Swedish Wennu (right) suffers from pancreatic cancer and travels to Switzerland with her husband, Brink, to seek euthanasia. Yoichi Miyashita took this picture for them. Wennu did not want to make the last photo of her life sick, and she chose to show it on the back. Her husband looked at her with a smile. (Photo/Photo courtesy of the interviewee)
"Keeping me against my will, is that called love?" In the movie, Ramon, who has been paralyzed in bed for 29 years, says to Rosa, who loves him. When Ramon was young, he was paraplegic due to a diving accident and had only his head to move. He is unable to take care of himself, feeding, washing, and excreting all rely on the care of his family. He lived what he himself called "hellish" and "undignified.".
Ramon is the protagonist of the Spanish film Sleep in the Deep, based on a true story. He asked Rosa to help him euthanize. At first, Rosa, like his family, flatly refused – at a time when euthanasia in Spain had not yet been legalized and Ramon could not be euthanized through normal channels. Ramon appeared on television, took the legal route, and called for euthanasia in various ways. "The person who really loves me is the one who helps me to euthanize." He said to Rosa.
In 1996, the real-life Ramon (the film character of the same name) wrote with his mouth on a pen and published Letters from Hell, telling his miserable life and the urgency to end it. The book put Ramon in the media spotlight at the time. Spanish society used this event as an opportunity to begin years of exploration of the legalization of euthanasia.
Rosa in the film is eventually persuaded by Ramon to help ramon achieve his wish. In 2005, "Deep Sleep" won the 77th Academy Award for Best Foreign Language Film, and the true story behind the film was known to more people, further promoting the process of euthanasia legislation in Spain. On March 18, 2021, the Spanish House of Representatives passed the euthanasia regulations after a final vote.
In 2016, Yoichi Miyashita, a Japanese journalist living in Europe, found the real "Rosa", Ramonna and Ramon's family, and interviewed the sensational events at that time. Spain is just one stop in a long interview with Miyashita, who centered on the implementation of euthanasia and wrote the memories of many family members and doctors into a long-form serial report "Until Euthanasia Is Achieved".
"There is a lack of communication around death in Japan, and even the beginning of informing patients of cancer is not a very long time." Miyashita said in the report. Miyashita, from east Asian cultures that value the family, revealed in his report a change in his views on euthanasia. Spanning six countries and lasting more than two years, these interviews were serialized in 16 issues in Sapio. The monograph published in 2017 won kodansha's Nonfiction Literature Prize. In June 2021, the Chinese translation of the single edition "Euthanasia Scene" was published, and Yoichi Miyashita was interviewed by a southern weekend reporter to share his observations and thoughts.
<h3>"Not even the difference between active euthanasia and passive euthanasia is known"</h3>
Ramon was a seafarer in his early years, traveling the world and wandering the world. He loves freedom, but after the age of 25, he has to face the most infrequent body - high paraplegia.
Ramona, who helped Ramon get "free," now lives a life of necessity. With three children, two jobs, earning 520 euros a month. In Spain, there are those who think she's doing a good job, and there are those who think she's a murderer, especially Ramon's family, who can't forgive her. But about that, she could now say to Yoichi Miyashita, "I helped." ”
On the first day of meeting Raymonda, Ramon asked her, "You'll help me with what I expect, right?" Ramona, 36, saw Ramon bedridden on a TV show and learned that he was in a nearby town and "immediately wanted to meet him." From that day on, for a year and a half thereafter, she went to Ramon's house every day.
At about 7 p.m. on January 12, 1998, Ramon whispered to Ramona, "Tonight, I want to leave." Ramon had to say a last word to the camera, and then let the camera film himself taking his medication. Ramona had medicine for him, and she couldn't be caught by the camera or make a sound. The drug-lethal process was about 30 minutes long, and Ramona behind the camera couldn't bear to see such a picture, she crawled on the ground, crawled out of the room, rushed into the bathroom, and covered her ears.
