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Good Death (?)

TATEIWA Shin'ya 2008 Tokyo, Chikuma-Shobo, 374p.

Good Death (?)『良い死』 Tateiwa, Shin'ya立岩 真也) Sep. 5, 2008
Good Death (?)『良い死』
Tokyo, Chikuma-Shobo, 374p.
ISBN-10: 4480867198 ISBN-13: 978-4480867193 2,940 yen

Chapter 2, section7-1

Book Review
[Japanese] / [Korean]

Tateiwa, Shin'ya Sep. 5, 2008 Good Death (?), Tokyo, Chikuma-Shobo, 374p. ISBN-10: 4480867198 ISBN-13: 978-4480867193 2,940 yen
_______ translation by HIRAGA, Midori________

Table of Contents


The introductory chapter Summary and today's situation

Section 1. Introductions
1. The shortest summary
2. A short summary
"Live with or without deciding after obtaining enough help"
- Speech for the 3rd general assembly of Japan ALS Association in Yamanashi Branch
3. Have we thought about it?
4. Good things to know

Section 2. The place it stays: Immortality
1. 2005 / 1983
2. Immortality of dignified death ideology

Section 3. The place it stays: Versatility
1. Dignified death as criticism AND the main stream
1) Autonomy value
2) Natural value
3) Self-sacrifice value

Section 4. The place it stays: Anti-reality, Against reality
1. Two set-epithets
1) "Just prolonging life"
2) "Hiding death"
2. Bring back to reality
3. Effect and the rest


Chapter 1. "My" Death

Section 1. Deciding death by myself, but...
1. Discussion on self-determination
2. It is important to decide by myself
3. ... but "my" decision can not be the absolute must
4. Uncertain factors surrounding self-determination
5. Outside influence on self-determination

Section 2. Problems
1. Danger of intervention
2. More problems
3. Thinking again on "my" decision

Section 3. Can't "my" decision influence others?
1. Underlying factor
2. Thoughts on "deciding for myself, by myself"
3. Thoughts on not influencing others

Chapter 2. Natural Death, and Life as Reception of Nature

Section 1. Artificial / Natural
1. "Natural Death"
2. Everything is natural
3. Cyborg is accepted cf. Cyborg
4. Theory on unlimited desire
5. Our body is a natural product and it feels pain

Section 2. Life politics
1. Actually, we are facing it more
2. Those who give / are given
3. Prolonged and closed

Section 3. About like and dislike
1. What people like and dislike
2. Let's say it was made-up
3. What we would not go through

Section 4. When they meet cf. Minamata Disease
1. Mismatched accusation?
2. Modified as it spread
3. When they meet

Section 5. Hoping it exists over the feeling
1. Is it possible to find the universal answer?
2. It might be trendy to discuss from individual case
3. Hope there is the answer over thoughts
4. Not everyone
5. Not to everyone

Section 6. Variety and flexibility
1. Concomitance and flexibility
2. Reducing the burden on decision of dying

Section 7. Regarding what is affirmed - English translation of this section below
1. Receiving the world
2. We need not go toward us

Chapter 3. Sacrifice and Shortage

Section 1. Anxiety and optimism
1. About anxiety and optimism
2. Summary

Section 2. When it cannot be avoided
1. Common property - sacrifice of life
2. In my humble opinion
3. No need to sacrifice

Section 3. Shortage - but there is no shortage
1. Resource
2. Manpower

Section 4. Transfer / Increase
1. Just change of looks
2. Increase

Section 5. How to calculate it?
1. How far is "for me"
2. Contribution to production and employment
3. Instead - Better to clarify the basic principle

Section 6. "Watering dead trees" can work
1. Contribution to economic growth
2. However, there are some conditions

Section 7. What are the obstacles?
1. Conflicts of interest
2. But more can agree
3. Do we have to tolerate for production and economic growth?
4. Do we have to tolerate to be internationally competitive?
5. Not every country can achieve this goal?

Section 8. Still OK, as it is
1. It's OK as it is
2. Those prudent people still worry
3. How to response


1. What I can say
2. What I think I should say

Endnote 1


Partial translation of Chapter 2, Section 7, by Robert Chapeskie

section 7. Regarding what is affirmed

*1 Receiving the world

Without using phrases like "a peaceful death", I have describe how there can be recognition of a person's existence while they depart from the suffering of being alive (section 3). I also stated that when we make this acknowledgement, or when we assert that it should be made, we acknowledge that it should be made of everyone, whatever sort of person they are. There is an attitude that holds we should try to affirm the existence and ways of life of other individuals in a sense distinct from our own positive or negative feelings towards them. We need not think of this attitude as something that falls out of the sky; acquiring it is something that people can actively desire (see section four). At the same time we cannot, of course, get away from the concerns raised by the various values we have ourselves adopted, nor is this necessary. As I state in section five, we can change our standards or decide to forget something in whatever way best fits the situation at hand.

