Debate Over Euthanasia in Japan Reignited by ALS Murder Case

Euthanasia is not legally permitted in Japan, but each time such cases come to light, they spark renewed discussions about whether the country should allow it.

One voice in this debate is Hiromi Sato, an ALS patient living in Tokyo. Her symptoms began suddenly in 2014 after a mountain climbing trip when her legs gave out on the descent. Despite numerous hospital visits, a diagnosis only came four years later. Initially, the lack of a care system made things extremely difficult. Today, she receives more than ten hours of assistance daily and says her life has become much more manageable thanks to the help she receives.

In 2020, following the high-profile Kyoto case involving the assisted death of another ALS patient, the accused doctor testified that the woman had communicated her wish to die using an alphabet board. "She said 'Please let me die'—I couldn’t just ignore her," he said during the trial, claiming he acted out of compassion. The woman had previously expressed her wish for euthanasia on social media. This triggered sympathy among some users and calls for Japan to legalize euthanasia, but also alarm among those with disabilities and chronic illnesses.

Sato was one of those alarmed. On her blog, she expressed her fear that society now seemed willing to view her life as expendable. "When I heard people say 'Just let them die, it's a terrible disease anyway,' or 'If I ever become like that, I want to be killed,' I realized society might be ready to let me die too," she wrote. "I’m afraid that even though I want to live, these voices could end up killing me."

Elsewhere, momentum for legalizing euthanasia has grown. Writer Mimi Kodama notes that since 2008, at least 12 countries have legalized euthanasia and 13 have approved assisted suicide. However, Professor Yasunori Ando, an expert in bioethics at Tottori University, warns that in countries where such practices are legal, the range of cases gradually expands. He fears that euthanasia, under the guise of respecting personal choice, could become a societal pressure to die—particularly in a conformist culture like Japan’s.

Toki Nose, who was born in Kyoto with a spinal cord condition that paralyzed him from the shoulders down, shares these concerns. He now lives independently with 24-hour care but says that growing up in hospitals meant a life of restrictions—from bathroom schedules to limited access to favorite foods and friends. Each time a new euthanasia-related case arises, he notices voices tying disability to death. "People say things like, 'They chose euthanasia, maybe you should too,'" he said. "That pressure is terrifying."

His childhood friend, Miyako Obu, suffers from a progressive nerve disease. Though there were times she felt down as her condition worsened, she credits her ability to live a fulfilling life—graduating university, studying abroad, working to support others with disabilities—to the support of family and friends. But when the Kyoto case made headlines, she was reminded how easily society can equate severe illness with loss of value.

Obu believes medicine should offer people ways to live more comfortably and fully—not just ways to die. "If someone in my condition says 'I want to die,' a doctor should work with them to find ways to live instead," she said. She worries that people who cannot speak out—like those with mental illness or severe disabilities—may be pushed into death in the name of autonomy. "What if someone targets me for euthanasia and makes it look like an accident?" she asked.

As more people advocate for legalizing euthanasia, Obu sees a dangerous trend. "If the movement gains momentum, I fear that my right to live could be undermined," she said. "Many disabled people want to live. We need our voices to be heard too."

Source: ABCTVnews