Since the 1970s, medical ethics has evolved from an informal approach to a more structured public discourse. The 4 principles proposed by Beauchamp and Childress in 1979 have gained international recognition and are useful for organizing ethical issues. However, this methodology has its limitations, and dialogue-based ethics are becoming increasingly important. Healthcare providers face 2 conflicting responsibilities: delaying death and ensuring a peaceful death, which are central to ethical considerations. Additionally, Japan's lack of legal clarity on life-shortening procedures introduces further ethical challenges. The ethical issues in advance care planning(ACP)include:(1)the shift from informal to public discourse ethics, (2)developing a methodology with dual focuses on ethical principles and dialogue, and(3)the acceptance of life-shortening procedures based on autonomy. While ACP as a public-opinion ethics approach will face challenges in creating forums for discussion, especially on the topic of death, improving proficiency in ethical principles and dialogue-based methodologies among medical professionals may address some of these issues. The extent to which life-shortening procedures should be tolerated remains a significant challenge and necessitates prompt legislative development.