Negotiating the "Good Death": Japanese Ambivalence about New Ways to Die

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New technologies and new interpretations of the relation between the individual and society in postindustrial countries have led to an expanded set of options for how to die, including hospice, euthanasia, and physician-assisted suicide. This study claims that the ambivalence among ordinary people toward these new ways to die is best understood through the thick description of in-depth ethnographic research. In Japan, inconsistencies in policies, mixed messages, and personal experience all contribute to ambivalence about what constitutes a good death. While bioethics attempts to label such ambivalence as confusion or lag, this article argues that it must be seen in the context of the negotiation of social roles and relationships. Data are drawn from a qualitative study, based on observation and interviews, of end-of-life decision-making conducted in urban Japan in 1996. (Good death, hospice, euthanasia, bioethics, Japan) ********** Although anthropology and bioethics share academic concerns about the process and meaning of human death (see Marshall and Koenig 1996 for a discussion of the relation between bioethics and anthropology), the disciplines differ fundamentally in their approaches. The origins of bioethics as a separate field of study are quite recent, and the major contributors to its development came largely from the disciplines of philosophy, religious studies, and medicine. Given their traditions of rational argument, textual analysis, or laboratory science, the inclinations of many bioethicists are toward simplicity, clarity, and brevity. The goal in both academic and clinical settings is to impose order on ambiguity, and thereby eliminate ambivalence. On the other hand, anthropologists are trained to provide context, to look for variation in patterns of behavior, and to notice the ordinary. (2) It is perhaps the very complexity of real life that draws anthropologists to the study of culture. Ambivalence seems normal, and the imposition of order implies the exercise of power. Social and technological changes of postindustrialism have challenged assumptions that there is a simple Japanese way to die. Policy makers, the media, and bioethicists have looked for, and in some cases have tried to create, a new consensus. Through multiple-choice-style surveys and selective reporting, they have attempted to impose order on knowledge and behavior. Yet inconsistencies in policy, personal ambivalence, and interpersonal ambiguities continue, often unacknowledged. When they are identified, bioethicists may perceive these as personal or societal confusion, or as cultural lag. This article demonstrates that they are neither. Culture does offer multiple models for how to die well. Japan has brought two quite different historical ideals to the attention of the West: the calm acceptance of the elderly Buddhist, and the ritual suicide of the loyal samurai. Ordinary Japanese probably rarely died according to these models, but they have represented culturally meaningful choices which people could elect at least in attitude, if not in circumstances. Contemporary Japanese society has experienced the medicalization of death, but a hospitalized dying supervised by medical specialists has not replaced these earlier approaches to dying. Rather, it appears to have expanded the repertoire of choices and combined in interesting ways with earlier ideas about how to die. This article explores such ambivalence as both a personal and societal response to changes in the way people die in Japan. Changes in technology and new interpretations of the relation between the individual and society have led to a new set of options for where and how to die that are generally not quite morally comfortable. The article begins by explicating Japanese ideas of the good death derived from ethnographic interviews and shows how changes in technology and values interact with this ideal. It then turns to the two extremes of a continuum for dealing with a less than ideal death, hospice on the one hand, and euthanasia and assisted suicide on the other. …