TOKYO, JAPAN (Reuters) – Japanese who have chosen how they want to end their days are still a minority.
But as ageing baby-boomers ponder their own demise and the country struggles with the worst public debt among advanced countries, due partly to rising expenditure on medical care, the taboo on avoiding life-extending care is slowly eroding.
Tarou Tanzawa, a director for the group promoting living wills, said his personal experience raised his awareness on the issue.
When his mother, Asako, learned at age 84 she had malignant lymphoma, she stuck to her decision not to undergo life-prolonging treatment and received palliative care at a nursing home for her final months.
After his mother passed away, Tanzawa himself signed a living will, stipulating he did not want to receive life-prolonging treatment when terminally ill or in a vegetative state.
Unlike in some countries such as the Netherlands, Belgium, France, Switzerland and some U.S. states, Japan has no laws regarding living wills, assisted suicide or voluntary euthanasia.
“My mother died in a dignified way, and that made me think, wow, there is a way to die so peacefully. My mother taught me a lot, but in the end she taught me the most important lesson,” he said.
The topic of “natural death” is increasingly being tackled in TV shows, newspaper and magazine articles and books; seminars on preparing for death are popular; and health experts say the use of feeding tubes for feeble elderly patients is declining.
Traditional Japanese views that families are obliged to care for elderly relatives have long been an obstacle to rejecting or withdrawing life-prolonging treatment. Many families fear being accused of callous abandonment, whatever the patient’s wishes.
Doctors worry about family members filing suits. Health Ministry guidelines issued in 2007 call for an informed decision by the patient or a proxy and say a decision to withdraw aggressive treatment should be made by a health care team. But these and other guidelines have not erased physicians’ concerns.
A Japanese lawmakers’ group – set up decades ago to discuss a law giving legal protection to doctors who withhold life-prolonging care with the patient’s consent – drafted a new version of a bill last year but it has yet to be introduced in parliament, largely because of opposition from disability rights groups who fear it could be a first step towards legalising euthanasia.
Representatives of disability groups, which have so far blocked submission of a bill, say such talk simply confirms what they suspect – public financial woes are driving the push for legislation that could be a first step toward legalising euthanasia of those society deems a burden.
“One point is that the state shouldn’t use the law to control how people live and die,” said Shoji Nakanishi, 72, president of the non-profit Human Care Association, who has been wheel-chair bound since a spinal cord injury at age 21. At time of the injury he was told he had just three months to live.
Legislation is unlikely to be submitted ahead of a national election expected in July for fear of upsetting elderly voters who turn out in big numbers at the polls, advocates say.
Some proponents say keeping the topic off the legislative agenda will allow time to consolidate the changing public consensus.
“There are instances where it becomes financially difficult to take care of the person and in that situation, the family will not be able to part on good terms. It needs to be done carefully but, I think idea of legalizing ‘death with dignity’ is a bad idea,” a cosmetics and health supplement seller, Masako Yoshida, said at a cemetery in downtown Tokyo after offering prayers to her relatives interred there.
“We’ve already decided that we don’t want treatment (to extend life), so I personally think ‘death with dignity’ is fine as everyone chooses the way they want to die,” said Chiho Yamaguchi, 27, another visitor to the cemetery.
Japan’s total spending on national health care topped 40 trillion yen for the first time in the year to March 31, 2104.
Spending on those aged 75 and over exceeded a third of the total. That share will grow as the age group expands to an expected 15 percent in 2020 and 27 percent in 2060 from 12.7 in 2015.