care practitioners who respect the privacy of our patients.

Yamagata University Hospital Policy on Clinical Ethics

The faculty and other personnel of Yamagata University Hospital observe the following principles of clinical ethics and act in good faith and sincerity in our practice of medicine.

1. Working with reference to evidence obtained in treatment, we provide fair medical care that is effective and safe without regard to faith or creed.
2. Respecting the patient's human rights, we make every effort to engage in medical practice that is founded upon the cooperation of our patients themselves.
3. Striving for communication with our patients (and their families), we convey correct information with full explanation and seek to build positive relationships of trust with our patients (and when necessary with their families) as we engage in our practice of medicine.
4. We respect our patients' personal information and privacy, and we observe the duty of confidentiality that is incumbent upon us because of our role.
5. In addition to making every effort to provide medical care that places greatest priority on treatment of our patients themselves, we also pursue clinical research aimed to raise the level of medical treatment while holding to high ethical standards and engaging in treatment in compliance with the Declaration of Helsinki as well as all guidelines regarding medical treatment and medical research.

Responses to Problems in Clinical Ethics

In addition to complying with the statutes and regulations relating to clinical actions that become ethical problems, we will respect published policies, guidelines, and other such directives, and implement them correctly. When matters arise for which guidelines cannot readily be determined under the conditions that obtain, we will act with respect for the will of our patient and consideration for the intentions of the patient's family, deliberate fully with the treatment team, ethics committees, and other such bodies, and determine how to handle the matter accordingly.

Responses to Major Examples of Ethical Problems

(1) When patients refuse beneficial treatment

Physicians will clearly state the drawbacks and the benefits of a treatment. It is the patients themselves who will decide how to balance the risks in surgery or examination, or the side effects of treatment, against the possibility of prolonged life or the improvement of symptoms. Patients are guaranteed the right to refuse treatment they do not want. However, in the case of infectious diseases or other such conditions for which the refusal of treatment may present a danger to third parties, constraints may be placed on the refusal of treatment.

(2) When patients refuse blood transfusion therapy

Even when patients refuse blood transfusion therapy due to their faith or for other such reasons, full explanations will be given to patients and their families regarding the content of the treatment, including testing and treatment methods, regarding the necessity of blood transfusion therapy as a life-saving measure, and regarding the side effects of such therapy. Having done so, we will follow the "Guidelines for Handling the Refusal of Blood Transfusion for Religious Reasons" and address the situation taking the patient's condition and age into consideration, as well.

(3) Reproductive and perinatal care

Fetal diagnosis will be performed with respect for the "Guidelines for Genetic Testing" from the Japan Society of Obstetrics and Gynecology and genetics-related societies and other such guidelines.

(4) Organ transplants

This hospital is a facility that provides organs for transplant from brain-dead donors and we are also a facility that performs kidney transplants. The determination of brain death and transplantation of organs are conducted in accordance with the "Determination of Brain Death" and "Organ Donation Manual" created in line with the Act on Organ Transplantation.

(5) Cancer notification

As a rule we provide notification out of respect for the patient's right to know.

(6) End-of-life medical care (including DNAR* directives)

End-of-life determination is made on the basis of objective information and with reference to published guidelines and other such sources, and policy is decided as a rule with respect for the intentions of the patient and through full discussion with the patient, the patient's family, and the treatment team. Efforts will be made to mitigate pain and uncomfortable symptoms as much as possible, and comprehensive medical treatment and care will be provided, including psychological and social assistance.

* DNAR: Do Not Attempt Resuscitation