In police investigations and in court, Ramona exercised her right of silence. Ramon also divides the steps of obtaining the drug in advance into 11 steps, with other friends acting separately so as not to go to everyone's culpability. Due to insufficient evidence, Ramona was not convicted. Paralyzed in bed for 29 years and 4 months, "can't find happiness two words," Ramon said in the video of his death.
Yoichi Miyashita's journey to find euthanasia began with his Spanish girlfriend. His girlfriend works at a special care nursing home in Spain as a nurse who provides palliative care for patients with advanced cancer. She often said to Yoichi, "If I had terminal cancer, I wouldn't hesitate to euthanize." At that time, euthanasia in Spain had not yet been legalized, and "many citizens did not even know the difference between active euthanasia and passive euthanasia.". Miyashita's idea intrigued Miyashita, who intends to find out about euthanasia in Europe.
Judging from the practice of Western countries, euthanasia in a broad sense can be summarized into four situations: First, deathbed sedation. At the time of the patient's death, the doctor prescribes palliative drugs to reduce the patient's suffering, while not replenishing water and nutrition, which eventually leads to a shortening of life. The second condition is called passive euthanasia, which is the suspension or termination of prolonged life therapy. In this case, if a patient with advanced cancer is dying, and the delay is considered to only prolong his pain, the doctor can give advice to terminate the extension and abandon treatment. In both cases, many patients have lost consciousness and are in the final stages of their lives.
There are also two situations, which can be called euthanasia in the narrow sense, and the countries that generally consider "euthanasia legalization" recognize these two or one situations. The first is active euthanasia, that is, the doctor administers drugs to the patient, causing his death. The second is assisted suicide, in which the doctor provides the drug and the patient drinks it himself or injects it and dies. In both cases, the patient must be conscious and clearly expressed a willingness to euthanize. In very few countries, patients generally need to meet the following conditions: unbearable pain (physical or mental), no hope of cure, and no treatment as desired by the patient. What Ramon did for Ramon was assisted suicide.
<h3>"Is death only about individual rights?"</h3>
Where did her laughter come from? I couldn't figure it out. Through Life Circle, switzerland's assisted suicide agency, Miyazami met a British man preparing for euthanasia. Hertz, 81, with terminal cancer, was confused by the smile she displayed before she died, "Even those who are determined to die should have fear." He wrote in the book.
Hertz put the backpack containing the love letters her husband had written to her for thirty years, and calmly turned on the venom switch. Before leaving, she was interviewed by Miyashita. Unlike Ramon, patients like Hertz have a fuller life. "If my life hadn't been satisfied, maybe I'd have wanted to live a little longer." Hertz said.
Switzerland is the only country in the world that accepts applications for euthanasia from foreigners. Three-quarters of Life Circle's patients are foreigners, and its founder, Presico, "sends" more than forty people away each year. Foreign patients need to translate their home case into English or one of the three official Swiss languages and get confirmation from two Swiss doctors to enter the euthanasia procedure, including signing a declaration of voluntary death; full videography; and police and coroners come to the scene after the incident to confirm assisted suicide.
In Switzerland, rather than saying that euthanasia is legal, Swiss law has opened a hole in euthanasia. Article 114 of the Swiss Penal Code stipulates that murder under commission is illegal and punishable by imprisonment for up to 5 years or a fine. This means that voluntary euthanasia loses legal space. However, article 115 of the Swiss Penal Code stipulates that if there is no self-serving motive, interfering in suicide will not be held legally responsible. That said, Swiss law is vague about assisted suicide.
So in Switzerland, it is the patient who turns on the drip switch of the lethal drug himself, or drinks the lethal drug prescribed by the doctor. The cost of euthanasia is 10,000 Swiss francs for foreigners and 4,000 for nationals.
Due to language and financial barriers, most of the people interviewed by Miyashita who came to Switzerland for euthanasia were middle-class people from various countries. There were Japanese patients with advanced stomach cancer who came to ask for help, but there was no Japanese medical certificate translated into English, so they had to stay in the Swiss countryside and die naturally.
