[ DEATH WITH DIGNITY - What kind of 'dignity' is there? / BULLETIN No. 142 / ,08 Feb. 20 ]

Shibata Yukinori (Jesuit Social Center) 
Euthanasia was very much in use, at one time, but now you can hardly hear that word. Instead, "death with dignity" is often used.
In opposition to "euthanasia" that means, let people die comfortably free from pain, "death with dignity" means the refusal of continuing a life that has usurped the dignity of a human being that was supposed to welcome a natural death without modern medical technology. Exactly speaking, "euthanasia" means to be liberated from pain impossible to bear, something that could also be called "death with dignity." Nevertheless, the expression "euthanasia" is, easily, misunderstood taking death as the only target. From this point of view, "death with dignity" is well accepted because brings into focus life, or in other words stresses the desire to fulfill one's life with dignity.
This book throws a stone at the "death with dignity," an issue that has received certain citizenship in Japan. The book deals with an incident, the dismissal of a respirator in a municipal hospital in Imizu of Toyama prefecture to 7 terminal patients. But, this is by no means a sensational book. It respectfully analyzes the background of the problem after checking a big amount of written materials and interviewing the main doctors involved, including the director of the hospital.
The author, a journalist that had been operated of breast cancer 37 years ago, has been doing research for over 30 years on medical ethics, especially on the issue of "euthanasia." She had been assisting her husband that died of cancer of the lungs and many other patients fighting for their lives and frankly confesses that she cannot simply assert what is to live with dignity and to die with dignity. With regard to bio-ethics that considers the complicated human life and death, especially in the fields of brain death and organ transplant, a vigorous and broad discussion exercises a great influence everywhere nowadays and the honest attitude of the author is much demanded.
The incident of the Imizu hospital refers to the affair of a doctor Head of the department of surgery, from the year 2000 to 2005, who removed the respirator to 7 terminal patients. The hospital tried to build up an accident preventive medical system at the time and called upon a veteran nurse, as a risk manager hospital vice-director. Thus, as soon as the affair was discovered, the Head of the surgery department was suspended.
TBut, dissatisfied with the punishment he appealed against and using the mass media took a fighting stand against Imizu City and the hospital. Mass media lifted him up as the "red beard doctor who threw a stone at the issues of death with dignity" and the result of all discussions opened the door to a set of Guidelines for Terminal Care made by the Ministry of Labor and Welfare.
According to the author, the Head of the department of surgery not only did not have a deep understanding of death of dignity, but his attitude towards the patients was so paternalistic that he will find any excuse to operate, in case there should be any little possibility of success. In other words, the real issue remains with the old predisposition of the doctor. The author insists that such doctors and district hospitals could still exist in Japan today. She adds that the most fearful thing, with regard to the discussions on death with dignity, is the situation of terminal care and the making of Guidelines for terminal care without a proper examination of the medical gaps that exist among local regions. The discussions deal with organs transplant, control of medical fees and the exemption of doctors, in other words, with consideration for the ones alive. No issue is made either of those walking to death or of whether real dignity had been honored at the last moment of people's life.
Death with dignity and terminal care sound very specialist, but after all, they are issues dealing with the life and death of each patient. This is why anybody can have a saying on them. Not only that, we all must express our opinions. Medical ethics, besides being economic and legal problems, are first of all a human issue. The golden saying, "Those not leading good lives cannot confront a good death," gives us once more a good opportunity to meditate on.

(Shibata Yukinori, Jesuit Social Center, Tokyo)

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