The Lower House voted yesterday to remove the major restrictions on organ transplants in Japan–an age limit and the need for family consent of the donor. Since the organ transplant law was passed, transplants have been difficult to get in Japan and are fairly rare–only 81 in the 11 years since the current law was enacted. Yesterday’s changes were spurred by pressure from the WHO, looking to stem the tide of “medical tourists” who go overseas to get transplants.
Of course, this isn’t to say that everyone agrees with the changes that were made. Many Japanese remain wary of organ transplants and the concept of “brain death,” necessary for organ transplants, is not as accepted in Japan as it is in the United States. Twice Dead, by Margaret Lock, details many objections Japanese people have; the most interesting one she cites relates to 贈答文化, exchange culture, in that a donee can not properly return the favor.
Now, this was nowhere near as interesting as the reason detailed in the newspaper handed to me this morning as I passed a group of protesters demonstrating outside the Diet. According to 関東「障害者」解放委員会, the Kanto “Disabled Persons” Liberation Committee, the law will allow the nefarious Japanese government to do what it has long wanted: harvest organs from workers and sell them on the global market. Social stratification in Japan has spread to the medical arena and politicans led astray by America’s neo-liberal influence are plotting to increase the number of its brain death diagnoses in order to save costs on emergency care and further oppress the working poor! Will the capitalists never cease their brutal exploitation of workers?
After getting over my shock in realizing I was actually reading the headline of the newspaper correctly, I found myself somewhat disappointed that the protestors couldn’t have put together a better case. It is possible to argue against organ transplants without sounding like a complete nut. Although the criteria for brain death are quite rigorous and misdiagnoses are nearly unheard of, there are rare cases of people being declared brain-dead and then coming back to life. The idea of brain death also conflicts with many religious and cultural notions of death. These aren’t limited to non-Western cultures; according to Wikipedia, the orthodox Jewish community is divided over the issue.
Of course, these nuanced arguments are complicated. It’s much easier to simply say that Japanese politicians are selling poor people’s hearts and livers to line their pockets. Ah, politics! I can’t wait to see what I’m handed the next time I head to Nagatacho.
(Interestingly enough, Japan has had problems with people who allegedly broker “used” organs. Also, see Roy’s post about Japanese organ harvesting in Thailand.)
I see this as a huge step forward, really. I didnt even know about the organ donor card. I had placed on my US license that I dont want to be an organ donor due to some horror stories of my body being whisked away to surgery moments after my death or something like that. But now I can kind of see that this stuff is necessary. The major media call the current situation “relying on overseas hospitals for transplants” but other claim that many patients just die without ever getting one (esp those under 15), and of course almost the entire Japanese population does not participate in the pool of donor organs.
According to the Nikkei, one motivation for the law to pass now was that the WHO was considering issuing a recommendation against allowing people to travel to foreign countries to become organ recipients.
Apparently Japan’s first-ever heart transplant in 1968 (the “Wada heart transplant incident”) was highly controversial. The 18 year old woman who received the heart was fine at first but apparently rejected the heart and was dead by the 83rd day after the surgery. It was later revealed that the patient was incorrectly diagnosed and did not actually need the surgery after all and the donor was not given a strict test to determine brain death, triggering a firestorm of criticism and apparently poisoning the public against the idea of transplantation.
After the death of the donor, the heart itself went missing for three months and when it finally reached the hands of a surgeon to dissect it parts had been sliced out.
All in all, Wada is blamed for having rushed into the surgery and then panicking trying to cover things up afterward. His sloppiness and lack of accountability has fed into the anti-transplant sentiment here.
Source: What else? Wikipedia
http://ja.wikipedia.org/wiki/%E5%92%8C%E7%94%B0%E5%BF%83%E8%87%93%E7%A7%BB%E6%A4%8D%E4%BA%8B%E4%BB%B6
This is all part of Parasite Eve’s master plan.
