In October, New Zealand voters approved a proposed referendum to legalize physician-assisted suicide, joining a small group of countries and territories that allow euthanasia under specific circumstances. The proposal arose out of a lawsuit brought by a lawyer dying of a brain tumor, and while she herself wasn’t seeking to end her life prematurely, she felt frustrated that the option didn’t exist. In court, she argued that euthanasia was not suicide, which is a crime, as the person in question was going to die anyway from the affliction that made her life difficult. She lost the case and died in 2015, but her husband continued to work on the matter and as a result, the matter gained media attention, who discussed the ramifications, including the type of guarantees needed. to prevent patients from simply terminating their lives due to advanced age or disability.
Such a discussion has yet to emerge in Japan, although a criminal case in Kyoto, which came to light in July, has sensationalized the issue. Two doctors have been arrested for murder after helping a woman named Yuri Hayashi with the neurological disease of amyotrophic lateral sclerosis (ALS) fulfill her wish to die. One of the doctors, Yoshikazu Okubo, provides palliative care and has apparently read Hayashi’s desire on social media. He contacted her in one way or another and offered to help. Hayashi ended his life last November, but due to his condition, which prevented him from eating or moving any part of his body, medical assistance necessarily required more than just a dose. fatal drug.
Media coverage has mainly focused on the criminal aspect. Before his death, Hayashi transferred 1.3 million yen to the bank account of Naoki Yamamoto, the second doctor arrested, prompting the police to charge the two doctors with “contract murder”. Police have published little information about Yamamoto, although he may have written a handbook on assisted death with no sign of assisted suicide. Police insist Hayashi’s death is not a case of euthanasia.
On November 3, the NHK series “Heart Net TV” featured Hayashi’s side of the story through his Twitter account and blog, which chronicled his situation for 586 days before his death.
NHK has been careful in its presentation. At one point, Hayashi tweeted that she felt “miserable” when she saw herself in a mirror. This is the kind of statement that disability advocacy groups cite as representing a line of thinking that sees people with disabilities as a burden on society and thus encourages discrimination. However, at another point in time, Hayashi speculates that if euthanasia were legalized, it could prolong more lives, as those with terminal conditions could live more fulfilling lives knowing that they could choose to end it if everyday life was getting too intense. to bear physically.
NHK mentions Okubo once, but does not detail how the plan to die was carried out. The half-hour schedule is essentially a permanent argument Hayashi has with herself about whether it’s better to end her life than to continue as she is. It oscillates widely between desperation and moments of contentment, and parties on either side of the euthanasia argument are likely to find remarks that support their respective positions.
Associate Professor Hitoshi Arima of Yokohama City University, who published a book on euthanasia, was interviewed at Toyo Keizai last August, in which he addressed the Kyoto incident to determine whether it was a case of medically assisted murder or suicide undertaken for humanitarian reasons. the reasons. The biggest problem Arima has with this case is that neither Okubo nor Yamamoto was Hayashi’s doctor. These were mainly external subcontractors brought in by the patient to perform a one-off service. Under such circumstances, the doctors did not have as deep an understanding of Hayashi’s state of health and state of mind as that of a primary care physician, who would have followed Hayashi’s situation for a period of time. long period and would thus have a glimpse of his declared desire. die. A service relationship conducted primarily on social networks cannot provide such a vision.
Arima is opposed to the legalization of assisted suicide, but his argument about close communication is the basis of euthanasia policy in countries where it is legal. A society must first take certain steps to come to an understanding of the implications of assisted dying, and Japan has yet to take these steps. The first would be to standardize the practice of living wills and do not resuscitate statements, which express a patient’s refusal to take extraordinary measures to keep them alive in the event of a medical emergency.
The government has tried to promote this way of thinking through the advanced care planning program, mainly for budgetary reasons. Japan’s National Insurance System spends a lot of money keeping people alive in a vegetative state simply because doctors are forced to administer extraordinary measures to keep patients alive regardless of the outcome in terms of quality of life. The advanced care planning program, better known as jinsei kaigi (life counseling), promotes family discussions about end-of-life care well before an elderly or terminally ill member needs such care. In 2017, a Department of Health survey found that only 2.8% of families had such a discussion and only 3.3% were even aware of the advanced care planning program. Since then those numbers have increased, but not by much.
The government’s subsequent actions to promote the advanced care planning agenda have been clumsy at best, as evidenced by an embarrassing poster campaign briefly run last year. Medically assisted suicide is still a controversial topic, even in countries where it is legal. But before this can even be discussed in Japan, people must be prepared to speak openly and frankly about their own deaths.