Significant attention is being paid to end-of-life preferences and their cultural variations. This study compares end-of-life preferences between older Japanese residing in Japan and the United States. A self-administered questionnaire was provided to elders affiliated with senior centers and clubs. Japanese Americans preferred to make decisions themselves about withholding life-sustaining treatments, whereas Japanese in Japan preferred to rely on physicians and family members. The U.S. sample showed more positive attitudes toward and higher completion rates of advance directives than the Japanese sample. Results suggest that end-of-life preferences differ between Japanese elders in the two countries and that preferences are influenced by contextual factors in one's country of residence. Practitioners need to be aware of both within-group and across-group diversity in end-of-life preferences, taking into account acculturation changes.
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