Make medical choices about life and death something people think through while healthy, record, and can revise any time
Steps to make it happen
- Every adult gets a chance to think about medical care at the start and end of life.
- At hospitals and public offices, people talk with an adviser who does not push them toward any choice.
- People write down their wishes about end-of-life treatment, organ donation, and what to do with frozen eggs or embryos.
- Everything written goes into one record that a person can rewrite at any time for free.
- People who do not want to write anything do not have to, and they lose nothing by that.
- When a person can no longer speak, doctors must always check the record.
- If the record and the family's feelings do not match, they talk it over with an outside third party.
- Choosing an ending and a way of passing on life that fit one's own way of living becomes normal.
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The proposal in detail
This proposal sets out a shared approach to medical care at the start and end of life, such as fertility treatment, end-of-life care, and organ transplants, so that a person's wishes are recorded in advance and put to use. It covers adults. What can be recorded includes wishes about life-prolonging treatment and care that eases pain, whether to donate organs or tissue, how frozen eggs, sperm, and embryos should be handled if the person dies or can no longer make decisions, and the naming of someone to decide on the person's behalf. Instead of leaving these in separate papers for each field, they are gathered into one record that the person can change or cancel at any time, free of charge. When the record is made, medical staff or trained advisers explain things from a neutral position, and steering the person toward a particular choice is forbidden. Choosing not to record anything is treated as a legitimate choice, and it must not cause any disadvantage in insurance or in the order of treatment. Medical staff are obliged to check the record when the person cannot state their wishes, and if the record and the family's wishes conflict, they talk it over together with a third party such as an ethics committee. However, even with a record, a person cannot demand acts that the law of that society does not allow, or treatment that has no medical effect. Also, if the record is old or the person's condition is very different from what was expected, it is not applied mechanically but used as a clue to what the person would probably have wanted.
BenefitsThe person's values are protected and the family's burden is lighter
The biggest benefit is that, at the most personal moments of life, the start and the end, the person's way of thinking, faith, and the things they have cherished are more likely to be respected. With a record, the family does not have to carry the burden of having decided alone, and it is easier for them to feel at peace that they followed the person's wishes. For medical staff too, there are fewer moments of doubt about whether to continue or hold back treatment, and they can talk with families calmly. For organ donation, the wishes of people who wanted to donate reliably get through, and there are likely to be more chances to save the lives of people waiting for transplants. Disputes over frozen embryos and the like also become less likely when there is a record made in advance. In addition, the process of making a record creates a chance, while people are healthy, to talk with family and those close to them about life and death, and a culture grows in which these topics are talked about rather than avoided. Because it does not force one answer and is built on the person's own wishes, it is also easy to apply in many societies with different values, which is another strength.
DrawbacksIt may create pressure not to be a burden
What opponents worry about most is that leaving a record could become a quiet kind of pressure. Elderly people, people with disabilities, and people with serious illness might write that they do not want life-prolonging treatment, not because they truly feel that way, but because they do not want to be a burden on their family or society. There is also the danger, which people have pointed out, that those who want to hold down medical costs might quietly encourage such choices. Also, what a person thinks while healthy can differ from what they feel when they actually face the situation. There is a concern that a record made many years ago will be taken seriously even when it no longer matches the person's present feelings. Furthermore, in cultures that value sharing life-and-death decisions as a family or community, the very idea of an individual deciding alone is hard to accept and may feel like the imposition of a particular set of values. Training neutral advisers and keeping records safe takes money and people, and people in areas with poor medical access or those who are not confident in reading and writing may be least able to use the system, so inequality could even grow.
Learn the background
Advances in medical technology have greatly increased the choices around the start and end of life. Keeping a life going for a long time with a ventilator, freezing eggs or embryos and storing them for years, and saving another person's life with the organs of someone who has died were once unthinkable choices. Yet these choices are often needed after the person has lost consciousness or died. As a result, all over the world, families are forced to make heavy decisions in a short time while trying to imagine what the person would have felt. Families often split in their opinions, and deep regret and conflict are not rare. On top of that, in many societies the expression of wishes about organ donation, the documents for end-of-life wishes, and the consent forms for fertility treatment are handled in separate systems, so people forget what they wrote, the papers cannot be found when needed, or the content stays out of date. Views on life and death differ greatly with culture and faith, so a society cannot decide on one right answer. That is exactly why a shared foundation that reliably takes in the person's own thinking is needed.
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This proposal was written in Japanese by AI (claude-opus-5-5, policy version 2026-10-15d) and translated by AI (claude-sonnet-5-5). Nobody has checked the facts. Read the original (日本語) How the AI writes