269

A Study on the Possibility ofLegalizing Euthanasia in JapanMIYAZAWA, Gimpei(Tsutsumibayashi Seminar 4th Grade)

Introduction
I

Euthanasia in JapanII

Euthanasia in Australia

III

Method of survey

IV

Result of survey

Introduction
In this paper I will discuss the issue of euthanasia in Japan. Today, in mostcountries, euthanasia is illegal, and this is true in Japan as well. Yet I strongly
believe that euthanasia should be legalized. To support this stance, I will firstcompare the current Japanese situation with the situation in Australia, where
euthanasia is soon to be legalized. I shall utilize a survey that I conducted in bothcountries, the analysis of which will demonstrate the general perception towardeuthanasia.
Thanks to the developed analgesic treatment, majority of patients today canspend their lives without pain. However, this is not tr ue for all patients;
approximately 10％ of patients cannot avoid severe. What is worse, there are quite afew numbers of patients who suffer from side effects caused by medication: for
instance, sleeplessness, nausea and vomiting, or even fecal incontinence. In these

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政治学研究61号（2019）

cases, patients may feel that their dignity is impaired, to the extent that life becomesinsufferable. Needless to say, however, they do not have a right to end their life,
even when they no longer wish to live. On the contrary, there are lots of ways toprevent patients from dying by resorting to the so-called life-prolonging treatments.
These treatments are aimed at postponing death for those people who can recover,even if only temporarily.
In general, in Japan, these actions must be taken, since they constitute the coreof doctor’s professional ethics based on the imperative to save lives. However, thisis not the case in Australia. Doctors will think over the most beneficial ways forpatients. A person nor decision-maker have no right to propose other treatments,
hence they need to obey the doctor’s treatments.
There are people in the world who find their harsh lives insufferable. But theyusually cannot resort to euthanasia, as it is illegal in most cases. Except for passive
euthanasia, euthanasia is at present illegal in most countries.
According to the “final exit”, passive euthanasia can be only applied to patientson life-suppor t machine. And for the approval of passive euthanasia, cer tain
conditions need to be fulfilled; most notably the patient’s prior consent in the formof a signature in a living will indicating the denial of terminal care when the patient
is no longer able to decide for him or herself. And patients also need to sign in thepermanently healthcare proxy: one of legal proxies that set who will make decisions
in medical treatment and make sure of the living will is done by the doctors.
Needless to say, there is no matter legally and ethically for this action.
In addition to the above, there is another kind of euthanasia called “active
euthanasia”. it is to commit suicides or ask someone to do that. The ways of active
euthanasia are sundr y, yet ingesting lethal dr ug is the most famous way.
Sometimes, this is carried out by the patients themselves. But since this often
proves difficult, it is more common to seek the assistance of someone else for going
through this process. It is a well-known fact that this kind of euthanasia is illegal
and controversial, yet my study suggests a strong case for legalizing euthanasia.

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I Euthanasia in Japan
In Japan, the notion of euthanasia was first acknowledged in the nineteenthcentur y when a book entitled Ikai (written by a German physician named C.W.
Hufeland) was translated and published by a Ranpoui (a doctor who studied
Western medicine in pre-modern Japan). By the end of Edo, Hufeland’s view cameto define Japanese doctors’ professional ethics. According to this view, euthanasia
was an irresponsible act that doctors were strongly advised to avoid.
This idea had lasted until the 1960s when the civil rights movement was taking
place in the US. People started to regard medical treatment as one of the services
that patients had the right to choose from. For instance, the idea and practice of
informed consent became increasingly important.
In the early 1980s, hospital doctors in Japan had to follow a certain kind of
manual. According to this manual, doctors must respect the rights of their patients.
Ancillary to informed consent, owing to the movement, patients in Japan began todemand rights to decide their future including euthanasia.
Despite this movement, however, euthanasia is still illegal in Japan. The
existing Japanese criminal law clearly states that a person who aids and abets
suicide or instigates and who is asked by someone or even the patient to kill or withthe patient’s approval will be punished.
This is the sentence,
Article 202 A person who induces or aids another to commit suicide, or kills
another at the other’s request or with other’s consent, shall be punished by
imprisonment with or without work for not less than 6 months but not morethan 7 years.1）
This being the case, however, there are some exceptions, such as thoseindicated in the clause below.
First, patients are suffering with intolerant pain
Second, the death is unavoidable and will take actions immediately
Third, there are no other ways to relieve the patient from his or her pain

