[Long-term care insurance system and adult guardianship system from the medical standpoint]

A long-term care insurance system went into effect in April 2000 in Japan. In the previous welfare system, the government could provide services ("take due measures") unilaterally regardless of the desires of the person receiving the care. In this framework, therefore, services could be provided even if the person did not have the ability to make judgments. Under the new system, however, the arrangement has changed so that the user (person requiring care) enters a contract directly with the service provider. Thus, whether or not the user has the ability to judge (enter a contract), or the degree of that ability, has become an issue. However, medical research on this judgment ability has been lacking in Japan, in contrast to other countries, where there have been intensive studies on the decisional capacity for informed consent, treatment and participating research. The development of the tools to assess such judgment abilities is proceeding in other nations. In Japan, assessment of the judgment abilities of demented elderly persons should be similarly investigated. Based on such studies, we look forward to the day when there will be appropriate respect for the right of self-determination and care.