Japanese and American healthcare providers enjoy abundant medical resources at their disposal, yet both systems often fail to adequately address a patient’s end-of-life (EOL) wishes for vastly different reasons.

In a society as highly structured in hierarchical and patriarchal dimensions as Japan’s, a terminal patient’s wishes are often superseded by the treating physician’s suggestions in deference to the doctor’s education and social status. In addition, a family member who has cultural authority tends to speak and make decisions on behalf of the dying person and the family.

Similarly, American healthcare providers often avoid the topic of EOL decision-making to deflect away from the realization that in spite of their formidable arsenal of available medical treatments, they are powerless to help. The American system of medical training also encourages physicians to advise their patients to fight an incurable disease to the end because the hope of prolonging life is never lost.

These cultural versus institutional factors have the same result. Oftentimes, the EOL wishes of a terminal patient is either not heard or lost at best. In either case, these factors have a major detrimental impact on the quality of a patient’s end-of-life experience as their wishes fall prey to more dominant cultural or social factors. This theoretical study discusses the importance of EOL conversation in providing quality care, and discusses how the medical professions in both countries can approach EOL discussions with the cultural sensitivity and understanding to improve the quality of living and dying.