Studying medicine in the Czech Republic, I have encountered very different cultural, religious, and legal traditions — yet many of the underlying struggles feel deeply familiar. Drawing on my own observations and on an interview with a palliative care physician at the Masaryk Memorial Cancer Institute in Brno, this article compares end-of-life and home-based care in the two countries, and reflects on how each society accompanies the closing chapter of life.【The Czech Republic】 In the Czech Republic, by contrast, the 2011 Act on Health Services (zákon č. 372/2011 Sb.) explicitly recognises advance directives (dříve vyslovené přání) in Article 36. The directive must be in writing with an authenticated signature, accompanied by a physician's written explanation of possible consequences, and is valid for five years (revocable at any time). Once these requirements are met, it legally binds healthcare providers — with exceptions for euthanasia, minors, persons lacking capacity, and certain emergencies. The Act also recognises "close persons" — spouses, parents, children, siblings, registered partners — who may express consent or refusal for an incapacitated patient. Where the patient's prior directive and the family's judgment conflict, the directive prevails; for adults lacking capacity, courts may appoint a legal guardian. The clarity of who legally holds medical consent is one of the most striking differences from the Japanese system. care"? Perhaps something heavy, distant, or not yet your concerns. Yet sooner or later it touches all of us — our parents, our grandparents, the people we love, and one day, ourselves. In Japan, most people say they would prefer to die at home, yet the majority still die in hospitals. As our societies age, this question is no longer a matter of policy alone: it is a question of how, and where, we want to live out our lives.【Japan】explicit legislation but by the Ministry of Health, Labour and Life (revised 2018). Rather than giving any specific document binding authority, it emphasises the process itself — repeated conversations among patient, family, and healthcare team. informed consent under the Medical Care Act is framed only as a duty of effort, shaped in practice through case law on civil liability for breach of the duty to explain.loses capacity. A guardian under the adult guardianship system is not understood to hold the right to consent to medical treatment, so the de facto surrogate role falls to "family become extraordinarily difficult. What images come to mind when you hear "end-of-life In Japan, end-of-life decision-making is guided not by Welfare's Guideline on Decision-Making in the Final Stage of Living wills and advance directives carry no legal force, and The institutional gap becomes most visible when a patient members" — yet the law does not define who counts as family. When relatives disagree, or no close family exists, decisions can Masaryk University, the Czech RepublicChinatsu KawanoIntroductionInstitutional and Legal Frameworks - Who decides? 11Home-Based Palliative Care in the Czech Republic and Japan - Common Ground and Differences
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