Page 26 - IJPS-8-2

International Journal of
Population Studies Japan’s death-laden society

Under pressure from the coming of a death-laden and financial burdens caused by critical medical decision-
society, as mentioned earlier, some policymakers in Japan making during moments of crisis or grief (Hirayama,
may find the promotion of “dying in place” a necessary Otani, and Matsushima, 2017). Over the past few decades,
policy direction (Interview data, Tokyo, June 3, 2021). an increasing number of medical institutions and related
According to a hypothetical estimate for the case of Tokyo, organizations have come to consider “dignified death”
if successfully promoted, a pursuit of “dying in place” could as de facto legal. However, a lack of codified laws that
potentially mitigate the shortage in hospital beds by up explicitly justify this practice still leads many clinical
to 30% by 2030 (Interview data, Tokyo, April 12, 2021). doctors to remain wary of patients’ requests to pursue this
However, if rushing unprepared, this may, in turn, cause option (Interview data, Tokyo, 11 May 2021).
a surge in the prevalence of “lonely deaths,” thus simply Meanwhile, other developed countries around the world
trading one major public health issue for another with which have already moved forward to legalize end-of-life options
society must contend for decades to come. First, an increase that involve doctors’ active role in responding to patients’
in the incidence of “lonely deaths” directly threatens the
comfort and dignity of those dying. In addition, it would desire to shorten their lives. One example is “physician-
result in increasing public health expenses for responding assisted suicide,” a form of voluntary euthanasia that may
to a range of associated medical and legal needs. Hence, be applied only to those suffering from terminal health
careful strategy and preparation are called for in promoting conditions who consistently express a conscious desire to
“dying in place.” On the verge of becoming a death-laden shorten their lives to end their sufferings (Kamm, 1999).
society, Japan is immensely pressured to quickly develop Unlike euthanasia in its conventional form, this option
an appropriate policy strategy to carefully and effectively involves doctors assisting a patient’s suicide by providing
rearrange the medical and social infrastructures for those the necessary means such as lethal doses of medication,
with terminal health conditions to die in their preferred or information about the means, for the patient to use to
places in the way they wish. perform the life-ending act (Ahlzen, 2020). In recent years,
an increasing number of countries around the world have
3.4. Urgency to facilitate national discussions on legalized this option, including Switzerland, Belgium,
end-of-life options the Netherlands, Luxembourg, Canada, Spain, and some
Japan must engage not only those in advanced age but also regions of the US and Australia (Canetto and McIntosh,
all citizens in a hard discussion on a subject that is highly 2022). While a pursuit of individuals’ rights to control their
controversial but may require swift policy consideration: deaths is the proclaimed reason to legalize this end-of-life
End-of-life options. As discussed above, many of those option, behind this trend, one of the root causes to call for
in advanced age in the country desire “dying in place” in access to this option stems from the steady aging of those
search of greater comfort and dignity during their last countries’ populations (Interview data, Tokyo, 22 February
days. To prepare for the ballooning deaths in the coming 2021).
decades, Japan today needs to solicit national consensus on To date, Japanese laws have never permitted any form
whether and how the country may offer those dying a new of euthanasia including “physician-assisted suicide.” Due in
end-of-life option in addition to what is available today. part to the lack of open public discussion about end-of-life
Under Japan’s current institutional framework, the options, neither the government nor medical professional
only end-of-life option that is publicly acknowledged is to communities have ever taken the initiative to formally
arrange “dignified death” (Spoden, 2020). One may seek discuss the possible importance of introducing this option,
“dignified death” by leaving advance directives for medical or anything similar, to Japan (Interview data, Nagoya, July
decisions before one’s own death, which spells out his or 29, 2021). The lack of the discussion stems in part from a
her preferences regarding medical treatment in the event traditional cultural value held among the citizens, today’s
of terminal illness, falling into a state of coma, or reaching older generations in particular, that tends to regard death
the late stages of dementia near the end of life (Japan and dying as a highly private matter (Interview data, Osaka,
Society for Dying with Dignity, 2022). Unlike euthanasia, February 14, 2021). The coming of a death-laden society
this option does not involve any medical intervention will likely force the country to respond to the demands
to actively shorten – let alone actively terminate – the of an unprecedented number of older people potentially
patient’s life. With the option of “dignified death,” the seeking to legalize “physician-assisted suicide” as a desirable
dying person may simply seek to die “naturally” by option to be added to “dignified death.” Despite this strong
expressing their desire to refuse mere life-extending likelihood, however, the lack of national discussion to date
medical interventions. This way, the person may avoid indicates that Japan remains unprepared for facing this
unnecessary suffering and relieve caregivers of emotional scenario.

Volume 8 Issue 2 (2022) 20 https://doi.org/10.36922/ijps.v8i2.301