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Forth, the patient clearly insists his or her desire to die
Doctors must not euthanize patients without all these rules 2）
These clauses may leave some scope for permitting euthanasia especially whenan emphasis is placed on self-determination. A strong case for euthanasia may bederived from a theory of self-determination. If patients are terminally ill and lacks
any prospect of recover y, it would seem not unreasonable to suggest that
euthanasia is one form of decision that concurs with self-determination.
Hence Japanese courts seem less reluctant to admit euthanasia so long as all
the strict conditions mentioned above are met. There was a case in Yokohama
district court that accepted euthanasia in Japan. At the court, the court said theexemption that I wrote above so that the court accepted euthanasia as a principle oflaw of emergency evacuation and a right of self-determination. Despite this,however, euthanasia is in principle illegal in Japan. The often invoked rationales aremany and varied. One of them is that it serves as a kind of buck-passing for doctors.
Pain is not easy to measure objectively, and there is also the problem related to theshortage of knowledge or lack of effort. In any case, it would be important to informand educate doctors on these matters. Another problem associated with euthanasia
is that it complicates the issues surrounding inheritance, which is also related to
the fact that living will is not legalized in Japan. This is further compounded by thelack of knowledge about euthanasia among most Japanese. One might argue that
there are guidelines concerning terminal care and how to deal with it from theperspective of medical practice. They outline when the practice should begin or besuspended, with the decision being left mainly to the patients with possible
collaboration of a team of medical practitioners. However, this has no legal
validation and if the patients lose their consciousness, doctors will no longer be able
to continue the practice.
People who disagree with euthanasia insist on these points and it isunderstandable. However, there are cases in which patients lose their will to go on
living, when they cannot lead a healthy life. According to the Japanese Ministry of
Health sur vey: the average life span comes from kouseiroudousyo“heisei22nenkanzenseimeihyo”and the health expectancy are from kenokujumyonio

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kerusyouraiyosokutoseikatusyukannbyotaisakunohiyounikansurukenkyu, there aregaps between average life span and health expectancy: it is that the length of life
when people can live by themselves. This gap clearly means that there are
numerous people who fall under this category. When we take this equation into
account, we must do something to resolve the issue. There are therefore people
who call for the legalization of euthanasia, since they believe it can relieve people ofextreme misery. This opinion is based on humane consideration and right of selfdetermination. As for the former, its aim is to relieve patients from pain which canbe physical as well as mental. The latter point emphasizes the importance ofdetermining one’s life for oneself, and it argues that this includes a right to die.

II Euthanasia in Australia
In 1995, Australia’s Northern Territory became the first region to approve aright to die. This was promulgated as the Rights of the Terminally Ill Act 1995 (NT),which enabled patients to take assisted suicide and active voluntary euthanasia.
It is easy to imagine how the legalization caused a stir not only in Australia but
also all over the world. Politicians, religious groups, healthcare professionals, “prolife” and “pro-choice” pressure groups, academics, the media and members of thegeneral public argued about the legalization, before and after euthanasia waslegalized. While the argument continued, the law was repealed a year later by theAustralia Parliament. In Australia, the Commonwealth had a power to alter the statelegislation, as stated in article 122 of the Constitution, which is this.
The Parliament may make laws for the gover nment of any ter ritor ysurrendered by any State to and accepted by the Commonwealth, or of any
territor y placed by the Queen under the authority of and accepted by the
Commonwealth, or otherwise acquired by the Commonwealth, and may allow
the representation of such territory in either House of the Parliament to theextent and on the terms which it thinks fit.
Therefore, this law was in force only for a very short period of time. During the

