Advance Directives and End of Life Issues

Dying, death, end-of-life care, and advance directives should be approached with courteous respect. Open frank discussion on dying and death may be difficult depending on the degree to which a person or his or family maintains traditional Japanese values. Traditional elders may wish to defer decision making totally to their adult children, often to their oldest son, whereas more acculturated elders may prefer to participate in end-of-life decision making.

In Japan, it is a common saying that Japanese are born Shinto but die Buddhist. In Shintoism, the emphasis is on purity and cleanliness. Terminal illnesses, dying and death are considered “negative” or impure and akin to “contamination.” Frank discussions on death and dying may be difficult at first. However, at some point most Japanese are said to embrace Buddhism in later life. As such, death is considered a natural process, a part of life. Life continues in the form of a rebirth. These individuals may be more open to end-of-life discussions.

It is also very important to bear in mind that a number of elder Japanese Americans are Christians and embrace a Christian view of the meaning of dying, death, and end-of-life issues.

In traditional Japanese culture, there is a term, “shikata ga nai,” literally meaning, “it cannot be helped.” Sometimes, in the presence of a terminal illness, discussions may be a little easier because this fatalistic view takes any sense of blame, responsibility, or feeling of failure off of the person and his or her family. It embodies a concept of stoic acceptance of a difficult or impossible situation or circumstance.