Recent comments by Deputy Prime Minister Taro Aso about the elderly in Japan, while controversial, make a great deal of sense to me because of my personal experience.
My mother suffered a massive brain hemorrhage two years ago in Tokyo, where she had lived in an assisted living facility. She was 85. By the time I was reached in New York where I live, she had undergone brain surgery. I was in Tokyo within 48 hours and found her in intensive care, her life hanging by a thread after having had part of her brain removed. A young surgeon informed me that her condition was dire and insisted that she have a minor surgery to insert a tracheal device so that she could breathe more comfortably. The long-term consequences of this procedure were not told to me.
As I watched and cared for her in the following days and weeks, it became clear that she was going to survive but that she was brain-dead. The doctor had also insisted on surgery for a gastric feeding tube for her nutrition to make her “more comfortable.”
My mother never would have wanted to live this way, and she had said so many times when we talked about others in a similar condition. I asked the young doctor what we could do. He replied that in Japan it would be considered murder if we took my mother off life support and that we “missed our chance to let her die” before the brain surgery. He added that my mother would have passed away within five days without surgery.
I asked how long my mother could live in this condition. He said, “Possibly many years with a five percent chance of limited recovery from brain trauma.” I stared at him, trying to control my rising anger and frustration. So much for medical progress.
Japanese law apparently does not recognize advance directives as legally valid. Japanese doctors are considered the authority and can ignore a patient’s wishes even if the patient is conscious. Moreover, many doctors opt for aggressive medical intervention to prolong life even when they know the patient will be vegetative.
Obviously there are many cultural differences in the attitudes toward death and assisted suicides, but I cannot think of one valid reason, no matter what culture we live in, to let my mother or those like her continue to live without allowing recourse to just letting go.
Ironically, in Japan, a gravely ill patient is usually not given the full prognosis by the physician. Instead, immediate family members are informed of the condition and consulted about care. It has been argued that this aspect of the family having the “power” to direct and agree to a treatment for the patient should be strengthened in cases of the terminally ill and the brain-dead. These issues need to be resolved to prevent undue burdens from being put on the patient as well as the family. The private nursing home my mother is in receives income from both the state and my family.
After my mother was moved to the nursing home, I instructed the attending physician and the nursing staff not to intervene if my mother’s health fails in any way. The doctor nodded, agreeing that Japan was regressive when it comes to the right to die. She cited a few cases in which hastening the death of terminally ill patients near death was found illegal and that the doctors involved either lost their license to practice and/or were convicted.
I would like to thank, Mr. Aso, for starting this difficult but necessary dialogue about what must be addressed.
The opinions expressed in this letter to the editor are the writer’s own and do not necessarily reflect the policies of The Japan Times.