But Miyashita had reservations about euthanasia, "Is human death just a matter of individual rights?" He asked the Southern Weekend reporter rhetorically.
"If euthanasia is to free patients from suffering, then why not in developing countries in Africa and Asia?" Miyashita believes that there are stronger emotional bonds between family members in developing countries, which distinguishes them from white societies. American doctors have told the palace that they have summarized the 4W rule: that is, in a multi-ethnic country like the United States, the wealthy (White), highly educated (Well-educated), anxious (Worried) people are more inclined to choose euthanasia, Asians and Latinos rarely choose euthanasia.
However, some non-terminal patients in Europe are also beginning to end their lives prematurely. Sandra, a 68-year-old Briton, suffers from multiple sclerosis (MS), a disease that is not fatal but accompanied by unbearable pain, and every time she speaks, the corners of her mouth spasm — trigeminal neuralgia — a life that has passed for six or seven years. "MS has evolved to the point where the quality of life has degraded to the point where you don't want to continue living." She said to Miyashita. As the poison gradually entered Sandra's body, before losing consciousness, she used all her strength to pour out the last words of her life: Thank you.
Sandra, who chooses euthanasia, has no children, which is what many patients who choose euthanasia have in common – none of them have children or are estranged from their children.
<h3>"Unbearable pain"</h3>
As the interview progressed, Miyashita began to understand the idea of some Westerners who choose euthanasia. Interviews in Belgium in particular gave him a new understanding of euthanasia options for psychopaths.
The Netherlands and Belgium are countries where both voluntary euthanasia and assisted suicide are legal, and in Dutch law, "unbearable pain" is not limited to physical pain. Further than in the Netherlands, Belgian law clearly states that "being tormented by physical or mental suffering" is one of the conditions for applying for euthanasia. In Belgian euthanasia cases, 5% of people with mental illness – including depression, dementia, personality disorders, autism, schizophrenia, etc.
Before going to Belgium for an interview, Miyashita's heart was unacceptable to euthanasia of the mentally ill. Belgian doctors will have some quantitative criteria to determine what degree of euthanasia is suitable for mental patients, such as multiple visits to mental hospitals but no cure, multiple suicide attempts, serotonin concentrations in the body, etc., but in general, the ambiguity is still very large.
Amy of Antwerp shook the palace's view. Amy, who suffers from autism and post-traumatic stress disorder, has attempted suicide 13 times, and doctors have approved her euthanasia request, when to carry it out is only at her thought. But to Miyashita's surprise, Amy, who faced him, said with a gentle expression: "Finally I can die, which makes me relax my heart." I want to live a few more days. Euthanasia became a deterrent to death. This is not a unique phenomenon of Amy, but a common phenomenon of psychopaths, "If euthanasia is not possible, severely psychopaths will attempt suicide multiple times." Amy's doctor, Tipon, told Miyashita.
"Just knowing the fact that euthanasia can be done can put a lot of people at ease, and there are many patients who end up dying naturally without euthanasia." Rob Yonggiel, executive director of the World DeathRight Alliance, told Miyashita. Amy died at the end of 2020, four years after she was euthanized.
Miyashita left Japan at the age of 18 and spent 27 years in Europe and the United States. Although there are only a handful of Western countries in the world that currently allow euthanasia and limit the conditions imposed to strict and harsh legal regulations, he also said that he can understand the society that chooses euthanasia legalization, but he cannot answer what is a happy death, "I don't think there is a recognized happy death." Everyone has their own ideal of death, either way. How you die is a reflection of how you live. Everyone's lifestyle is different, so everyone's way of dying is also different. He told Southern Weekend reporters.
If he returns to Japan, Miyashita says his choice will not be euthanasia. "I'm not alone, and with the support of the people around me, I'm alive and want to live." With the support of those around him, or with the people who guard him, he believes that "unbearable pain" can be alleviated, "not the individual advocating death, but thinking with the people around him about how to live."