Maybe making people pay 400 million yen (about 4 million USD) up front will change hearts and minds about brain death and organ transplants:
http://www.yomiuri.co.jp/national/news/20090618-OYT1T00016.htm?from=main3
I understand some of the forces at work that led to this (the WHO leaning towards a ban, the fact that foreign patients showing up in the US are often already in pretty bad shape by the time they get there, which leads to them being bumped to the top of the priority chain, as well as the risk of higher medical costs due to the patient’s condition), but holy…
4 Million dollars? Who came up with that figure – Dr. Evil?
Oh, and Ben – exactly right about the Kanto Disabled Persons’ Liberation Committee – Whiskey Tango Foxtrot, Over?!? Just be careful, don’t ever confuse them with the Liberation Committee for Kanto Disabled Persons, nor the Committee for the Liberation of the Kanto Disabled Persons, nor the Kanto Committee for Disabled Persons Liberation….
What have the Romans ever done for us anyway?
The “pseudo-reportage” manga “Black Jack ni yoroshiku” that I recommened in that other thread is dealing with the history of this very problem in its current story arc.
I’m not sure that I like the “Japanese culture” argument being thrown around in relation to this debate (and neither would Black Jack). I mean, seriously, its not like Western Christians were that crazy about the issue of transplants from brain dead patients either – it was something that “we” got past through very painful public debate, however. In addition, by any measure, statistical or otherwise, Japanese show a very low attachment to religious ideas compared to, say, Americans. In the end, this is something that Japanese conservatives have been pulling a lot lately – don’t have an adequate argument? Just say “Japanese culture” which can be anything from the Heian Court to Medieval Buddhism to Edo red light districts to 1930s Nichiren ultranationalism to 1960s housewife wisdom to Miyazaki – it can mean anything that one wants it to.
“Black Jack ni….” makes another point – when transplants first started happening in Japan, people were accusing the families of donors of doing it for the cash. That, and the resistance of ultra conservative doctors, the same sorts of guys who are keeping out the global standard asthma drugs for some reason.
As for the crazy cracking down on the working poor argument – this is the classic leftwing bait and switch. Leftwingers do it all the time – make an obtuse connection to bring a real issue (“working poor”) a bit more attention. The Japanese left has also been arguing that the government is, at the behest of America, trying to gut employment to make it easier to introduce a DRAFT. Ie. creating poverty is the easiest way to militarize. Note that most leftists realise that these connects are far out there, but have capitalized on them to keep issues like “working poor” in your face.
“bait and switch – Leftwingers do it all the time”
As do right-wingers.
“Guantanamo needs to be closed, and the people held there transferred to US prisons.”
Rightwing response: “Those seeking to close Guantanamo would release terrorists onto American streets.”
“Just be careful, don’t ever confuse them with the Liberation Committee for Kanto Disabled Persons, nor the Committee for the Liberation of the Kanto Disabled Persons, nor the Kanto Committee for Disabled Persons Liberation….”
Thank you, LB. I was hoping I’d get a comment like this.
“I’m not sure that I like the “Japanese culture” argument being thrown around in relation to this debate (and neither would Black Jack).”
Well, I didn’t do a very good job of summarizing Twice Dead (did you see the link?), but it’s definitely work a read. I can’t really defend the argument it presents since I read it so long ago, but it is far from typical Nihonjinron tripe. It’s based largely on interviews/ethnographic fieldwork and I think I remember Japanese being quoted that the idea of breaking up the body or accepting a part of the body of a deceased person was simply unthinkable. Of course, I don’t remember how much those cases were generalized out and I don’t remember what Lock said about conservatives who would use quotes like that to maintain the political status quo. I should probably reread that book but I have no access to an academic library right now.
Also, cultural arguments don’t really explain why the measure was passed now–that’s probably mostly because of the recent WHO announcement. I seem to remember from Twice Dead that there were similar political forces pushing through the transplant law in America.
“As for the crazy cracking down on the working poor argument – this is the classic leftwing bait and switch.”
Oh sure, but my point is that it’s _funny_
Saw the link. Can’t argue about the book, because I haven’t read it, but I have seen a half dozen or so “cultural objections” voiced in the last few days on TV and in the press.
“I remember Japanese being quoted that the idea of breaking up the body or accepting a part of the body of a deceased person was simply unthinkable.”
It seems to be okay for only a few bones to be taken after cremation. This was what was done during the war.