But if this is the case what is being affirmed? Let us assume it is understood that I (you) should want you (me) to let me (you) live, no matter what the situation and no matter what you (I) think. But in saying "no matter what the situation" and removing all conditions, are we not left with something of a vacuum? If someone holds to the idea that they should not foist their own ideas and attitudes directly on another person, what is it that they think must be preserved or affirmed by not imposing their own will? And why should I want to continue living no matter what my circumstances may be?

In actuality there are many different reasons why people want to live or want others to live but there is no need to list and classify them here. As I have claimed that there is no need to affirm people based on their attributes or our preferences regarding their attributes, there is also no need for me to list attributes which should be affirmed. While we should keep in mind this fact that such a list is not necessary, it should be possible to describe several examples of such attributes. It should also be possible to say something about such attributes based on what has already been discussed.

It has been said that living creatures have an instinctive desire to survive. This may be the case. Human beings also have a concept of death in addition to this will to live. The idea of death is frightening, and while we normally do not dwell on it we have trouble dealing with being told exactly when our death is going to occur. This is an obvious point but one which is very important, and it is odd that discussions of death with dignity often proceed as if this conceptual fear of death did not exist.

It seems clear that I would be relieved to be able to continue to exist in the world, no matter what kind of "I" I am, but since questions of life and death are such a serious matter I state this extremely obvious fact in order to make sure it is not forgotten. I do so because while extremely obvious it is something which is often overlooked. Even if there is nothing especially good about living, what is scary is scary so we must not proceed as if this were not the case. Not only must we not forget this, but we must regard it as an active reason people want to go on living.

As I have said in other books and as I will discuss in the next chapter, putting aside the reasons for claiming that life is a good thing, in any case the reasons for rejecting life are not very persuasive. Basically this is how I think we should address this question. If we focus on the reasons for affirming life and these reasons are lost then dying becomes acceptable. The reasons for affirming life can also become the reasons for affirming death. As I stated in the previous section, I do not want such conditions to be applied to myself or others.

This does not mean, however, that nothing can be said to affirm life. For example, the people who reject violence against the body discussed in section four affirm all of nature including the human body. Even if all of the assertions described in section one are accepted, a definition of "nature" still emerges which decries destruction and even change which does not destroy. We have the sense that it is better for the world to exist than for it not to exist.

Where does this sense come from? I don't really know. It seems likely there are many causes, and it is not clear to what extent each of these is fixed.

One thing which is clear is that humanity is in no way superior to nature. This fact cannot be denied. People do all kinds of things - some of which may have extraordinary and unintended consequences (for example, humans could carry out actions which would result in the destruction of all living things) - but all of these things never comprise more than a small part of what occurs within the whole of nature. Humanity can never equal the sum total of the rest of nature. This is self-evident. Humanity can destroy nature but nature is always larger than humanity, and also more subtle and complex. This fact instills in us a sense of awe.

Of course we cannot always accept this fact stated exactly in these terms. We sometimes think things are good not because they are a part of nature but because they are beautiful. In other words, another reason given for why we value nature is that we find it beautiful. At the same time we shun some parts of it; we are discerning, avoiding, for example, things which are rotten. I can agree with those say we have come to feel this way because to do so aids in our survival. So what about our finding things beautiful? There might be a similar explanation which might also be to some extent correct. There are also those who turn to things like plastic surgery out of an "awareness of beauty". And those who do not intervene but leave things to chance do so as part of a way of living which is itself a decision and an activity. There is also intervention because nature is a means of survival. This is necessary. We can see this kind of modification of nature even in English scenery and Japanese "satoyama" (areas which appear wild but are actually managed/altered by people living near them). This has lead to the assertion that there is no longer any "purely natural" nature, and I think this is true. This fact does not, however, usurp the superiority of nature, nor does it destroy or diminish our sense of awe.

