Skip to main content
SpringerLink
Log in

Contesting the natural in Japan: Moral dilemmas and technologies of dying

  • Published:
Culture, Medicine and Psychiatry Aims and scope Submit manuscript

Abstract

The paper opens with a discussion about the recognition of “whole-brain death” as the end of life in North America in order to perform solid organ transplants. This situation is contrasted with Japan, where, despite no financial or technological restrictions, brain death is not recognized, and transplants from brain-dead bodies cannot be performed. The Japanese cultural debate over the past twenty-five years about the “brain-death problem” is presented, followed by an analysis of Japanese attitudes, towards technological intervention into what is taken to be the “natural” domain, together with a discussion of current Japanese attitudes towards death. This debate is interpreted as one aspect of a search for moral order in contemporary Japan, revealing ambivalence about self and other, Japan and the West, and tradition and modernity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Death 1968 A Definition of Irreversible Coma. Journal of the American Medical Association 205:337–340.

    Google Scholar 

  • Amano, K. 1987 Nôshi o Kangaeru, Zôki Ishoku to no Kanren no Naka de (Thoughts on Brain Death in Connection with Organ Transplants.) Gekkan Naashingu 15, 13:1949–1953.

    Google Scholar 

  • Andrews, L.B. 1986 My Body, My Property. Hastings Center Report 16: 28–38.

    Google Scholar 

  • Annas, George J. 1988 Brain Death and Organ Donation: You Can Have One Without the Other. Hastings Center Report 18: 28–30.

    Google Scholar 

  • Asahi Shinbun 1989a “Seimei rinri wa tsumami yoi de naku” (Life ethics should not be piecemeal) January 16.

  • Asahi Shinbun 1989b “‘Jin ishoku o chûkai’ to sagi” (Medication of kidney transplant and fraud) April 23.

  • Asahi Shinbun 1991a, “‘Nôshi wa shi to mitomeru’. Nichibenren ikensho rincho o hihan jinken shingai no osore” (“Recognition of brain death as death.” Fear of violation of human rights in the opinion of the Japanese confederation lawyers) September 21.

  • Asahi Shinbun 1991 b “Giron fûjûbun to hihan no kenkai” (Insufficient debate is the critical opinion) October 17.

  • Asahi Shinbun 1991c “14 reimoku no seitai kan shoku” March 16.

  • Asahi Shinbun 1992a “‘Nôshi’ wa hito no shi’, tôshin” (Brain death is death, says report) January 23.

  • Asahi Shinbun 1992c “‘Nôshi’ rippoka no nao kadai” (Legalization of brain death still a task) January 23.

  • Asahi Shinbun 1993 “Zôki ishoku ishigawa no taisei ippô susumu” (Doctors arrangments with respect to organ transplants have advanced a little) October 16.

  • Bartlett, Edward T., and Stuart J. Youngner 1988 Human Death and the Destruction of the Neocortex.In Death: Beyond Whole-Brain Criteria. R. Zaner, ed., pp. 199–216. Dordrecht: Kluwer Academic Publishers.

    Google Scholar 

  • Chengappa, Raj 1990 The Organ Bazaar. India Today July 31, pp. 60–67.

  • Childress, J.F. 1989 Ethical Criteria for Procuring and Distributing Organs for Transplantation.In Organ Transplantation Policy: Issues and Prospects. J.F. Blumstein and F.A. Sloan, eds., pp. 87–113. Durham, N.C.: Duke University Press

    Google Scholar 

  • Cumming, Bruce 1993 Japan's Position in the World System.In Postwar Japan as History. A. Gordon, ed., pp. 34–95. Berkeley: University of California Press

    Google Scholar 

  • Douglas, Mary 1970 Natural Symbols. New York: Vintage.

    Google Scholar 

  • Feldman, Eric A. in press My Dead Body: The Enigma and Economics of Death in Japan.In Containing Health Care Costs in Japan. N. Ikegami and J. Campbell, eds. Ann Arbor: Michigan University Press.

  • Fine, Alan 1988 The Ethics of Fetal Tissue Transplants. Hastings, Center Report 18: 5–8.

