Health experts say ALS woman's death in Kyoto not euthanasia


Health experts are calling the case of two doctors arrested last week on suspicion of assisting in the death of a 51-year-old woman with ALS "fundamentally different" from past euthanasia cases that led to other doctors' convictions for murder in Japan, because she allegedly asked them to kill her for money on Twitter.

Yoshikazu Okubo, who operates a clinic in Natori, Miyagi Prefecture, and Naoki Yamamoto, a doctor in Tokyo, allegedly administered a lethal dose of barbiturates to Yuri Hayashi at her home in the western Japan city of Kyoto on Nov 30 with her consent, investigative sources said.

Short-acting barbiturates, such as pentobarbital, taken in large dosages cause death by respiratory arrest and are known to be used by groups that assist with suicides in Europe and the United States.

Hayashi's disease, amyotrophic lateral sclerosis, also known as Lou Gehrig's disease, causes gradual paralysis with no fundamental treatments established.

According to the sources, neither Okubo, 42, nor Yamamoto, 43, were the woman's attending physician, and the ALS patient and Okubo are believed to have exchanged messages using the social networking service for nearly a year prior to her death.

It was Hayashi who offered 1.3 million yen for the job, nearly the same amount charged by a Swiss group for assisting suicides.

On the day of the incident, Okubo and Yamamoto, using false names, visited Hayashi's apartment in Kyoto's Nakagyo Ward. They left about five to 10 minutes later, and a caretaker, who had left the room while the doctors were with the woman, found Hayashi unconscious soon after. She was later pronounced dead at a hospital.

The investigators said communication between Okubo and Hayashi was done through direct messaging and could only be viewed by them. Hayashi transferred the money into Yamamoto's bank account, but there is no trace of the funds being deposited into Okubo's bank account.

In February 2018, Okubo took a survey in which he asked people on Twitter how much they would be willing to pay to be euthanized with a multiple choice of 100,000 yen, 500,000 yen, 1 million yen, and 10 million yen. There were nearly 3,000 votes, with most people choosing 1 million yen.

When soliciting opinions in 2018, Okubo wrote, "It seems there is no one willing to take the risk of losing their medical license and being thrown into prison."

A Kyoto prefectural police official, who summarized the case to the media last Thursday night, said questions were raised about "whether this can even be considered a case of euthanasia" because of the transfer of money involved. The investigative sources also said Yamamoto is suspected of having obtained his medical license illegally.

Experts have also expressed outrage over what appeared to be a contempt for the suffering woman's life because of the intention of getting money, while many Twitter users have said they still empathize with Hayashi's wish to die.

On a blog believed to belong to Okubo, he writes articles about methods using drugs to kill people and even suggests how to avoid being investigated by the police by not leaving any evidence of murder.

"It's no sweat for medical workers to snuff somebody out and leave no trace behind," he writes.

Kaoruko Aita, a specially appointed professor of clinical ethics at the University of Tokyo's graduate school, said, "If doctors who weren't her attending physician took the money and administered a drug, this case is totally different from previous cases involving doctors or cases of non-indictments."

"It is fundamentally different from the arguments built up by the state and those involved in cases concerning end-of-life medical treatment," she said.

While Yamamoto was running a clinic for erectile dysfunction in Tokyo's Shinagawa Ward and considered himself a doctor "pursuing the best way to be a professional," according to his Twitter account, Okubo appeared to fashion himself after the late Osamu Tezuka's "Black Jack" comic character Dr Kiriko who specializes in euthanasia for people who have no prospects of recovery.

Since 2013 on Twitter, Okubo has made several references to Dr Kiriko, who, instead of treating patients like Black Jack, helps them end their life for a hefty fee.

In a post in January 2013, Okubo said, "I wrote in my yearbook that my dream is (becoming) Dr. Kiriko because I became well aware of how disconsolate medical care for the aged is by the time I graduated from medical school."

Aita said if the doctors did in fact administer a heavy dose of sedatives to end Hayashi's life, she worries such acts "might cause misunderstanding and confusion among workers trying to remove pain from patients in palliative care through appropriate use of sedatives."

In Japan, patients who have no hope of recovery or are terminally ill, may hope for what is termed "death with dignity," which differs from euthanasia, as the patient requests a natural death by refusing to artificially prolong life with medical treatments and devices.

With the aging of society and the advancement of medicine in recent years, more and more people and their families wish to determine how they end their lives. The Japan Society for Dying with Dignity touts over 100,000 members.

In 2018, the health ministry, based on changes in how people in Japan view health care they would like to receive at the end of their lives, revised guidelines for terminal care. It called for discussions with medical teams and family members based on the individual's wishes.

Euthanasia, meanwhile, although illegal in Japan, has its proponents such as scriptwriter Sugako Hashida, known for writing internationally acclaimed TV drama series Oshin in the 1980s, who in 2016 called for recognizing assisted death in an article for a monthly magazine.

Assisted suicide is legal in Switzerland using drugs prescribed by doctors in lethal dosage. Public broadcaster NHK aired a documentary last year, featuring a Japanese woman who chose to have euthanasia performed in Switzerland.

Paralympic medalist wheelchair racer Marieke Vervoot, who lived with a degenerative spinal condition that caused her constant pain, took her life through euthanasia in October 2019 in Belgium.

While opinions on life and death regarding euthanasia vary, groups for disabled persons argue that condoning suicides threatens the life and dignity of people with disabilities or patients with incurable diseases.