My question in this circumstance is – is a reaction to breaking up the body or accepting a part of the body of a deceased person really anything to do with Japanese culture? Or is it the same type of hesitation that was seen in other cultures, just defined in Japanese terms? Once again, its not like Christians were perfectly culturally fine with taking organs from the brain dead or anything. What changed the debate was the very real issue of saving more lives. It also seems that many Japanese have been perfectly fine with going overseas and getting body parts.
Saw one TV feature where a mother has been caring for her brain dead son for 15 years. She claims that he responds to her voice and so on, but the doctors say differently. Is there a real cultural foundation in this apart from some extreme sentimentality that is preventing patients from getting much needed organ donations on a national scale? I have doubts.
“It seems to be okay for only a few bones to be taken after cremation. This was what was done during the war.”
And it is what is done now as a matter of course (speaking as one who has been through the whole process, and will have to do it again eventually – hopefully later rather than sooner). I think the “breaking up the body/accepting only part of it” refers to before the cremation. It may be a leftover from the old days, when Japanese buried their dead, and possibly, like the Chinese, they held that the body must be intact to proceed on to the afterlife. I have never seen or heard that view expressly stated in Japan, unlike when I was in China where they cremate but still only grudgingly, as the State tells them they must do it. Cremation here has become so widely accepted aside from a portion of the Christian community, and for so long, that no-one thinks twice about it. However, the existence of ghost stories involving a spirit staying in this world searching for some missing part of themselves suggests to me that at one time the belief that the body must be buried intact existed.
But there again – you can find similar stories in the West, so I don’t think there is a significant, fundamental difference in traditional attitudes between Japanese and Westerners on the topic – allowing for a gross overgeneralization and simplification of attitudes on both sides, of course.
I do think Japanese have fairly strongly held onto the belief that “life” centers on the heart. That seems to be one of the issues being dealt with when it comes to “is brain death the death of a person?” I have heard this brought up numerous times in discussions and news stories over the years. Even again this morning, with young parents dealing with their brain-dead young daughter. The girl has been brain dead since just after birth (caused by massive blood loss, apparently), but the body lives on, and is growing. The hair grows out and needs cutting, as do the fingernails. Teeth have come in. The heart is still beating (a respirator is required, though). The parents say, similar to the case M-Bone cites, that their daughter grunts differently depending on the situation (their daughter seems to “grunt” a lot, and did so throughout the video, it seemed to me to just be a side effect of being on a respirator).
The parents were torn – to them, their daughter is “alive” because of all of this. They can’t seem to bring themselves to take the step of admitting that their daughter is, in reality, not “living”, is not thinking or feeling anything, and never will. I don’t think there is anything uniquely Japanese or cultural about that emotion, though – remember the Schiavos?
Good points.
Agreed on the “heart” idea – which includes a dimension of spirit/thought/will as well. However, I’m not sure that this is really that entrenched an idea in daily life or that many Japanese could articulate a developed view on it. My concern is that the sentimental decision comes FIRST and the reasons located in Japanese culture come AFTER.
“They can’t seem to bring themselves to take the step of admitting that their daughter is, in reality, not “living”, is not thinking or feeling anything, and never will. I don’t think there is anything uniquely Japanese or cultural about that emotion, though – remember the Schiavos?”
Indeed. I saw a feature on the same case (Japanese one) two weeks ago. And my worry is that the emotional side of the issue has too much influence on the debate in Japan.
It is sometimes interesting to consider just how these debates turn out in Japan. The smoking debate, for instance. In Japan it is all about the individual and business owner’s personal rights. In “the West” it is now all about the good of the group. So much for the stereotypes.
“Saw one TV feature where a mother has been caring for her brain dead son for 15 years.”
Let me say I hope that not a single yen of public healthcare money is going to keep braindead zombies un-dead. In fact, it’s probably not even a good idea to allow her to pay for it herself, as it wastes the time of doctors who could be working on living humans.
“My concern is that the sentimental decision comes FIRST and the reasons located in Japanese culture come AFTER.”
I generally agree, but I don’t think you can say that cultural factors are entirely baseless. After all, look at Ben’s example of orthodox Jews in his initial post, as well as other religions (I’m looking at you Christian “Science”) that ban transplantation or other medical procedures. I think the existence of cultural contexts which are clearly the SOURCE of the taboo should at least justify giving consideration that it could be an intensifying factor to distaste for organ donation in Japan.