This sense of awe we feel towards nature and affection we have for the world, as is perhaps obvious, does not lead to an affirmation of dying a "natural" death, in the sense that the latter shortens the time we are alive and the former encourages us to continue experiencing nature and the world for as long as possible. Even if we consider the possibility that there is another world to be experienced after death, most people lack sufficient confidence in the existence of such an afterlife to warrant dying sooner than necessary. Even in those whose belief in life after death is very strong this belief does not encourage them to want their experience of this world to cease.

I included a chapter entitled "To go on living 1" and a section called "Receiving the World" in my earlier book ALS:
"There are some patients who are left with only the ceiling to look at, and there are some doctors who encourage patients to consider, when deciding whether or not to be put on life support, the fact that once they are put on an artificial respirator they will have nothing else to do but spend their time staring up at it. This kind of statement can also be found in associations' guidelines. Some who are more frank state directly that it is better not to use an artificial respirator (it is better to die), because life on a respirator holds nothing to look forward to (only a very low QOL can be expected)"
There is of course a straightforward reply to this which states that the problem can be addressed by moving the patients so that they can see a wider variety of scenery and experience nature and the changing of the seasons.

[419] Ken'yta Nishio [269] said to Yukio Matsuoka, then working as the head of the Japanese ALS Association, "If I stay alive, won't I be able see the cherry blossoms in spring, the sea in summer, the changing leaves in autumn and the snow covered landscape in winter?"[269]. I did not write about to what extent this idea was carried out, but after his death he left behind a website ・・ishio・サ-1999] ) that still contained pictures of a snowy scene in the garden of his house and beneath them a brief description: "This is a picture of my garden in the winter. I look at it while taking a bath.

[420] Toru Tsuchiya [247] , a patient at Yamanashi Central Hospital, writes: "It was thanks to the care taken by the nurses that I became able to see Mt. Fuji. I had been staring up at the ceiling for a long time, and when they changed the position of my bed because they thought I was getting depressed a whole new world opened up for me. I could see Mt. Fuji". (Tsuchiya[1993:9] )

And of course sight is not the only sense.

[421] Shigeharu Chimoto [399] wrote the following in July of 1988 at Kagoshima University Hospital. "When I tasted tea for the first time in four and a half years I felt the excitement as when I first began to use this computer. It was the excitement of sensing that my life was about to become richer" (Chimoto[1993:135] )

He writes in August of 1992 "In the hottest time of day, when even the bell crickets stop moving, a nurse called Akamatsu came into my room, prepared a chilled glass, turned off the air conditioner, and proceeded to give me a drink of beer, offering the strange but from my point of view happy explanation "it's Obon" [a Japanese holiday in which the dead are remembered]. . . she poured the beer into my mouth using a glass needle, and I felt its coolness and lively bubbles slide down my esophagus and into my stomach. . . I wish every day were Obon". Chimoto [1993:273] , The numbers in square brackets refer to paragraphs from ALS)

*2 We need not go toward us

In the same book I included several more quotes after the ones listed above, and in the following section discussed the topic of "sending messages". Which is more important, to be able to send messages or to be able to receive them? This is a somewhat strange question, and the correct answer would seem to be that both are important. But as a means to an end, for example, communicating that you are itchy so that someone will scratch you, sending messages seems to take priority. The need to send messages would diminish, however, if such problems could be dealt with by other means, e.g., if you could be scratched automatically whenever you are itchy or if you could become no longer capable of being itchy.

Apart from such basic concerns, people also enjoy communication for its own sake. Communicating is no doubt a very important activity for most people. In this case being able to both send and receive messages is important. However, even if a person can only receive messages they are still able to develop relationships - in the normal sense of the word - in which other people speak to them in the knowledge that there is someone there who can listen and feel.

What else is there? Expressing yourself. Being able to relate things to other people about yourself, what is happening inside you, and what you are thinking. These are things people want to do and ought to be able to do. And there are some things which people say not because they want to but because they must; there are cases where our interlocutor makes mistakes which must be corrected. We feel the need to talk about these mistakes, particularly in cases where they concern ourselves or people/things connected to us. Mistaken statements make us uncomfortable as incorrect assertions, and as they involve us directly they may also cause bad things to happen to us. As a result it is necessary for individuals themselves to be able to provide alternative accounts which are not mistaken. In such cases we cannot help but share our views. If no one made mistaken assertions in the first place there would be no need for us to defend ourselves.

Apart from such cases we speak because we want to. It is indeed a fact, and furthermore a good thing, that there are many people who have the desire to talk about things happening in the world and their thoughts regarding them. I do not understand claims that the activities of thinking and speaking must have some other significance above and beyond this.