The following is an interview.
Yoichi Miyashita. (Photo/Photo courtesy of the interviewee)
<h3>"They should not be easily allowed to leave"</h3>
Southern Weekend: You heard the 4W claim in an interview in the United States, what do you think of this statement?
Yoichi Miyashita: Before I knew this pattern, I met and interviewed some foreign patients who had died in Switzerland, and then I thought that they all had 4W characteristics. But I'm not quite sure if only white people are willing to die euthanized, because there are a lot of Japanese people who want to euthanize in Switzerland now.
On the other hand, people living in underdeveloped countries may not need to consider shortening their lives because they have more spiritual support from their families. In today's European and American societies, there are fewer and fewer children who can support their parents, especially when they are old and sick. Japan's youth population is small, and many families have only one child, so it is difficult to take care of their parents when these children have to work hard. This is one of the reasons why japanese elderly people tend to think of death before they actually get sick. In the underdeveloped countries, on the contrary, they have no such worries. So, euthanasia is associated with societies with low fertility rates.
Southern Weekend: Have you ever discussed euthanasia with your own family?
Yoichi Miyashita: To tell you the truth, everyone in my family except me has a strong desire to end their lives through euthanasia. I must state that I am not opposed to the way people die. My readers often mistakenly think that I am against euthanasia. What I don't agree with is just that it is legalized in Japanese society for the reasons I mentioned earlier.
If they choose to do so, I absolutely respect their opinions, but I don't want them to choose to do so simply because they don't have enough support. That would be very sad. We should not confuse physical pain with mental pain. If it is the latter pain, we must have some solution and should not easily let them go.
Southern Weekend: You mentioned mental anguish, you interviewed Amy of Antwerp, Belgium, before, and was still strong alive until the book was published in Japan. Euthanasia succeeded in curbing her suicidal tendencies. Now that four years have passed, how is her life?
Yoichi Miyashita: Amy passed away at the end of 2020. Euthanasia does have a powerful power to prevent the death of a mentally ill person. I don't know exactly what she went through, but I think she couldn't control her depression anymore. However, I'm pretty sure that if euthanasia is legal in a society, it's a good amulet for those who want to commit suicide. Amy must have felt a great relief after being authorized to euthanize herself, otherwise she might have ended her life years ago and her family might have been haunted by her suicide.
Southern Weekend: You just said that psychopaths cannot be easily euthanized, and it seems that Amy's example does not shake your view of the use of euthanasia for psychopaths?
Yoichi Miyashita: Not all mentally ill people have the right to choose euthanasia. For psychiatrists, it's hard to tell if they're really fit to be euthanized. Today, including in Japan, there are many people who want to die in Switzerland, but most of them are not even patients, but only have suicidal thoughts because of work, broken relationships, financial problems, etc. If people are not mentally supportive of them, and they want to die peacefully without pain, rather than committing suicide, this is a normal thought. These "psychopathies" are possible to get rid of, although it depends on the level of depression. This is a complex debate in the Netherlands, Belgium, Switzerland, and will be the same in new countries where euthanasia has been legalized, such as Spain, New Zealand, and Canada.
<h3>"We don't have European fears."</h3>
Southern Weekend: At the time you were interviewed, euthanasia in Spain had not yet been legalized, it was now legal. You live in Spain, what have you learned about this in recent years?
Yoichi Miyashita: Previously, Spain had a long history of fighting assisted suicide for terminally ill patients, and there were many cases of husbands or wives helping their spouses die and being caught by the police. Most Spaniards have always supported euthanasia, but the ruling People's Party, the government associated with the traditional churches in Spain, has never accepted the legalization of euthanasia. Much has changed since the Workers' Socialist Party became the ruling party in 2019.
Although the bill has been passed and is now in force, I'm not quite sure if the Spaniards know what will come with this law. Ideals and reality are completely different. In fact, the bill, while already discussed in Parliament, is not discussed among citizens.
