Deciding one’s own death in advance: Biopower, living wills, and resistance to a legislation of death with dignity in Japan

The usage of medical technologies alongside the medicalization of death brought about the medical norm of fighting for life with all means available. Yet, this norm was questioned and the demand for patient autonomy gained importance. It is in this context that the right to die movement emerged in 1976, and living wills were introduced in Japan. The right to die movement promotes legislation of “death with dignity” arguing for patient empowerment, whereas their opponents warn against social exclusion of severely ill, old, and disabled people. Against this discursive background, I draw on qualitative interviews with Japanese who signed a living will and examine what motivated them to engage in advance decision-making. In recourse to the Foucauldian notions of biopower and biopolitics, I show that the living will is a technology of the entrepreneurial self, to govern itself. My research participants expressed their critical awareness for a variety of problems they aim to solve by their living will, e.g. paternalism and overtreatment, conflicting values and attitudes toward life-sustaining treatments between family members, as well as shortcomings in the social security and care sector. Hence, through the living will the risks of life are shifted to the self-responsibility of the individual, who opts for death to avoid becoming a burden on others and society. Accordingly, the living will can be seen as a means of the neo-liberal state to increasingly withdraw from its social responsibility of granting the right to comprehensive health care, a secure old age, and adequate care.