Table Of ContentFinal Days
C C C
Final Days
C C C
japanese culture and choice
at the end of life
Susan Orpett Long
university of hawai‘i press C honolulu
© 2005 University of Hawai‘i Press
All rights reserved
Printed in the United States of America
10 09 08 07 06 05 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Long, Susan Orpett.
Final days : Japanese culture and choice at the end of life /
Susan Orpett Long.
p. cm.
Includes bibliographical references and index.
ISBN-13: 978-0-8248-2910-0 (hardcover : alk. paper)
ISBN-10: 0-8248-2910-7 (hardcover : alk. paper)
ISBN-13: 978-0-8248-2964-3 (pbk. : alk. paper)
ISBN-10: 0-8248-2964-6 (pbk. : alk. paper)
1. Death—Social aspects—Japan. 2. Terminally ill—Japan.
3. Life and death, Power over. 4. Ethnopsychology—Japan.
I. Title.
HQ1073.5.J3L65 2005
306.9'0952—dc22
2005010226
University of Hawai‘i Press books are printed on
acid-free paper and meet the guidelines for permanence
and durability of the Council on Library Resources.
Designed by LucilleC.Aono
Printed by The Maple-Vail Book Manufacturing Group
In memory ofEdna, Sue, and Teruo
who have taught me that there
are many ways to die well
Contents
Acknowledgments ix
1. Culture and Choice at the End of Life 1
2. Anthropology and the Study of Dying 14
3. Structuring the Options for Dying: Japan as a
Postindustrial Society 29
4. Metaphors and Scripts for the Good Death 52
5. Who Decides? Social Roles and Relationships 73
6. Deciding to Treat or Not to Treat 110
7. Life-and-Death Decisions and Cultural Stereotypes 150
8. New Scripts and Culture Change 183
9. Choice and the Creation of a Meaningful Death 205
Notes 217
Bibliography 251
Index 279
Acknowledgments
During this more than decade-long study of end-of-life decisions in Japan
I have been privileged to receive the assistance of many people and organ-
izations. I owe my deepest debt of gratitude to the patients and family
members who allowed me to get to know them in the midst of challeng-
ing times in their own lives. I am extremely thankful to them, and to the
many physicians, nurses, social workers, chaplains, administrators, and
volunteers who made this research not only possible but also stimulating
and gratifying. I also gratefully acknowledge the critical assistance of
three senior physicians. Because of their reputations and close association
with their institutions, naming them individually might compromise the
confidentiality of their patients and colleagues. Yet without their coop-
eration, patient teaching, and introductions, I could not have conducted
this study.
In addition, I have been fortunate to receive several grants that pro-
vided financial support for this project. In 1992I was granted a National
Endowment for the Humanities Summer Stipend to begin my study of
bioethics in earnest. A John Carroll University Grauel Faculty Fellowship
made possible six months of full-time participant-observation research in
an American hospital in 1993.My 1996research in Japan was supported
by an Abe Fellowship administered by the Social Science Research Coun-
cil and the Japan Foundation.
As I began to analyze the literature and participant-observation data,
I presented papers at a number of conferences. I am grateful to my col-
leagues at the Midwest Japan Seminar, the Midwest Conference on Asian
Affairs, the American Anthropological Association, the Cleveland Bioeth-
ics Works-in-Progress group, and the University of Michigan Center for
Japanese Studies for their comments and suggestions. Portions of this
book have grown out of these papers, which were revised and subse-
quently published in Cambridge Quarterly for Healthcare Ethics, Ethnology,
x | acknowledgments
Journal of Clinical Ethics, Journal of Japanese Studies, Journal of Medical
Humanities, Journal of Palliative Care, Social Science and Medicine, and The-
oretical Medicine and Bioethics. Reviewers and editors for those journals
helped me to refine the ideas that are presented here. Patricia Crosby,
Terre Fisher, and the staff at the University of Hawai‘i Press have provided
gracious assistance and support for this book.
Many individual scholars have provided support, advice, and stimulat-
ing ideas upon which I have drawn. I am especially grateful to George
Kanoti, Jacquelyn Slomka, Martin Smith, and Joal Hill for introducing
me to clinical bioethics and for insights into the hospital as a field site.
My understanding of bioethics was broadened with the help of Japanese
bioethicists Asai Atsushi, Hoshino Kazumasa, Sakai Akio, and Tanida
Noritoshi. I have also greatly benefitted from responses to earlier drafts
of portions of this volume by Patricia Boling, Michael Fetters, Carl Long,
David Plath, John Traphagan, Tsuruoka Koki, Tsuruoka Yuko, Wendy
Weidenhoft, and the reviewers for the University of Hawai‘i Press. I thank
John Campbell for responding to innumerable questions about the Japa-
nese health and welfare systems, Keiko Nakano for assistance with Japa-
nese, and David Plath for his continuing guidance in the exploration of
Japanese culture and of human lives.
Local arrangements for housing, schools, and introductions to field
sites are critical to ethnographic research. I am grateful to Frank Baldwin
and Toda Takuya of the Abe Fellowship Tokyo office, and to Iwai Noriko,
Steven Nissen, and Shirakashi Sanshiro for their efforts to make my stay
in Japan productive and pleasant. I am grateful that Carl and Eric Long
were able to share the adventure.
There are no words to thank my multiple families who have given
counsel and moral support through all these years of research and writing.
The Horii, Ueda, and Sano families have provided me a home in Japan for
nearly forty years and have been my primary guides toward understand-
ing Japanese society. Okamoto Yuzo and Okamoto Atsuko have been
good friends and teachers for nearly as long. I am also grateful to my par-
ents, Rita and Howard Orpett, for the practical and moral support they
have given me through this project, and for raising me to ask questions
that lack simple answers. My husband, Bruce Long, has always been part
of this project, whether near or far, offering encouragement, patience,
insights, stories, and interpretations of the mysteries of the medical world.
