Anthropological Study of Reconstructing End-of-Life Care Culture in Contemporary Japan

Keywords

Death, end-of-life care, culture

Objectives

This study aims to develop a new end-of-life care culture in a local community by shedding light on community-based integrated care in the rapidly aging society in contemporary Japan and existing views of life and death or character and family values, with the concept of “domestication of medicine” as a clue.
Japan is transforming into a rapidly aging high-mortality society at a globally unprecedented pace. While deaths in hospitals account for approximately 80% of all deaths, as “end-of-life plans” and funerals have diversified, cultural and social transformations in relation to death have taken place as typically represented by “death that expresses one’s personality” or “self-determination of death.” In addition, such terms as “elderly people living alone” and “dying alone” indicate transformation of family values and local communities. In recent years, with a rapidly aging high-mortality society in view, the Ministry of Health, Labor and Welfare has hammered out a policy change from hospital-based healthcare to home healthcare, and begun reviewing end-of-life care. With this as a trigger, people have begun exploring how “end-of-life care” at home (including aged care facilities) should be in many parts of the nation. It is clear that improving healthcare and welfare systems and interprofessional work (IPW) is essential to end-of-life care at home, but practical and academic challenges lie ahead. The former is a problem faced by existing community-based integrated care systems, i.e., how to achieve a balance between public nursing care and family caregiving. The latter concerns theoretical issues associated with the medicalization of death, the transformation of views of life and death and family values, and reviews of local communities that promote individualization of death. In this study, with “end-of-life care” practices abroad as the reference point, we present a road map to reconstruct “end-of-life care culture” in contemporary Japan while dealing with the aforementioned two challenges in a cross-sectoral manner.

Research Results

The following five pieces of insight were gained from this inter-university research project.
1. Perspective of “End-of-Life Care Culture”
　Although the perspective of “culture” has been neglected recently in cultural anthropology, by focusing on end-of-life care culture, the practice of end-of-life care, which tends to overemphasize medical care, can be returned to experts and family who surround the dying person, and repositioned to spaces of “living together” in the community.
2. Four Analytical Perspectives
　Four perspectives were identified for analyzing end-of-life care practices: 1) ambiguity of care, 2) rethinking of self-determination of death, 3) placeness when facing the end, and 4) community.
3. Transcending the Division Between Medical and Non-Medical
　Because medical (or “formal”) and non-medical (or “informal”) care in in-home end-of-life care is tied together and difficult to separate, constructing an end-of-life care culture must start with the dying individual.
4. From Division to Overlapping of Roles
　Interprofessional collaboration is a prerequisite for care of the elderly, but having roles that overlap with each other (cross-functional) in care is more important than having roles that function separately.
5. Separation of Those With and Without Family
　With the increase in elderly living alone who have family and elderly without family, it would be possible to construct a new form of community that differs from community in the conventional sense, which is based on regional or familial ties.