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Confucius said: “When your parents are alive, serve them according to ritual. When they die, bury them according to ritual, make sacrifices to them according to ritual.”

Ayako Sono said: “Old people are growing more and more selfish. Human beings have an obligation to die at a suitable time.”

Hiromi Shimada said, “The only hope is to throw our parents away.”

Two of these three names call for an introduction. Sono, 84, is a writer of some eminence, known for her staunchly conservative views. Whether this particular remark, published in February by Shukan Post magazine, is conservative or progressive or something else altogether need not concern us. Our purpose is to consider whether she and Shimada are talking sense, or nonsense, or something worse.

Shimada, 62, is featured in Shukan Post this month. He is identified as a religious scholar. The comment quoted above forms the first part of the title of his latest book, a best-seller since its release in May. The rest of the title is, “No Need for Nursing Care, Funerals or Legacies.” (The Japanese title in full is, “Mo Oya wo Suteru Shikanai: Kaigo, Soshiki, Isan wa Iranai.”)

The overall situation is well-known: Japan is aging at a pace with no historical precedent. Its current median age, third-highest in the world, is 46 and rising. Its current life expectancy, highest in the world, is 84 and rising. Roughly a quarter of the population is 65 or over; roughly one-sixth is 75 or over. Out of a population of 127 million, the number of people suffering from dementia is 4.6 million, and “increasing beyond our expectation,” says the Japan Society for Dying with Dignity. It’s a demographic, economic, emotional, psychological nightmare from which there seems no awakening.

Ghastly episodes in the lives of dementia sufferers and their caregivers are growing so commonplace that we almost forget how shocked we were the first time we read of one. Examples will readily arise in the reader’s mind: the 91-year-old man who wandered onto a railroad track and was killed by an oncoming train; the 82-year-old man who torched his house when his wife stepped out for a moment; the apparently hyper-stressed 23-year-old nursing home employee who allegedly pushed three residents to their deaths from upper-floor balconies. The case Shukan Post cites as representative occurred last November at the Tone River near Tokyo — a 47-year-old woman arrested on suspicion of murdering her mother and disposing of her father’s corpse. The suspect reportedly told police she’d intended to kill herself too. She was her parents’ principal caregiver and just couldn’t take it anymore.

One marvels at the nation’s having been caught unawares. No crisis is more predictable than a demographic one. A birthrate falling at such-and-such a rate and life expectancy rising at such-and-such a pace produce mathematically calculable results. Adequate facilities staffed by properly trained, adequately paid staff should have been set up decades ago.

One reason they were not is Japan’s supposedly ingrained Confucianism. Filial piety, the government assumed, would solve the problem. Reverence for parents would make institutions unnecessary — abhorrent, in fact. What dutiful son or daughter would dream of institutionalizing parents who deserve (as all parents do, by definition) to be cared for at home?

“Yes, but,” says Shimada, in effect. There is the world as it should be and the world as it is — a messy enough place whose harsh realities are sometimes non-negotiable. Confucian ethics regarding the reverence due our parents are not, he points out, universal. Other cultures have different values. The ancient Japanese, legend has it, abandoned their aged parents to starve on mountaintops. Nagano Prefecture’s Obasuteyama (literally Mount Throwing-Grandma-Away) draws its name from the tradition.

Confucius (552-479 B.C.) lived when the life expectancy at birth was under 30. He himself survived to a healthy old age but could hardly have imagined mass-aging and senility on anything like Japan’s present scale. What he would have thought if he had imagined it, we cannot know. What Shimada thinks, evidently, is that there’s something to be said for obasute.

The parent-child bond, he insists to Shukan Post, is not naturally eternal. Animals sever it as a matter of course. So do most humans. In early Japan, he says, the eldest son was dignified above other offspring in return for burdens he would assume in his parents’ old age; the other children went their separate ways. More recently, in the immediate postwar years, rural-born children migrated to Tokyo to work, and made lives for themselves there, away from their parents.

But where are Tokyo-born Japanese to go today? Overseas, perhaps. Failing that, the harsh realities referred to above are in this case roughly as follows: 40 percent of Japan’s workforce is part-time. Feeling unable to marry on meager part-time salaries, many grown children settle in with their parents indefinitely, dependent to a greater or lesser degree on parental savings and pensions, on the understanding, spoken or tacit, mutual or one-sided, that they will provide care as needed.

It’s hardly a prescription for a full life. And when the needs of caregiving intensify to the point of requiring the caregiver to quit work, which often happens as dementia advances, the tightening economic pinch can make an awful situation unbearable. Shimada says cases like the Tone River alleged parent-murder, not unique even now, have a rising future ahead of them, barring drastic new thinking.

New thinking: obasute? Shukan Post fails to clarify precisely what Shimada means by “throwing parents away,” but quotes him quoting in his book a 1969 magazine article by gynecologist and vanguard death-with-dignity activist Tenrei Ota: “I would like to suggest that the best solution to the isolation of the elderly is suicide.”

That’s a minefield. What does he mean — that one should commit suicide at a certain age as a matter of course? Or at a certain level of physical deterioration? What level? At what point does life become not worth living? Whose point of view would prevail: that of the care recipient, whose dementia might involve neither pain nor unhappiness, or that of the physically exhausted, emotionally depleted caregiver?

One thinks naturally of “death with dignity,” euthanasia, “physician-assisted suicide.” Switzerland set the pace, legalizing assisted suicide, under certain conditions, in 1940 — 57 years ahead of the second country to do so, Colombia, in 1997. Five others have followed suit, Canada most recently earlier this year. Five U.S. states also permit it.

In Japan the issue has yet to reach the legislative agenda. Is it relevant in any case? Death with dignity generally arises when terminal illness or extreme incapacitation makes a misery or mockery of what is left of life. Dementia is neither fatal nor physically painful. When Ayako Sono speaks of an obligation to die at a “suitable time,” whose dignity is she thinking of, the elderly person’s or the caregiver’s?

If the latter, is that necessarily bad?

Michael Hoffman is the author of “In the Land of the Kami: A Journey into the Hearts of Japan.”

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