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政治学研究61号（2019）

time that the law was valid, only 4 people were euthanized.
However, in 2019, the situation changed. Euthanasia be legal in the state ofVictoria. There, euthanasia was admitted so long as the following rules were strictly
followed.
– The person must be aged 18 years or more
– The person must be an Australian citizen or permanent resident; andordinarily resident in Victoria– The person must have decision-making capacity in relation to voluntar y
assisted dying– The person must be diagnosed with a disease, illness or medical condition
that is incurable, is advanced, progressive and will cause death– The person’s illness is expected to cause death within weeks or months, notexceeding 6 months. In the case of a neuro-degenerative disease (for instance,
Motor Neuron Disease), the time frame for eligibility is extended to 12 months.
– The person’s illness is causing suffering to the person that cannot be relievedin a manner that the person considers tolerable.
– A person is not eligible for access to voluntary assisted dying only because
the person is diagnosed with a mental illness or a disability.
– Requirements for assessing Health Practitioner
Minimum requirements for co-ordinating medical practitioners and consulting
medical practitioners:– Each co-ordinating medical practitioner and consulting medical practitioner
must hold a fellowship with a specialist medical college; or be a vocationallyregistered general practitioner.
– Either the co-ordinating medical practitioner or each consulting medical
practitioner must have practised as a registered medical practitioner for at least
5 years after completing a fellowship with a specialist medical college or
vocational registration (as the case requires).
– Either the co-ordinating medical practitioner or each consulting medical
practitioner must have relevant expertise and experience in the disease, illness
or medical condition expected to cause the death of the person being assessed. 3）

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In addition, patients must obey the process for euthanasia, which are thefollowing
A person may make first request to registered medical practitioner. The
practitioner must advise patient of all treatment options and their likely
outcomes, including Palliative Care.
Registered medical practitioner must accept or refuse first request. Refusalmust be clearly explained to the patient. Request must be accepted or refused
within 7 days.
The person applys for a registered medical practitioner. Patient must notify alltreatments and their likely outcomes, including Palliative Care.
The registered Medical Practitioner must accept or deny the request and thedecision must be made within seven days. In case, the registered medical
practitioner rebuf fs those determination, they must insist their opinion
undoubtedly.
The 2nd request must be a written request and be signed by the person
making the declaration in the presence of 2 witnesses and the co-ordinating
medical practitioner.
The witnesses must be:(a) aged 18 years or more; and(b) not an ineligible witness.
A person is an ineligible witness for the purposes of a written declaration if theperson—(i) is a beneficiary under a will of the person making the declaration; or(ii) may otherwise benefit financially or in any other material way from thedeath of the person making the declaration; or(b) is an owner of, or is responsible for the day-to-day operation of, any healthfacility at which the person making the declaration is being treated; or the
person making the declaration resides; or is directly involved in providing
health ser vices or professional care ser vices to the person making thedeclaration.4)

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政治学研究61号（2019）

The written insistence must clearly indicate that the person request by theirown wish and is not forced and assimilate the traits and effect of the document thatthe patient is making.
The last offer is made to the co-ordinating medical practitioner. The patientmust appoint a person whose age is more than 18 years old. Then, all the procedureneeds to be followed up by the co-ordinating medical practitioner, before it will becertified that the request prerequisite has been fit for the requirements and that theprerequisite or decision-making capacity have been maintained. And the mostimportant point is that patients can interrupt the operation whenever there is achange of mind. needless to say, there is no obligation to continue at any time andthe patients can stop it whenever they want.
Although the process is long and arduous and hence it is not open to every
patient, at least patients in some situations will be able to opt for euthanasia. This isa considerable change since patients without will to live can be released from theirpainful and miserable lives.
However, there are some contrary indication that say the legalization might
expand in the future, in short, euthanasia can be of wide application. As I mentioned
earlier, euthanasia may relate to some other issues, thereby making ambiguous theline between justified case and non-justified case. Moreover, legalization could
impair the eagerness of both doctor and society to explore better ways ofconfronting with patients. What is more, they insist that we need not to rely on
euthanasia, we should choose other ways as the reasons of deserving euthanasia
often comes from not physically pain, but fears about future when they may beburden for their families.