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I tend to agree with euthanasia but funds should only be charged for actual expense, not profit.

12 ( +13 / -1 )

...she allegedly asked them to kill her for money.

Murder for hire. There is no difference between the so called doctors and a hit squad.

-16 ( +1 / -17 )

Murder for hire. There is no difference between the so called doctors and a hit squad.

Yeah, no difference between doctors who are looking to help people not be in pain and to have comfortable lives, and muderers who want people to die. None at all.

19 ( +20 / -1 )

There are of course lot of things that are not known here, but appears to be much more about the ego of a unethical doctor proud to be able to fool the law and do whatever he wants without consequences than a genuine desire to help patients. Someone that is genuinely trying to change the situation for the good of the patients would not try to hide his participation or be so interested in how much profit he could get from it.

For a doctor ethical considerations are the very center of the professional life, there is no such thing as an absolute purpose that will justify any means to reach it. That is an extremely dangerous thing for a doctor to think and it has ended up in cases where "euthanasia" is performed for patients that still had hope of recovering to a productive life, I would not be surprised if investigations find up this has been the case with this doctor in the past.

The end result? the image of euthanasia becoming much worse and decades of work by real activists with genuine interest in the patients becoming trash, all for a single doctor that really appears to be too full of himself, I really hope this is not the case.

1 ( +2 / -1 )

Murder for hire. There is no difference between the so called doctors and a hit squad.

People with ALS are fully conscious but lose all ability to move or talk. It is a living hell. Any doctor that will put everything at risk to help such a person shouldn't be compared to a "hit squad".

16 ( +16 / -0 )


 ""sources also said Yamamoto is suspected of having obtained his medical license illegally.""

Now why am I not surprised at all!!!

I feel that way almost every time a visit a doctor here.

5 ( +6 / -1 )

Agree with virusrex. There needs to be an honest and open discussion with new laws around assisted suicide and euthanasia. Japan tends to hide things that are embarrassing and inconvenient to their idea of a perfect and homogeneous society and because of this, inadequate and outdated laws prevail and control the narrative. This case has the potential to ruin all the progress that legitimate activists have made for a more humane and dignified death by choice.

1 ( +1 / -0 )

I don’t think these doctors are murderers. This woman was in incredible suffering and wanted to die in a humane way. She had nothing to loose and willingly paid the money. I don’t want to compare it to putting down a dog with cancer out of its suffering but I think that’s better than suffering through your final days.

2 ( +3 / -1 )

"a doctor in Tokyo, allegedly administered a lethal dose of barbiturates to Yuri Hayashi at her home in the western Japan city of Kyoto on Nov 30 with her consent"

They should have stated it was consensual as "scientific and data gathering" seems to work for just about anything these days.

1 ( +2 / -1 )

Hopefully common sense will prevail.

But this is Japan, so I won’t hold my breath

3 ( +4 / -1 )

They should have stated it was consensual as "scientific and data gathering" seems to work for just about anything these days.

That would obviously would backfire, because a proper ethical review by a registered committee is an indispensable requisite for any kind of research involving humans, and this obviously unethical enterprise would never be approved. The label of "scientific" is not simply something that makes anything OK, it is the opposite, only things that are done properly and ethically can be called scientific.

By the way there are perfectly valid studies about euthanasia, but patients do not have to pay to be included, the researchers do not use false names and they specialize in things much more closer to the topic than treating erectile dysfunction.

0 ( +0 / -0 )

Japan's healthcare system requires users to pay cold hard cash for everything. The insurance is billed to individuals who later make co-payments in cash. Many Japanese hospitals and clinics operate to make profits. Given that situation, it is bizarre that in the case of enthenasia, the "experts" are suddenly shocked, viewing a patient's money payments to a doctor unethical or unacceptable.

3 ( +3 / -0 )

The woman was in pain and suffering living her life day by day! These doctors helped her! For a country which has a high Suicide rate like Japan, it’s better that people die comfortably rather than horribly jumping in front of a train!

4 ( +5 / -1 )

Question: Is dying by suicide illegal in Japan? ie if someone tries and fails to die by suicide, will the police arrest them?

I don't mean the whole 'for inconvenience caused to the public' fine. I mean the actual act of suicide.

2 ( +2 / -0 )

Question: Is dying by suicide illegal in Japan?

In Japan there's Death Penalty.

If the lawmakers can take your live, you should be allowed to take your live by yourself too.

2 ( +3 / -1 )

Well. Okubo really backed himself into a corner with his surveys and articles didn't he?

So-called experts vs normal people: coldness vs empathy

People should be in control of their own lives.

1 ( +1 / -0 )

A glimmer of hope from tge health experts, let's hope they have some pull

-2 ( +0 / -2 )

Many people do, sadly they often mess up other peoples lives at the same time... late trains... blood spatter at the bottom of a high rise... This conversation is well overdue, not just in Japan but worldwide

If the lawmakers can take your live, you should be allowed to take your live by yourself too.

-1 ( +0 / -1 )

To the people who wanted the perfect euthanasia doctor and the perfect euthanasia scenario try to remember these guys had to break the law to help this woman. Right up front that requires a non-conformist and non-conformists always deviate from other norms besides the one in question. Many are labeled as "nutty" and many are. But many are also more misunderstood than nutty.

As for the money they are going to need it for their court defense now won't they?

There is only one way to get perfect euthanasia scenarios and that is by way of setting up a legal euthanasia system. Until then, expect more imperfection.

1 ( +1 / -0 )

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