    Google Scholar 

  • Fost, Norman 1988 Organs from Anencephalic Infants: An Idea Whose Time Has Not Yet Come. Hastings Center Report 18: 5–10.

    Google Scholar 

  • Fox, Renée C., and Judith P. Swazey, 1992 Spare Parts: Organ Replacement in American Society, New York: Oxford University Press.

    Google Scholar 

  • Fukumoto, Eiko 1989 Seibutsugaku jidai sei to shi. Tokyo: Gijitsu to Ningen sha.

    Google Scholar 

  • Gaylin, Willard 1974 Harvesting the Dead. Harpers Magazine 52: 23–30.

    Google Scholar 

  • Gervais, Karen G. 1987 Redefining Death. New Haven: Yale University Press.

    Google Scholar 

  • Gluck, Carol 1993 The Past in the Present.In Postwar Japan as History. A. Gordon, ed., pp. 64–95. Berkeley: University of Califormia Press.

    Google Scholar 

  • Gôto, Masaharu 1992 Body and Soul: Organ Transplants. Look Japan 38: 32–33.

    Google Scholar 

  • Guttmann, Ronald D. 1992 On the Use of Organs From Executed Prisoners. Transplantation Reviews 6: 189–193.

    Google Scholar 

  • Hardacre, Helen 1994 The Response of Buddhism and Shintô to the Issue of Brain Death and Organ Transplants. Cambridge Quarterly of Healthcare Ethics 3: 585–601.

    Google Scholar 

  • Harootunian, H.D. 1989 Visible Discourse/Invisible Ideologies.In Postmodemism and Japan. M. Miyoshi and H.D. Harootunian, eds., pp. 63–92. Durham: Duke University Press.

    Google Scholar 

  • Hendry, Joy 1986 Becoming Japanese: The World of the Pre-School Child. Manchester: Manchester University Press.

    Google Scholar 

  • Hirosawa, Kõshiichirõ 1992 Tachiba kara mita nôshi to shinzô ishoku (Brain death and heart transplants from the point of view of a circulatory system specialist).In Nôshi to zôki-ishoku (Brain Death and Organ Transplants). Takeshi Umehara, ed. Tokyo: Asahi Shinbunsha.

    Google Scholar 

  • Ikegami, Naoki 1989 Health Technology Development in Japan. International Journal of Technology Assessment in Health Care 4: 239–254.

    Google Scholar 

  • Kaga, Otohiko 1991 Ikiteiru shinzô (Living Heart)., Tokyo: Kôdansha.

    Google Scholar 

  • Kalland, Arne, and Brian Moeran 1992 Japanese Whaling: End of an Era? London: Curzon Press.

    Google Scholar 

  • Kantô Chiku Kôchôkai 1992 Rinji nôshi oyobi zôkiishoku chôsa kai.

  • Kass, Leon 1992 Organs for Sale? Propriety Property, and the Price of Progress. The Public Interest April, pp. 65–84.

  • Katô, I., et al. 1986 Nôshi zôki ishoku to jinken (Brain Death, Organ Transplants, and Human Rights). Tokyo: Yuhikaku.

    Google Scholar 

  • Komatsu, Yoshihiko 1986 Sentaku gijutsu to nôshironsô no shikaku (The blind spot in advanced technology and brain death debates). Gendai Shisô 21: 198–212.

    Google Scholar 

  • Kopytoff, Igor 1986 The Cultural Biography of Things: Commoditization as Process.In The Social Life of Things: Commodities in Cultural Perspective. Arjun Appadurai, ed. Cambridge: Cambridge University Press.

    Google Scholar 

  • Kosaku, Yoshino 1992 Cultural Nationalism in Contemporary Japan: A Sociological Inquiry. London: Routledge.

    Google Scholar 

  • Kôseishô 1985 “Kôseishô kenkyûhan ni yoru, nôshi no hantei kijun” (Brain death determination criteria of the Ministry of Health and Welfare). Tokyo.

  • Lamb, David 1990 Organ Transplants and Ethics. London: Routledge.

    Google Scholar 

  • Latour, Bruno, and Steve Woolgar 1979 Laboratory Life: The Social Construction of Scientific Facts. Beverly Hills, Califormia: Sage.