III Method of survey
I have conducted a survey to find out how Australians and Japanese feel about
euthanasia. The survey was conducted between Mid-December 2018 and the firstweek of January, 2019. The numbers of respondents were 59 in Australia and 61 inJapan.
The percentage of men in Australia was 50.8％, and women 47.5％. The

277

remaining 1.7％ did not specify their sex. In Japan, figures were 50.8％ male, 49.2％
female.
I did not distinguish between permanent residents Australian nationals.
The questionnaire is as follows:
The text of survey in English
Are you an Australian or Australian permanent resident?
Australian
Permanent resident

34%
66%

34%

66%
Australian

Permanentf﻿igure 1 ratio of Australian or permanent resident
Australian

Permanent

Choose your age
5%
29%

10%
29%

5%
19%

37%

37%

10%
-19

20-29

19%
30-39

40-49

50-59

-19

20-29

30-39

40-49

50-59

figure 2 ratio of age
2%

51%

2%

47%

10%
19%

278

政治学研究61号（2019）

-19

20-29

30-39

40-49

50-59

Choose your sex

2%
47%

51%

male

femaleprefer not to say

figure 3 ratio of sex
What is your political preference (if you choose other, please specify)
Conservative
Moderate
Liberal
Other

2%
2%

2%

2%

2%

2%
4%

3%

37%

7%
38%

liberalmoderateconservative

anarchist

independentsocialist

progressive

towards liberal

greensnothingnofigure 4 ratio of political preference

279

Educational
Junior high school
High school
University
Technical/vocational
Post-graduate

2%

2%
15%

31%

39%

12%

junior high school

high school

university

technical/vocational

post-graduate

master's degree

figure 5 ratio of educational
Interest on the topic of euthanasia
1 not at all
2 very little
3 neither31%

4 a little

15%
7%
8%

5 very39%

1 not at all

2 very little

3 neither

4 a little

5 verytechnical/vocational

280

政治学研究61号（2019）junior high school

technical/vocational

39%

12%

junior high school

high school

university

post-graduate

master's degreehigh school

university

post-graduate

master's degree

15%

31%

7%
8%
39%15%

31%
1 not at all7%

2 very little

8%

3 neither

4 a little

5 very39%
figure 6 ratio of interest
in euthanasia

Do you agree or disagree in legalizing euthanasia
1 not at all

Agree

2 very little

3 neither

4 a little

5 very17%

Disagree15%

Unsure68%agree 17%disagree

unsure

15%
68%

agree

disagreeunsureFigure7 the ratio of pro and cons of legalizing euthanasia
If you choose unsure, please specify the reason◦ complicated ethics and such a case by case issue!
◦ Haven’t experienced this situation before◦ Thin end of the wedge, requires tight regulation◦ Not really know about euthanasia◦ Concerned about safeguards

281◦ Not aware of topic◦ Not had a reason to think about it◦ Don’t know well
◦ Sometimes agree and sometimes disagree
If you disagree, which criterion is it based on:(if you choose other, please specify)
Religious
HumaneOther

figure 8: ratio of reason for disagreement for
legalizing euthanasia

45%

relgious

55%

humanefigure 8 ratio of reason for disagreement for legalizing euthanasia
If you choose humane, choose which factor is your choice based on:(if you choose
other, please specify)
Doctors kill patients
Patients kill themselves

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政治学研究61号（2019）

11%
33%

56%

doctors kill patientspatients kill themselves

killing should not be accepted

figure 9 ratio of the reason for disagreement in humane reasons
11%

If you disagree based on your religion: what is33%
your religious belief
13%
Christianity (Catholic, Protestant, others)
13%
56%

Buddhism
Hinduism

75%

Islam
Judaism
Atheistdoctors kill patientspatients kill themselves

killing should not be accepted

christianity (catholic, protestant, others)

buddhism

non-specificbuddhism

non-specific

13%
13%
23%

8%
75%

13%

48%

8%
christianity (catholic, protestant, others)

