Terminal care

A few days ago, a TV program was on regarding the terminal care, especially, the life sustaining care in the terminal stage. This topic was a kind of off-limits for mass media. With a surprise to know such topic is coming on mass media, I watched it for a while. The tone of the arguement was generally positive for death in dignity.

Now, it is an era of advanced age in Japan. The terminal care should be a problem for many people. The expenditure for the terminal care is told to occupy the greater part of the cost for medical services. From that standpoint, this topic should have been discussed long before as well.

It has never been possible for medical staff to discuss about or propose death in dignity to their patients or their families, even though there have been many occasions necessary for that. Mercy killing has been out of question here. The medical staff are destined to go on treating his/her patient until the very last minute. Without doing that, we could be accused for "unintentional killing". Among medical staff, it has been a matter of question. But it has officially been an untouchable  area in medical services. We should wait until the people themselves become aware of that and start discussing about it as an own problem.

It is a good thing that such a topic is coming up for discussion among the people, even if it is lead by mass media. Our life is not eternal. We should accept death sometime. It is questioned how to accept it now. We could not know when and how it comes on us. But we should get ready for that by ourselves.

The only worry about this problem is that it is not us but the bureaucratics and/or politicians who
have lead it behind mass media. Their concern is only about the growing expenditure for the termical care. It could distort the discussion. The discussion should be based on our own idea regarding how to live and how to die.


  1. Hi Shin,

    In the West we have similar taboos. The subject of death makes people uncomfortable and it is not discussed openly. I believe that in the past when religious values were stronger in the community, this was not so. In the farming communities especially death was considered a natural return to God. But materialism and the decline of religious belief leads people to fear death because we don't know what happens afterwards, if anything.
    I am surprised that Japanese society faces the same dilemma. Certainly the Buddhist communities of South Esat Asia view death more openly, especially if the person has led a good and blameless life. There is nothing to fear. But I am reminded that these societies are also moving away from the old certainties and are starting to embrace gross materialism, so this attitude to death is changing.
    Old people are not cared for by family or community anymore, and the medical professions take the burden. Out of sight and out of mind, except for the new carers, the nurses and doctors who now take the responsibility of ensuring a noble death somehow. It seems unfair.

    1. John,

      I would emphasize there is a dilemma in the termial care in our society. The social system won't catch up with the reality that medical science won't assure good quality of life if it could save and maintain it for years. We, doctors, are trained to do our best to do so. We are expected to do that way even if there is no exit for that. Due to this dilemma, a few doctors, who have not started or gone on life sustaining treatment procedures in absolutely fatal cases, have been accused for that in the past.

      As you say, possibly since the power of religion is gone away and the medical science has progressed a lot, people won't confront the reality that our life is not eternal. Another reason could be that most people are dying at hospitals and family members won't experience seeing their family dying just next to them. Death seems to have become a virtual reality to them.

      Death is a fact of absurdity for everyone. Maybe no solution for that. But I believe we should consider how to accept it by ourselves.

      As for me, I have been raised in a family under Chirstianity. However, I feel relieved with an idea to, when dying, go back to the soil away from diverse causes to worry about. Of course, in the situation it becomes a reality, it could be dofferent. But, as the last aria of Matthew's Passion sings, if we could rest in peace, it won't be more blessing to me than anything in the world.