A lunchtime talk on Nov 24, 2018

Born and raised in Japan, educated at university in America, Yumiko has experience of working with dementia patients and the dying in both the US and Japan. Her speciality is music therapy, and as well as the guitar she plays harp. ukelele and Native American flute. Her experiences on both sides of the Atlantic have led to her writing two books in Japanese about her experiences. She currently lives with her husband in Washington DC, and is over here for a short lecture tour in Japan. WiK was delighted she could find time to stop off at Kyoto on her way from Kobe to Tokyo.

So what are the main differences in terms of treatment of the dying between the US and Japan? Yumiko suggested it had to do with the treatment of the individual needs of the patient in the US compared with a focus on doctors and medical procedure in Japan. For instance, patients are much more likely to be kept artificially alive in Japan, whereas a patient’s wish to be taken off machine dependency would be respected in the US. Death with dignity is gaining currency in the West but not in Japan, where euthanasia was once carried out on the mentally ill and is now considered taboo. According to the internet, ‘As of April 5, 2018, California, Colorado, District of Columbia, Oregon, Vermont, and Washington have death with dignity statutes; the Hawaii statute, approved in 2018, goes into effect on January 1, 2019. In Montana, physician-assisted dying has been legal by State Supreme Court ruling since 2009.’

As might be expected, individual rights are much more recognised in the US than Japan. Living wills for instance have legality in America, but not in Japan where the doctor can overrule them  ‘Doctors are God,’ is a Japanese saying. Moreover, practices such as tying patients’ hands to the side of the bed are common in Japan (to prevent tubes being taken out), but are considered unethical in the USA. Morphine use is much less common in Japan than the US, where pain has been eliminated for the dying. In Japan painful death is still common, even in cases where patients ask to be put out of their misery. This may be due to stigma, Yumiko felt, with doctors wishing to guard their reputation. (It’s also said to be part of ‘gaman culture’.)

Finally, Yumi considered attitudes to dying, and here she didn’t find there was much of a cultural difference. Patients everywhere had different levels of contentment with their lives and it depended on the individual. One interesting point was that though religion was supposed to be a great consolation and there were those who felt assured of going to heaven, there were also those convinced they were going to hell.

Music had helped her soothe and comfort patients, evoke warm memories in those with dementia, and above all build relationships with patients who were then able to open up about their feelings. There were many individual anecdotes, but one in particular lingered in the memory. A particularly wealthy man who had seen success in the material things with which he surrounded himself had realised in the face of death that it all counted for very little. “We don’t take what we’ve gained, we only leave what we’ve given,’ is how he put it.

Our many thanks to Yumi. ‘Can music save your mortal soul?’ asked Don McLean. After listening to her talk, we can definitely say yes!