-19
20-29
30-39 of40-49
50-59
figure10 ratio
religion

The text of survey in Japanese
23%

13%
8%

8%

48%

75%

283
christianity (catholic, protestant, others)

buddhism

あなたの年齢を教えてください

8%

23%

13%

48%

8%

-19

20-29

30-39

40-49

50-59

figure 11 ratio of age

あなたの性別について教えてください

figure 12: ratio of sex

49%

51%

男性

女性

figure 12 ratio of sex
あなたの最終学歴についてお教えください。
中学校
高校
四年制大学
専門・短大
博士、修士

non-specific284

政治学研究61号（2019）

figure 13: ratio of educational

10%

7%

15%

69%

figure 13: ratio of educational
中学校

高校

四年制大学

短大又は専門学校

7%

修士又は博士15%

10%
figure 13 ratioof educational

figure 14: ratio of political preference
政治的立ち位置について、お尋ねします。主観で構わないので、御自身の政治的立ち位置をお教えください。

25%

69%
13%

革新
中間

中学校

高校

四年制大学

短大又は専門学校

修士又は博士62%

保守

figure 14: ratio of political preference
革新

25%

中間

保守

13%

3%
62%
13% 8%
16%
革新
中間
59%

保守

figure 14 ratio of political preference
1 全く関心がない

2 あまり関心がない

3 どちらともいえない

以下では、安楽死に対するあなたの考え方についてお尋ねします。あなたは安楽4 少し関心がある
5 非常に関心がある
3%
死全般に対して、どの程度関心を持っていますか。
13% 8%
1

全く関心がない2

ほとんど関心がない

3

どちらでもない

16%

59%

1 全く関心がない

2 あまり関心がない

4 少し関心がある

5 非常に関心がある

3 どちらともいえない

62%

4

少し関心がある5

非常に興味がある

革新

中間

285

保守

3%
13%

8%
16%

59%

1 全く関心がない

2 あまり関心がない

4 少し関心がある

5 非常に関心がある

3 どちらともいえない

figure 15 ratio of interest in euthanasia
以下では、日本での安楽死についてお尋ねします。日本で、安楽死を制度化すべきだと思いますか。
制度化すべき
制度化すべきではない
その他

20%

80%

制度化すべき

制度化すべきではない

figure 16 ratio of opinion for legalizing euthanasia

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政治学研究61号（2019）

制度化すべきではないとお答えした方にお尋ねします。その反対の理由は、宗教的観点、人道的観点、又はその他の理由のいずれでしょうか。その他の場合は、その理由もお答えください。
宗教的観点
人道的観点
その他

15%

85%

宗教的観点

人道的観点

その他

figure 17 ratio of the reason of disagreement for legalizing euthanasia
The reason for others（その他）◦命の炎が消えるまで抗うべき (We should live until the life ends)◦必要性を感じない (I do not think it is necessity)
42%

人道的な観点であると回答した方にお尋ねします。人道的に問題であるのは、医58%

師が殺人を犯すことですか、それとも患者が死を選ぶこと、またはその他の理由でしょうか。その他の場合は、記入していただきたいです。
医師が殺人を犯すこと
患者が死を選ぶこと 医師が殺人を犯すこと50%

患者が自殺を選ぶこと50%

宗教的観点

人道的観点

その他

287

42%
58% 15%85%

医師が殺人を犯すこと
宗教的観点

患者が自殺を選ぶこと

人道的観点

その他

figure 18 ratio‌of reason for disagreement for legalizing euthanasia inhumane reason
宗教的観点とお答えした方に、お尋ねします。何を信仰なされていますか。その宗教についてご記入ください。
キリスト教（カトリック、プロテスタント、その他）
仏教
ヒンドゥー教

50%

50%

42%

58%

イスラム教
ユダヤ教
無神論者
その他

医師が殺人を犯すこと

キリスト教

50%

キリスト教

患者が自殺を選ぶこと

無神論者

50%

無神論者

figure 19 ratio of religion

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政治学研究61号（2019）

IV Result of survey
The survey result shows that 80.3％ of the Japanese respondents are favorable
to the legalization of euthanasia. This is higher than the figure for Australian
respondents, which is 67.8％. This survey thus shows that more people in Japan are

20: the number of agreement for
favorably disposed tofigure
euthanasia.
legalizing euthanasia

100
9080.327868852

80
67.796610169

70
60
50

AustraliaJapanfigure 20 the number of agreement for legalizing euthanasia
What is also noteworthy is that, according to the survey, both in Japan and Australia,
most dissenting opinion is based on the humane reason. However, there is a stark
contrast between the two countries on the following point: while no objection was basedon religious reason in Japan, 45.5％ of Australian respondents mentioned this reason.