The son that I referenced is at home, but I think that the daughter that NB mentioned is hospitalized. If the child is “alive”, they are no doubt entitled to public health. Another reason for a stronger “brain death is death debate”.
There is a very powerful scene in the manga that I mentioned where a doctor does an extreme face to the floor 土下座 in order to get a couple to understand that their braindead son isn’t sleeping, he’s dead. I hope that the doctors in the real cases did everything that they could to convince the parents that their son/daughter would never live.
My gut feeling is that there isn’t anything “Japanese” at work here – it is a very human emotional hysteria. The parents no doubt feel that their daughter will wake up any day now, go to school, bring a boy home, graduate from college, etc. The financial and emotional cost of this fantasy is unfathomable, not to mention the dozens, hundreds, thousands or more who have died in the decade or more that the has passed, waiting for organ transplants that never happened.
“After all, look at Ben’s example of orthodox Jews in his initial post, as well as other religions (I’m looking at you Christian “Science”)”
Those cultural contexts are permeated by (fundamentalist) religion. You could say that every aspect of their lives and social relations revolve around strong religious ideas. There is also a great deal of consistency in the beliefs of those groups and if you change your beliefs, you are no longer a member of the group. This is not true of a broader group like “Japanese” that is probably best considered as a vast number of interlinking cultural spheres in which Japanese religious ideas have proven very flexible over time. Toilets inside Shinto shrines!?
Cultural factors are always important – but is it the “traditional” vision of death, or is it the “Japanese dream” of the postwar family – the mother selflessly devoting herself to her children through thick and thin – that is at work here?
I don’t know. But I have talked to a bunch of Japanese around me about this. Those who support considering brain death death and organ transplants acknolwedge that it is a hard issue but better for everyone – including the family and the person. This seems to be the very process that Christian countries went through. Those who support keeping brain dead people alive and say that they would not want their organs taken are only able to give me sentimental reasons. There doesn’t seem to be a lot of consensus across a group with very similar religious (all Jodo-shu put non practicing, virtually none know much more about it than that it has something to do with Amida, classic mushukyo) background, education, class, etc. That doesn’t mean that a reason can’t be “cultural”, but it makes me doubt that there is anything that can be identified as a universal or even very common Japanese trait here.
In a way, there is a similarity with the Google Street View debate – in claiming that there are fundamental Japanese objections to it, it is almost like saying that Japanese who DO want the service aren’t “real” Japanese. In the context of the current rightwing “Japanese young people aren’t Japanese” rhetoric, there is a reason to be careful.
(PS Ben – I know that you were just presenting different viewpoints, I’m not arguing against you but rather the viewpoints that have been put forward by the opponents of the law on various TV shows, articles, that I have seen in the past weeks and the “anti” point of view that I was introduced to in “Blackjack ni” and confirmed by reading parts of several non-fiction Japanese books on the subject).
I don’t mean that you necessarily have to take some kind of broad essentialist “Japanese” cultural trait as a reason for perhaps having a stronger anti-organ transplant taboo than America. Mightn’t there be some groups within Japan that, for some reason or another, have more dislike of it? After all, there must be some reason that organ donation hasn’t taken off in Japan, despite having the financial and technological resources for it long before it was acceptable in some less well-equipped countries. I don’t know what that might be, but it certainly isn’t a completely random accident. Anyway, “cultural” doesn’t have to be essentialist, it can certainly be a side effect of some recent development as well. But again, it’s not like I have a theory, just playing devil’s advocate in saying that it doesn’t make sense to avoid looking for one.
“Japanese who DO want the service aren’t “real” Japanese”: Is anybody actually arguing that? There certainly seems to have been more complaints about the service in Japan than anywhere else, and that led to people speculating on cultural reasons for it, but it’s not like hating Streetview has become some sort of test of Japanese-ness.
“but it’s not like hating Streetview has become some sort of test of Japanese-ness.”