This is one of the things I don't understand about the affirmation and praise of "talking" and "narrative". Another person, for example a healthcare provider, says something that sounds wrong or does not listen to what you say. This is a problem for you. Here you can say that they should listen to you because you are speaking. This sense of speaking being important is easy to understand. When something makes you happy you want to talk about it. When you are confused about something you talk about it because it bothers you and you think that talking about it will make you feel better. Such situations occur in which speaking is indeed a good thing.

However, when it comes to thinking and writing about topics like living, living with illness, and being alive but very ill and considering death, or about what the nature of these topics might be, and speaking about these things regarding oneself and others, while it is not the case that all such activities are necessarily bad it is also not the case that they are especially good. They cannot be thought of as necessary activities, and they cannot be thought of as giving meaning to living, being ill or dying.

As I state in Tada-no-Sei(Tateiwa, 2008), I do not think that the preservation of life itself is something of particular value. In this sense I cannot take the position - assuming it exists- of absolute respect for life. I think life should exist because it has something within it, or there is something good about it. But I do not think that this goodness is something we ourselves maintain, or something found in examining, understanding or speaking about ourselves. We may find things if we search within ourselves, but they cannot be expected to be things of great importance. Some may also assert that such self-examination is itself meaningful, regardless of what may be found. I find this even harder to understand. Why is this something that must be done? The answer to this question has never been given in a way that I can understand.

The world is always bigger and richer than I am. So I think it is natural to suppose that what we can receive from the world is bigger and better than what we can find within ourselves. And the world also includes the inside of my body, so experiencing the world also includes the many warm sensations found within my body, the sensation of liquids passing through it, and the feeling of sunlight on the surface of my skin. The world might continue to exist after I am gone, but the world that exists in my experience will disappear along with me. For me this is regrettable.

On the other hand, there may also be a human tendency to pursue nothingness. Death, however, obliterates even oblivion and so ought not to be pursued by those in search of nothingness. Most are in search of a tranquil world rather than genuine non-existence. It is not living in a world in which various things occur itself but rather the specific things which actually occur that they dislike. The many things that happen in this world tire them out. They want to escape from this fatiguing existence. They no longer want to exist because they find the human world unpleasant or are sick of social life and human interaction. The occurrences that cause people to worry or suffer in this way are human events; they are things which are related to us and stick to us. There are some things we cannot forget even if we try. For example, there are people who could not escape from their experiences of being in a concentration camp and felt they had no option but to die. They should never have had such experiences. But they did, and there is no way for them to escape from them. Whatever else this might be, it is clearly a human problem.

Things happen which don't need to happen, and the people involved, being human beings, cannot completely separate themselves from them after the fact. Even if the person who commits an act feels they had no choice, their actions can leave them debilitated. There is no sure technique for getting rid of such scars. If a person with such experiences speaks of them before dying, this relating of past events may be meaningful as a kind of testimony or warning. People may also entreat someone to share such experiences, and while it is obviously an area in which caution must be exercised let us assume that this is something which should be accepted. But even in such cases, can we say that someone should be compelled to speak about what they have done and experienced? It may be claimed that if they do not tell their story people will likely commit the same crimes again in the future, but even without being given concrete examples of bad actions people have a fundamental idea of what is right and wrong, and if so there should be no need to demand people relate experiences if they are not inclined to do so.

Since shortly after the current era began, narratives of educating and taking care of oneself and thereby conquering or overcoming something have begun to feel somewhat crude. And at least in the case of accounts of the process of growing weaker and facing death they have not seemed particularly worthy of telling or hearing. This is obvious, but nonetheless such tales have proliferated. While the problems with telling such stories have been well understood, there has also been the idea that there are different ways of relating these narratives, that neither their forms nor aims are fixed, and that new ways of telling should be sought out. This kind of narrative has also been considered a new narrative for the era following the modern.

However, while I agree to a considerable extent with the idea that there are narratives worth telling and which should be told in order to prevent bad things from happening as I state above, there is indeed no need for us to demand such narratives be told; those who do not want to tell them need not be obliged to do so, we should not expect everyone who wants to tell them to have the capacity to do so, and those who cannot tell them or give up on telling them should go on living in silence. Furthermore, it can be claimed that the concept of "self" long held in the current era does not refer to something fixed but rather to something which may be discovered through searching or is perhaps the act of searching itself. As a result I cannot see anything especially novel in the pursuit of these narratives (33).