    Google Scholar 

  • Ley Stepan, Nancy 1986 Race and Gender: The Role of Analogy in Science. Isis 77: 261–277.

    Google Scholar 

  • Lifton, R.J., et al. 1979 Six Lives, Six Deaths: Portaits from Modern Japan. New Haven: Yale University Press.

    Google Scholar 

  • Lock, Margaret 1980 East Asian Medicine in Urban Japan: Varieties of Medical Experience. Berkeley: University of California Press.

    Google Scholar 

  • 1988 A Nation at Risk: Interpretations of School Refusal in Japan.In Biomedicine Examined. M. Lock and D.R. Gordon, eds., pp. 391–414. Dordrecht: Kluwer Academic Publishers.

    Google Scholar 

  • 1993 Encounters with Aging: Mythologies of Menopause in Japan and North America. Berkeley: University of California Press.

    Google Scholar 

  • in press Deadly Disputes: The Remaking of Death in Japan and North America.In F. Zimmermann and B. Pfleiderer, eds. Cambridge University Press.

  • Mainichi Daily News 1984 “Cover-up suspected in first heart transplant” March 31.

  • Mainichi Daily News 1991a “Kidney transplant from brain-dead man revealed” May 30.

  • Mainichi Daily News 1991b “Family not told of donor's brain-death” May 31.

  • Mainichi Shinbun 1991 a “Cover-up suspected in first heart transplant” March 31.

  • Mainichi Shinbun 1991 b “55% approve of transplants from brain-dead” October 16.

  • Maruyama, Kumiko, Hayashi Fumi, and Kamisasa Hisashi 1981 A Multivariate Analysis of Japanese Attitudes Toward Life and Death. Behaviormetrika 10: 37–48.

    Google Scholar 

  • Miura, Shumon 1991 Attitudes Towards Death. Japan Echo 18: 67.

    Google Scholar 

  • Morioka, Masahiro 1991 Nôshi no Hito. Tokyo: Fukutake Shoten.

    Google Scholar 

  • Najita, Tetsuo 1989 On Culture and Technology in Postmodern Japan.In Postmodernism and Japan. M. Miyoshi and H.D. Harootunian, eds. pp. 3–20. Durham: Duke University Press.

    Google Scholar 

  • Nakajima, M. 1985 Mienai shi: Nôshi to zôki ishoku (Invisible Death: Brain Death and Organ Transplants). Tokyo: Bungei Shunjũ.

    Google Scholar 

  • Nakayama, Taro 1989 Nôshi to Zôki Ishoku. Tokyo: Saimaru Shuppansha.

    Google Scholar 

  • Namihira, E. 1988 Nôshhi, Zôki Ishoku, gan Kokuchi. Tokyo: Fukubu Shoten.

    Google Scholar 

  • Newsweek Nihon Han 1993 “Zôki ishoku no saizensen” (The frontline in transplants) February 25. Japanese Edition.

  • Nihon Keizai Shinbun 1985 “Nôshi to shinzôshi no hazama no kadai” (The issue is the gap between brain death and heart, death) May 20.

  • Nihon Keizai Shinbun 1992 “‘Nôshi ishoku’ michisuji nao futômei” (“Brain death and organ transplants,” the path to follow is still unclear) January 23.

  • Nudeshima, Jiro 1991a Nôshi zôkiishoku to nihon shakai. Tokyo: Kôbundô.

    Google Scholar 

  • 1991bObstacles to Brain Death and Organ Transplantation in Japan. Lancet 338: 1063–1064.

    Google Scholar 

  • Ohi, Gen, Tomonori Hasegawa, Hiroyuki Kumano, Ichiro Kai, Nobuyuki Takenaga, Yoshio Taguchi, Hiroshi Saito, and Tsuinamasa Ino 1986 Why are Cadaveric Renal Transplants, So Hard to Find in Japan? An Analysis of Economic and Attitudinal Aspects. Health Policy 6: 269–278.

    Google Scholar 

  • Ohnuki-Tierney, Emiko 1984 Illness and Culture in Contemporary Japan. Cambridge: Cambridge University Press.