The euthanasia bill looks beautiful, but, as far as I know from my investigation, it is not so easy to make people die, especially the mentally ill, and there are always people who will regret it. I don't know if the Spaniards recognize this, but there will definitely be tough situations in the future and they will definitely come back to discuss.
Southern Weekend: You can see several shifts in your attitude toward euthanasia in your book: from initial incomprehension to understanding, to later deeper reflections on how the situation in Japan may not be suitable for the legalization of euthanasia. How did you come to this shift?
Yoichi Miyashita: My investigations always start from scratch. I'm a journalist. When I started writing a book, I tried not to have any stereotypical ideas about what I saw. If I had, I would definitely lose my balance and not be able to remain neutral. My goal is to travel with my readers and learn things together.
My thinking changes step by step, chapter by chapter, which is normal, but I think it's good, including making mistakes. What I want is to be honest, to write what I see, talk about, and feel, without coloring the facts.
In terms of my transformation, I would say that in Oregon, USA, when I met Dr. Stevens, he told me that there are a lot of patients who shouldn't be euthanized, but they are in some way "forced" to die. The different doctors you meet will bring you to different destinations. People usually believe what the doctor says and try to follow his instructions – the danger is here, and as long as euthanasia is allowed, you may end your life sooner than expected. "When treatment is rejected, it is the end of the day," he said, which impressed me. When he asked me why no one cared about euthanasia in poor countries, I didn't know what to say.
Since then, I have been carrying the question: Is your will to die really your will? Aren't you encouraged or forced by someone to choose euthanasia? This is one of the main reasons why I disagree with the legalization of euthanasia in Japan. We are taught not to decide things for ourselves, but to decide with everyone, in other words, self-determination is not considered a virtue. In an individualistic society, euthanasia may be more appropriate, but conversely, in a collectivist society, it is more complex.
Southern Weekend: Four years after this book was published, has there been any change in your perception of euthanasia during that time?
Yoichi Miyashita: When the book was published, I thought euthanasia was only suitable for Europeans and Americans, but as I received a large number of letters and messages from readers, I began to think more deeply about this issue. My overall view of Japanese society has not changed dramatically, but I have come to feel that people who are very determined may be more likely to go to Switzerland for euthanasia. I realized that it was up to the patient, even if he lived in Japan.
Southern Weekend: You say in the book, "There is a lack of communication around death in Japan." What do you think is the root cause of this culture?
Yoichi Miyashita: As I mentioned before, education in Asia is different. We are not individualists. In our society, we always work and live together. I have no intention of offending Western society at all, and each culture has its own strengths and weaknesses. I don't think we're more taboo about talking about death, I think we just don't have the European fear that death is lonely, we have a stronger feeling that when it comes to death, I can get the protection or support of my family, so we have less worry about "how to die" than in Western countries.
Southern Weekend: After the publication of "Euthanasia Scene", was there any discussion in the Japanese medical community? What was the direction and focus of their discussions?
Yoichi Miyashita: The book I came out with was about a Japanese woman who was euthanized in Switzerland – it was Euthanasia Live that sparked her wishes. Her story sparked a national discussion. Not only the medical community, but also the mass media and citizens have been raising their voices in the hope that they can open up a national debate. The publication of my book in China is the result of this echo.
In August 2020, two Japanese doctors were arrested on charges of murdering an ALS patient in Kyoto (reporter's note: amyotrophic lateral sclerosis, known as alzheimer's disease). The woman, who wanted to die in Switzerland, wrote me a message before she died. The two doctors had never seen her before, but they wanted to achieve their "ideal ending." Since there is no euthanasia act in Japan, this is considered murder, and I agree with that.
But when this shocking news came, the medical community got nervous and stopped discussing euthanasia. But I'm a journalist, and I'm going to investigate around the world and re-debate so that people can get information, or at least they can think about precious lives — and at the same time their precious deaths.
Southern Weekend reporter Wang Huazhen