No, but that’s a small-scale net example and the arguments raised have a similarity to other patterns of recent debate. A vocal minority, for example, have been trying to turn thinking that Japan’s wars were just fantastic into a Japanese-ness test, however. Here’s a gem from Sakurai Yoshiko –
戦後の私たち日本人は、あまりんおも祖国日本についての知識や価値観に背を向ける教育のなかで、まともな日本人が育まれるはずがない。日本の歴史を学び、日本文明を育んだ価値観を識ったとき、はじめて、わたしたち日本人としての自覚をもつことができる。ひとりひとりが日本人としての力をつけるとき、戦後、ながきにわたって国家ではなかった日本に国家としての意識が生まれるだろう。国家としての意識があって、はじめて日本の再生が可能になる。再生を果たした日本の前に、どんな問題が出来しようとも、日本と日本人は自らの力で問題を解決することができるのである。(The context of the quote is the idea that Japanese people were stripped of their Japaneseness during the American occupation)
This sort of idea is having an influence on some education debates (not a big one, but people do argue this way and get taken seriously). I think that we should be wary of anyone who breaks out these types of arguments – as the anti-brain dead is dead lobby and conservative TV commentators have been doing. Before looking for cultural reasons, we can consider why this lobby has been stronger – I would say that emotional arguments and vague cultural appeals are behind this.
If Sakurai would just say that wartime militarism was great and that we should all be like that, I would’t agree, but it would at least be a real point. As it stands, in quotes like the one above, she is defining whatever she happens to like as “real Japanese culture”. In a similar sense, if Streetview opponents had just said that they are concerned about crime and privacy, that would have been fine (there have been similar reactions in the UK). Why go fishing around the Edo Period when young Japanese don’t seem so impacted? In a similar sense, I agree with you that cultural explanations should be raised and assessed. If the brain death is not death crowd could point to elements of Buddhism that support such a view, once again, I would’t agree, but I would acknowledge it as a reason. Just saying that “ware ware nihonjin” think this way to promote what seems to be a minority view… I think that way of arguing has got to go.
Here is a quote from an opponent quoted on TV –
わたしは死体と寄り添っていたの？温かい体があり、成長する体がある
The best that a leading protest group can come up with –
正式に「脳死」と判定された人でも、脈があり、血圧も変動し、触れれば温かく、汗や涙が出ます。
主要な脳機能の反応が見られないだけの重症患者を「どうせ間違いなく死ぬのだから」と他の人の治療に利用することは、体（てい）の良いロ実で、最も弱い立場の人を切り捨てることに他なりません。「脳死」患者は、まだ生きている人なのです。
One argument that I have seen is that “the Japanese” find the procedure (taking organs from the brain dead) to be ethically 不自然. I’m not sure that anyone would find it “natural”, but Japanese don’t seem to have trouble with any number of other medical procedures.
My concern is that opponents are offering primarily emotional arguments and then linking it to something all encompassing like “Japanese culture” to grab more authority in debates.
If I were going to try and find a cultural explanation for opposition to Google Streetview, I would probably look at how contemporary notions of privacy in the home are related to post-war urban living conditions and land usage rather than trying to go back to the Edo period. That’s the sort of thing that I think of when looking for “cultural” explanations. To a large degree, separating explanations cleanly into cultural and structural category strikes me as highly artificial, since cultural views largely arise as means of copying with structural factors.
Now, with organ transplants it might be difficult to make that kind of connection, and the more religious side of culture would probably have more to do with it. Could it be something to do with Shinto notions of impurity, as has been suggested? I’ve no idea, but I wouldn’t object to someone doing serious research to find out (not vapid punditry, as in your Sakurai Yoshiko quote). Of course, even religious taboos like the Shinto notions of impurity clearly have their roots in the fact that some jobs (like handling dead bodies) are likely to cause disease, much in the way that Jewish and Islam food taboos partially consist of a list of animals that were more difficult to eat safely in antiquity due to parasites.