    Google Scholar 

  • 1994 Brain Death and Organ Transplantation: Culture Bases of Medical Technology. Current Anthropology 35: 233–254.

    Google Scholar 

  • Omine, Akira 1991 Right and Wrong in the Brain-Death Debate. Japan Echo 18: 68–71.

    Google Scholar 

  • Pernick, Martin 1988 Back from the Grave: Recurring Controversies over Defining and Diagnosing Death in History.In Death: Beyond Whole-Brain Criteria. R. Zaner, ed. pp. 17–74. Dordrecht: Kluwer Academic Publishers.

    Google Scholar 

  • Prottas, J.M., and H.L. Batten 1988 Health Professionals and Hospital Administrators in Organ Procurement: Attitudes, Reservations, and their Resolutions. American Journal of Public Health 78: 642–645.

    Google Scholar 

  • Pyle, Kenneth 1987 In Pursuit of a Grand Design: Nakasone Betwixt the Past and Future. Journal of Japanese Studies 13: 243–270.

    Google Scholar 

  • Randall, T. 1991 Too Few Human Organs for Transplantation, Too Many in Need ... and the Gap Widens. Journal of the American Medical Association 265: 1223–1227.

    Google Scholar 

  • Rohlen, Thomas 1978 The Promise of Adulthood in Japanese Spiritualism.In Adulthood E. Erikson, ed., pp. 125–143. New York: Norton.

    Google Scholar 

  • Saitô, Takao 1992 Nôshi o hito no shi toshite voi ka (Is brain death acceptable as human death?).In Nôshi to zôki-ishoku (Brain Death and Organ Transplants). Takeshi Umehara, ed. Tokyo: Asahi Shinbunsha.

    Google Scholar 

  • Sasaki, Shizuko 1986 Guaranteeing Medical Integrity Unnecessary Hysterectomies in Japan. Paper presented at the AM International Conference on Health Law and Ethics in Sydney. August 19.

  • Shôwa 54 nenpann yoron chôsa nenkan (Yearbook of Opinion Polls) 1979 Zenkoku kenmin ishiki chôsa (Research on the consciousness of the Japanese prefectural populations).In Naikaku Sôri Daijin Kanbô Kôhôshitsu, ed., pp. 585–591. Tokyo: NHK hôsô yoron chôsacho.

    Google Scholar 

  • Shôwa 55 nenpan yoron chôsa nenkan (Yearbook of Opinion Polls) 1987 Kokoro no jidai. Zenkoku yoron chôsa (The era of “heart.” Opinion poll by the Mainichi publishing house for the whole of Japan)In Naikaku Sôri Daijin Kanbô Kôhôshitsu, ed., pp. 508–510. Tokyo: Mainichi Shinbunsha.

    Google Scholar 

  • Simmons, R., et al. 1987 Gift of Life: The Effect of Organ Transplantation on Individual Family, and Societal Dynamics. New Brunswick, N.J.: Transaction Books.

    Google Scholar 

  • Smith, Robert 1974 Ancestor Worship in Contemporary Japan. Stanford: Stanford University Press.

    Google Scholar 

  • Somerville, M. 1985 Access to Organs for Transplantation: Overcoming Rejection. Canadian Medical Association Journal 132: 113–117.

    Google Scholar 

  • Tachibana, Takashi 1991 Nôshi (Brain Death). Tokyo: Nihon Hôsô Shuppan Kyôkai.

    Google Scholar 

  • Taylor, Charles 1989 Sources of the Self: The Making of the Modern Identity. Cambridge, Mass.: Harvard University Press.

    Google Scholar 

  • Transplant News 1984 “Japan Society Approves Organ Transplants from Brain Dead Patients.” June 30, p. 3.

  • Umehara, Takeshi 1991 The Majority Opinion is a Theoretical Failure. Asahi Journal 33: 21–22.

    Google Scholar 

  • Umehara, Takeshi, ed. 1992, Hajime ni (Introduction).In ‘Nôshi’ to zôki-ishoku (Brain Death and Organ Transplants). pp. 1–7. Tokyo: Asahi Shinbunsha.

    Google Scholar 

  • Umehara, Takeshi, and Michi Nakajima 1992 Still Brain Death is Not Death. Bungei Shunjũ March. 302–312.

