Petition: Request for the legalization of euthanasia, first draft, supplementary materials ① Japan's institutional gaps and current situation

[Petition: Request for the Legalization of Euthanasia, First Draft, Supplementary Material ① Japan's Institutional Gaps and the Current Situation]

第一稿　補足資料　１.pdf

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I. Current legal and institutional situation in Japan

-The legal status of euthanasia

In Japan, "active euthanasia," in which a doctor ends a patient's life using drugs or other means in accordance with the patient's explicit wishes, is not explicitly recognized by law and is understood to be prohibited from the perspective of criminal law and other laws.

Active acts of ending a life by a doctor or third party may constitute the crime of homicide or assisted suicide.

- Distinction from "passive euthanasia (cessation/withholding of life-sustaining treatment)"

In Japan, "passive euthanasia" (sometimes also discussed as "death with dignity"), in which treatment is discontinued or withheld, is permitted in a certain form, or has been considered.

However, this "decision regarding discontinuing life-sustaining treatment, etc." remains at the guideline level and is not clearly guaranteed by legal regulations.

In other words, even when offering euthanasia as an option, doctors and medical institutions may face legal risks and ethical ambiguity.

- The absence of a system of "euthanasia" or "death with dignity" laws

Japan has yet to establish a comprehensive law governing euthanasia and dignified death, and a legal vacuum has existed for many years.

As a result, the criteria for judgment, legal basis, procedures, and responsibility in the medical field are not clear, creating a structure that is prone to causing anxiety and confusion among patients, their families, and medical professionals.

- Social changes and delays in the development of legal systems

On the other hand, an increasing number of countries are institutionalizing euthanasia internationally, widening the gap with global trends.

Furthermore, even in Japan, although there has been progress in end-of-life care and palliative care, there is no guarantee that all patients will be able to receive the palliative care they desire . Furthermore, it is now commonly recognized in the global palliative care community that there are limits to palliative care in end-of-life care ( see last page ), but the Japanese palliative care community continues to turn a blind eye to this fact.

As a result, there remain cases where pain relief and dignity are not adequately maintained due to regional disparities in medical care, the patient's condition, and the family situation.

II. Issues and Consequences

- Distress and limited choices for patients and their families

Under the current law, where active euthanasia is illegal, patients and their families who wish to be "free from pain" or "have a dignified end" have no legal options . This means that the system does not guarantee the dignity and right of self-determination of individuals .

・Ethical and legal dilemmas in the medical field

Medical professionals are also forced to make complex decisions, such as discontinuing or withholding life-sustaining treatment or providing palliative care, while also weighing legal responsibility, ethical conflicts, and how to respond to families. The lack of clear legal grounds tends to make practice in the medical field unstable.

・Lack of transparency and consistency in the system

If the decision to discontinue treatment is left to "guidelines" or "medical institutions and doctors in charge," standards will not be consistent, and responses will likely vary depending on the region, hospital, and medical professional.

Furthermore, the current system does not have a mechanism for publicly recording and reporting the implementation status and decision-making process, and social transparency is not ensured.

・Gap with international standards

Compared to countries that have legalized and institutionalized euthanasia, Japan's legal system lags far behind , and it lags behind in terms of the range of medical and welfare options available. This could lead to an "exodus of patients from the system," with some patients and their families considering moving overseas.

III. Our understanding of the current situation

We have defined ourselves as the "Group Aiming for the Legalization of Euthanasia," and on our website we state that "legalization of euthanasia is a global trend," calling for the establishment of a system for this in Japan.

Our argument is that there are voices in Japan calling for euthanasia and people seeking relief from pain, and the current situation in which there are no institutional options is problematic from the perspectives of humanity, ethics, and human rights .

In light of this reality, we believe it is an urgent task for the Diet and relevant ministries and agencies to consider the legal framework and system design.

IV. Conclusion

The current legal system does not have a clear system for active euthanasia, and there is little legal guarantee for the discontinuation or withholding of life-sustaining treatment. As a result, the options available to patients, their families, and medical professionals for ensuring a dignified end of life are extremely limited.

Meanwhile, an increasing number of countries are institutionalizing and legalizing euthanasia internationally, widening the gap with the rest of the world. Japan too must squarely face the realities of ethics, human rights, and medical care, and begin considering establishing a legal system.

This Supplementary Material 1 summarizes the legal and institutional gaps and the current situation, and should be viewed as basic material for future consideration of legislation.

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The limits of palliative care

Report submitted to the House of Commons (section on palliative care)

Even with the highest level of palliative care

・'79%' means a peaceful death

・21% are painful deaths

Similar results have been reported in other countries (Belgium, the Netherlands, Canada, and the United States).

There are no accurate statistics in Japan, but since there is no difference in palliative care techniques, it is assumed that the rates are about the same.

This means that approximately 20% of patients who receive palliative care in Japan die in pain.

Fuji TV The Non-Fiction

[What my mother decided: A family's record of facing life and death]

(The female X account is here ⇒ @mahomelc)

Mayumi's X account name is Meishii

The reason why he didn't die in Japan but went to Switzerland: (Summary of X's post)

Palliative care itself has its limitations.

- There are many cases where even the highest level of comprehensive palliative care cannot prevent excruciating pain.

(More than 20% of people who receive palliative care die in pain)

-Doctors (despite knowing this fact) never acknowledge it and never inform the public (they constantly preach about their "omnipotence" and make exaggerated advertisements, leaving patients and their families in despair inside a black box).

- Whether pain relief or sedation is used, discomfort such as dizziness and nausea will occur as the patient approaches the end, and pain, to a greater or lesser extent, will naturally occur.

- Terminal sedation is at the discretion of not only the family but also the medical team. If someone refuses or hesitates, they are left alone with a "let's do our best" (at that point, terminal sedation is paternalism in itself).

Euthanasia is the right to decide the timing of death. The right to decide is ultimately left to the patient.

She had desperately sought a way to die in Japan, but when she saw the tragic and fragile state of the palliative care industry, she became desperate and chose to end her life in Switzerland, seeking a dignified and peaceful end. *This is an element not depicted in the documentary.

・Other: There are many testimonies on the internet and social media of people who died in pain despite receiving palliative care ( collected on the website ).