By Makoto Hase

One fact we human beings can not avoid is death. How one died is becoming important. Is it right to keep patients alive as long as possible when they are terminally ill―even if they donﾕt want treatment? And what about the families? Do they have a right to stop or extend treatment? These are difficult questions.

On April 1, 2002, Mercy Killing (also called euthanasia) was legalized in Holland for the first time anywhere in the world. Until now, Mercy Killing was only allowed by state law in California and Oregon, U.S, but this case in Holland is the first time to legalize it at the national level. Of course, this subject comes up not only in Japan but throughout the world. The main requirements for allowing euthanasia are as follows; 1) the patient wants to die because, 2) the patient can no longer withstand the pain, and, 3) the doctors who perform euthanasia must consult with other doctors. Also, the largest pro-euthanasia organization in the world, The Dutch Voluntary Euthanasia Society (NVVE), carries on with its movement so that euthanasia will be granted to not only these with ﾒphysical distressﾓ but also these with ﾒmental distress.ﾓ

In Holland, the controversy about euthanasia recurred from the early 1970s, so euthanasia has been accepted through the guidelines of the medical profession or legal judgements. Moreover, the Burial Law, which was revised in 1994, is a standard for granting euthanasia. In following this law, over 4,000 cases of euthanasia are carried out every year. Hollandﾕs neighboring country Belgium, which has been influenced by Holland, has begun the procedure toward legality. In the case of Belgium, however, it seems they already allow euthanasia like the Dutch. It is right to say that Belgium began legal procedures for allowing euthanasia because of the influence of Holland.

Why did the Mercy Killing Bill reach the national level in Holland? I think it relates to Hollandﾕs heritage of individuality and freedom. They donﾕt want to be interfered with by others, and they are tolerant as long as others donﾕt cause trouble. The Mercy Killing Bill could be reached in this social climate.

Euthanasia relates directly to medical aspects, and is connected to religious issues. In Holland about 20 percent are Catholic, about 16 percent are Protestant and about 60 percent are agnostic (1997). In the 1950s, many people belonged to the Catholic or Protestant church. But since then there have been many social changes with less focus on religion. Respect for individuality and freedom increased along with the number of agnostic people in Holland. This must be one big reason the first Mercy Killing Bill was introduced.

In Japan, various discussions arose after the introduction of this bill. However, the movement toward the approval by society continues about ﾒdeath with dignity.ﾓ Most Japanese donﾕt see life extension as related to the issue of mercy killing. There is an indication in Japan, that as the treatments for relieving pain improve, many people would rather have ﾒdeath with dignityﾓ than do ﾒmercy killing.ﾓ We need facilities like hospices or home terminal care because many terminal patients refuse life extension treatments and meet death with dignity. Most people have a misunderstanding about hospices because hospice is not yet a familiar word in Japan. Essentially, however, hospices are places where patients come to the end of their lives in their own way. I can agree that we have to create more facilities like hospices so that people can have an understanding of what a hospice is.

Eventually, patients who hope to carry out euthanasia should let their families know of their resolution. A simple reason for carrying out euthanasia should not be permitted and we need various requirements as they do in Holland. On the other hand, the more euthanasia increases, the less we may hesitate to choose death as our resistance to this idea decreases. Should we promote death?

We can learn many important things from Holland where they discuss about facing death through public and political forums. I can not imagine euthanasia as it is in Holland, but it will become a big problem which will take a long time to discuss and contemplate on the basis of Japanese culture, history and religion.