Learning, searching, and continuing to search are not bad things. They may be good things for people who want to pursue them. But they are not things that everyone must engage in. Even if searching for the meaning of one's own illness represents a way of embracing living with a disease, in some cases such a meaning may not be found even if it is looked for. In such cases people are comforted by being told that the act of searching itself is more important than what is found, but still cannot expect to discover anything by doing this and the effort of searching seems pointless. This is a reasonable conclusion to draw. There are also people who do not have the energy required to carry on with such activities. This introspection and self-expression being recommend to people who are ill is an undertaking that is considerate of their already weak bodies and diminished ability to physically control and interact with the world around them. Even so, the recommendation is not a good one. It is better to exist within the world around you than to search for things within yourself.

The world is received differently by each individual who lives in it. Each individual has their own world. Each of us no doubt sees the world in a different way, but at the same time these differences are probably not that great. However, as I have already stated, whether or not there are differences between these views of the world is a separate question from whether or not they are proprietary and belong to individuals. The proprietary nature of these inner worlds does not depend on some special thing existing within them. These worlds are necessarily unique. They end when life ends, ceasing to exist when the individual who creates them dies. Allowing these worlds to be lost is not a good thing.

If we do not see things this way and rearrange the order of what is affirmed, the existence of someone who simply experiences the world passively can be rejected. Death is then affirmed. It is not clear to what extent this way of thinking is connected with the choosing of death in our society. But it can be connected to most cases in which death is chosen due to an actual or expected loss of various things/abilities/opportunities. There are of course also cases in which death is caused by economic distress. This distress has its roots in our society's system of ownership and private property. This problem is connected to many cases in which people choose death out of an apparent dissatisfaction with themselves. Does this tendency not emerge, however, from the doctrine of affirming oneself, a doctrine which includes the idea that one should try to improve in the areas where one is lacking and which has been used to improve the self-image of those who may be inclined to choose death? It is better to become a recipient of the world than to struggle in this way, even though it is often difficult to arrange things to your liking once you are entangled in the world around you.

This could be said to amount to the clich? advice that you should do whatever helps you survive, keeping in mind that some restraint must be exercised in how we treat both the natural and human worlds.

Note.33 I wrote the this section after reading The Wounded Storyteller: Body, Illness, and Ethics (1995) by Arthur Frank , who came to Japan in 2008 to attend a seminar organized by the Ritsumeikan University Graduate School of Core Ethics and Frontier Sciences/Ars Vivendi: Forms of Human Life and Survival Global COE. I did not understand chapter six "The Quest Narrative", or at least it seemed to me that it could only be understood if certain premises which need not necessarily be accepted were assumed.

I have often felt this way when reading thinkers who classify themselves as belonging to "postmodernism". I talk about the same kind of thing in chapter six of "Freedom and Equality".

"Third, freedom appears once again. It is defined as being separate from what exists and what occurs, a freedom independent of all else. At this point it might no longer be considered pure liberalism. Here talk of my actions includes a wider range of activities and is not limited to actions related to production. The directing of the self towards production is criticized. But this theory, even if I believe its assertions, assume it is a good approach and can accept it to a certain extent as my own choice, still involves me as one who is able to produce and therefore an owner trying to survive as myself. Freedom of expression, too, even if it has no ulterior aim is itself something to be created. Here we can see several signs of "progress", such as people no longer naively believing in the authentic existence of the self or the possibility of its acquisition and no longer using words like "ownership" with their tendency to lead to control and coercion. There have also been attempts to cast off what is given. Ultimately, no matter what is made, as a made thing this made self can again be said to be something to be escaped from. This is both a destructive and creative process and becomes something I am driven by.

The following footnote was inserted at "here we can see":

"......" (Cornell[1998=2001: 34] ) I in no way reject this desire, but can it really be said to be necessary? This is the point I try to make both in this chapter and in other writings such as [20001127] .

Drucilla Cornell once visited this university to give a lecture, and at that time I asked her (had someone ask her) about this but recall having the sense that she didn't really understand. I don't want to dismiss this lack of understanding as simply being due to "cultural differences", but there could indeed be such differences at play here.

In order to avoid speaking if we do want to speak and/or have nothing which ought to be said, it is important to distinguish, list, and evaluate the positives and negatives of what we say when something we do not welcome occurs. Yamaguchi Maki [2008] has begun this work.

UP:200800902, 20090120 REV:
Euthanasia / Death with Dignity  ◇TATEIWA Shin'ya  ◇立岩 真也  ◇『良い死』
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