Journey from life to death : an anthropological study of cancer patients in Japan
The kind of diseases affecting Japanese people and the causes of death in Japan have changed a great deal in the last several decades due to various factors, most notably the advancement of medical technology and changes in life style. The number of people who die from life style diseases such as cancer, which are chronic and possibly need long-term hospitalization, increases every year. In the 1970s the hospice philosophy was introduced to Japan from the West. It encourages patients and their families to affirm life and to regard dying as a normal process, and offers a support system to help patients live as actively as possible and sustain a sense of selfhood, autonomy, and dignity until they die. In practice, however, the dying process is still not regarded as normal in contemporary Japan and many patients fail to die in the way proposed by the hospice philosophy. There is also disagreement between the patients and the medical professionals regarding their respective idea of good death. Hospices and PCUs, which were initially developed in order to provide humane care, have become places which provide a new form of institutionalized death, and consequently constrain the patients' dying patterns. In this thesis, I investigate the above issues from the perspectives of the anthropology and the ethnography of Japan. I demonstrate how the framework of van Gennep's rites of passage and Turner's concept of liminality can be used to analyze the current situation in Japanese hospice settings. I also perform an ethnographic analysis of Japanese attitudes towards health, illness, and death in order to illustrate the reasons why some Japanese patients fail to die a good death as proposed by the hospice philosophy.