Nearly 20 percent of hospitals with pediatric departments responding to a survey said that parents had refused last year to allow their children to receive medical treatment recommended by doctors, it was learned Sunday.

The reason most often cited by parents who refused further treatment was that they did not feel they would be able to continue raising the child, who would not fully regain his or her health.

Thirty-three percent of the children in such cases died, higher than the 12 percent whom doctors had predicted could die even if all medical options were implemented.

The survey was carried out by a study team of the Health, Labor and Welfare Ministry.

A total of 328 hospitals responded to the survey, which was carried out between February and March and covered cases in 2003. Eighteen percent of them said they experienced parental refusal.

According to medical experts, it is difficult for doctors in Japan to treat children if their parents refuse, unlike in the United States, for example, where courts can order treatment after screening a request submitted by a doctor.

Observers say the results of the health ministry survey indicate that some form of legal framework to protect the rights of children to receive medical treatment is needed.

The survey showed that 60 hospitals encountered a refusal from parents during 2003. In 10 percent of the cases, hospitals said the refusals were tantamount to child abuse.