  • Uozumi, Tôru 1992 Nõshi mondai ni kansuru shikkan to teian (My opinion and proposals on the brain death issue).In Nôshi to zôki-ishoku (Brain Death and Organ Transplants). Takeshi Umehara, ed. Tokyo: Asahi Shinbunsha.

    Google Scholar 

  • Veatch, R.M. 1978 The Definition of Death: Ethical and Philosophical and Policy Confusion. Annals of the New York Academy of Sciences 315: 307–321.

    Google Scholar 

  • Watanabe, Toyô 1988 Ima naze shi ka (Why Death Now?). Tokyo: Niki Shuppan.

    Google Scholar 

  • Weisz, George, ed. 1990 Social Science Perspective on Medical Ethics. Dordrecht: Kluwer Academic Publishers.

    Google Scholar 

  • Williams, J.S. 1985 Human Organ Sales. Annals of the Royal College of Physicians and Surgeons of Canada 18: 401–404.

    Google Scholar 

  • Woss, Fleur 1992 When Blossoms Fall: Japanese Attitudes Towards Death and the Otherworld: Opinion Polls 1953–1987.In Ideology and Practice in Modern Japan. R. Goodman and K. Refsing, eds., pp. 72–100. London: Routledge.

    Google Scholar 

  • Wright, Peter W.G., and Andrew Treacher, eds. 1982, The Problem of Medical Knowledge: Examining the Social Construction of Medicine. Edinburgh: University of Edinburgh Press.

    Google Scholar 

  • Yamauchi, Masaya 1990 Transplantation in Japan. British Medical Journal 301: 507.

    Google Scholar 

  • Yokozawa, Gunshirô 1986 Kikitai no wa zôki ishoku no fu no sokumen (What I want to hear about are the negative aspects of organ transplantation).In Nôshi to wa nani ka? Nani ga mondai ka? (Brain Death — What is it? What is the Problem?). Tokyo: Tôdai PRC Kikaku linkai Gijutsu to Ningen sha.

    Google Scholar 

  • Yomiuri Shinbun Editiorial Department 1985 Inochi Saisentan: Nôshi to Zôki Ishoku (The Leading Edge of Life: Brain Death and Organ Transplants). Tokyo: Yomiuri.

    Google Scholar 

  • Yomiuri Shinbun 1988 “Okaruto bûmu. Nezukoi higôri shikô” (The occult boom. The firmly rooted intention to be irrational) November 6.

  • Yomiuri Shinbun 1992a “53 sai josei ‘sengensho’ ikasu” (Written declaration of 53 year old woman restores life) Ocober 18.

  • Yomiuri Shinbun 1992 b “Nôshi ishoku yonin o saigo tôshin” (Final report approves of brain death, organ transplants) January 23.

  • Yonemoto, Shôhei 1988 Sentan iryô kakumei (The Revolution in Advanced Medical Treatment). Tokyo: Chûkôshinsho.

    Google Scholar 

  • Yoshida, Teigo 1967 Mystical Retribution, Spirit Possession, and Social Structure in a Japanese Village. Ethnology 6: 237–262.

    Google Scholar 

  • Youngner, S.J., M. Allen, E.T. Bartlett et al. 1985 Psychosocial and Ethical Implications of Organ Retrieval. New England Journal of Medicine 313: 321–324.

    Google Scholar 

  • Zaner, Richard M. 1988 Introduction.In Death: Beyond Whole-Brain Criteria. R. Zaner, ed., pp. 1–14. Dordrecht: Kluwer Academic Publishers.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Social Studies of Medicine, McGill University, 3655 Drummond Street, H3G 1Y6, Montreal, Quebec, Canada

    Margaret Lock

Authors
  1. Margaret Lock
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Portions of this paper were first given as the inaugural Roger Allan Moore lecture series on Values and Medicine: “Ethical, Religious and Cultural Perspectives”, Harvard University, May 1992.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lock, M. Contesting the natural in Japan: Moral dilemmas and technologies of dying. Cult Med Psych 19, 1–38 (1995). https://doi.org/10.1007/BF01388247

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01388247

Keywords

Search

Navigation