Organ transplant is one of those things that I assume almost everybody finds “unnatural” (because it is) and slightly creepy. I don’t actually believe that religion/culture anywhere is actually the root cause of that sensation so much as natural instinct is (although after a couple of generations of swapping out our parts for vat-grown clones organs I assume the cultural taboo will fade completely), just that there are background cultural elements that people may latch onto when considering how to think about such a radical new procedure, and which gives them the excuse to elevate something about which they feel uncomfortable to the level of taboo. So perhaps, as a hypothetical, you could say not that “Japanese culture makes the Japanese less comfortable with organ transplant” but instead that “everybody around the world feels uncomfortable with organ transplant at first, and in Japan commentators have used references to traditional Japanese beliefs to guide the public discourse on the subject, and sustain and amplify that natural discomfort to a greater state than in other first world countries.”
“That’s the sort of thing that I think of when looking for “cultural” explanations.”
That’s fine. And I wish the brain death opponents were doing that.
“Could it be something to do with Shinto notions of impurity, as has been suggested? I’ve no idea, but I wouldn’t object to someone doing serious research to find out”
Indeed. But the problem with that kind of research is that it often turns out like –
Q: So did Shinto influence your view?
A: Yes, now that you mention it, it did.
Even if the the researcher isn’t as irresponsible as this, most people go into these types of things knowing that they are going to be asked about a certain theme and prepare answers – the act of which may actually be creating a new cultural explanation that had nothing to do with the original attitude.
“everybody around the world feels uncomfortable with organ transplant at first, and in Japan commentators have used references to traditional Japanese beliefs to guide the public discourse on the subject, and sustain and amplify that natural discomfort to a greater state than in other first world countries.”
That’s exactly what I’m worried about in this case. I mean, are we really surprised that a wareware totetsumonai nihon guy like Aso is opposed to the new plan?
Found an argument by a philosopher 梅原 猛-
日本人は、縄文時代以来、万物に魂が宿るとするアニミスティックな霊魂観を持ち、脳にのみ魂が宿り、身体は機械に過ぎないという近代西洋的な発想を持たない。だから、臓器を機械の部品のように交換することは、日本人にはなじまないというわけだ。
But hell, its not like Christians think that the soul is lodged in a hole in the brain or anything and its not like Americans thought Descartes first and then started to transplant organs. In any case, the idea of these soul bearing parts could also be summoned as a reason why organs SHOULD be preserved and given new life. It also seems to have no impact on ideas about cancerous organs being removed, etc.
On a similar note, opponents who claim that “Japanese culture” is sensitive to the lives of the braindead – this means that conversely that countries that certify the braindead as dead are bad. Hence arguments like this one taken from a blog –
米国で臓器移植が多いのはなぜなのだろう？米国の医療では「貧乏人は死ね」という医療が行われる。貧乏人の家では、仮に家族が脳死になって、レスピレーターを装着し心拍動を維持したいと思っても、金の切れ目は縁の切れ目。宗教が何であろうが関係なく、経済力の弱いものは、脳死を人の死と認めざるを得ない局面が多いような気がする。
This becomes a reason why Japanese taxpayers should support families who keep braindead loved ones on life support for over a decade.
Wow. Just saw a gobsmacker of a quote from a mother who has kept an infant daughter on life support for 8 years この子は『延命』しているのではない。こういう『生き方』をしている。
And in response – 生まれ変わらせてやれよ.
Sometimes 名無しさん on 2ch speaks the truth.
Of course, “he” also says – ブサヨの諸君にはもうしわけないが、俺は提供カードの「提供する」にマークを付けたぜ。
“This becomes a reason why Japanese taxpayers should support families who keep braindead loved ones on life support for over a decade.”
Well, as I said above I’d be totally fine with making it illegal for rich people to waste doctors’ time keeping their irrecoverably braindead relatives alive.
I read, but can’t confirm, that the government is paying disability benefits to families who keep braindead relatives alive – more than enough to cover the costs of care. I saw the abstract of one article where the author argues that it is a moral imperative to ensure that keeping braindead patients alive does not place a financial burden on their families.
Anyway, the main gist of my comments was that if we don’t stand up against this discourse soon, someone is going to use it to do something crazy like defend rape games or something.
Let’s just legalize the organ market so that Japan becomes one step closer to as described in Neuromancer. I think that’s as good a basis as any for policy-making.
“Let’s just legalize the organ market so that Japan becomes one step closer to as described in Neuromancer.”
I think that we should start by tearing some organs out of the non-Japanese otaku who are praising the porn game company for standing up to feminism.