Australia

Japan

0%

15%
45%

55%
85%

relgious

humanethe others

relgious

humanethe others

figure 21 the reasons of dissenting opinions towards legalizing euthanasia

Australia

Japan

45%

55%
289

85%

I shall list below, some of the other interesting findings
Approximately 60％ of the people who disagreed out of concern for humane
humanethe others
humane andthe others
treatment relgious
did not thinkthat patientsbe allowed relgious
to kill themselves,around 40％of people’s disagreement is based on the reason that the doctors should not killtheir patients in both countries.

Japan

Australia

11%
33%

42%
58%

56%

doctors kill patients

doctors kill patientspatients kill themselves

patients kill themselves

killing should not be acceptedkilling should not be accepted

figure 22 ‌the reasons for disagreement for legalizing euthanasia inhumane reason

Japan

Australia

3%

As for the interests in euthanasia, approximately 70％ of the respondents chose
4 (the interest in euthanasia is a little) or 5 (the interest
in euthanasia is very) in
13% 8%
15%

31%there are differences in the number of people who chose 5. Thatboth countries, yet
7%
17%
8%
number in Australia is approximately
30％, while in Japan it is less than 15％.

Though the number 39%
of people who chose 5 in Japan 59%
is less than half of that ofAustralia, at least, large numbers of people in Japan are interested in euthanasia andthe majority of people are also in favor of euthanasia.
1 not at all

2 very little

4 a little

5 very3 neither

1 not at all

2 very little

4 a little

5 very3 neither

290

doctors kill patients

doctors kill patientspatients kill themselves

patients kill themselves

killing should not be acceptedkilling should not be accepted

政治学研究61号（2019）

Japan

Australia

31%

13%

15%

3%

8%

7%

17%

8%
59%

39%

1 not at all
4 a little

2 very little

3 neither

5 very1 not at all

2 very little

4 a little

5 very3 neither

figure 23 interest in euthanasia

Drawing on these findings, although there is long way to go in comparison
with Australia, I strongly believe that Japan should consider legalizing euthanasia.
Japan is an increasingly aging society, where more and more people suffer fromdeteriorating health and its consequences. Furthermore, Japan is renowned for its
high average life expectancy; but this longevity does not necessarily correspondwith healthy and pain-free lifestyle. There are quite a few numbers of patients whoare bedridden and suffering extreme pain.
According to the Japanese governmental survey conducted in 1999, there are1243000 of people who are bedridden and what is worse, according to the Japanese
Ministr y of Health sur vey: the average life span comes from kouseiroudousyo“heisei22nenkanzenseimeihyo”and the health expectancy are from kenokujumyonio
kerusyouraiyosokutoseikatusyukannbyotaisakunohiyounikansurukenkyuthe, thenumber seems to be increasing, with the gap between average length of life andhealthy life years widening every year. It may also be the case that the number ofpatients who are forced to alive against their will is on the increase.
In Australia, as mentioned above, doctors do not always have to take lifeprolonging treatment when they do not recognize it is the best way. Yet doctors inJapan must always choose life-prolonging treatment: it is considered the doctor’s
mission to make patients alive as long as possible.

291

I believe it is worth considering the possibility of legalizing euthanasia is there
are increasing number of patients who is suffering extreme pain and is made to live
against their will. Japan should introduce euthanasia to the doctors whose mission
is to extent patient’s life as possible as they can, yet this is duty and even if they areconscious that this treatment is not seemed to be the best treatment, they must do.
It is time to reconsider what Japanese medical situation faces now and change ourmind toward medical treatment. It cannot be the best to live as long as patients canwhen they do not want to live, it can be the best to die in proper timing by
euthanasia.
1） The Japanese criminal law Article 202．
2） Hanreijihou1503go, (1995, July)．
3） Dying with dignity Victoria.
4） Dying with dignity Victoria.
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