From November 21st to 23rd, 2024,Support for sustainable decision-making and arrangements that preserve dignity for everyone during and after life" project, we conducted a survey in Taiwan. We interviewed Professor Kodama of Kyoto University and Researcher Sawamura of the Japan Research Institute, who conducted the survey, and will share their learnings and realizations that they gained from the survey in three parts.
-Thank you for your research in Taiwan. I would like to ask you about the learning and realizations you both gained from your respective visits.
National Taiwan University Hospital
- First, about the event at National Taiwan University Hospital on November 21. The topic of the exchange of opinions at the Ethics Center was end-of-life care and palliative care, which I believe is close to your specialty, Dr. Kodama. What did you think, Dr. Kodama?
(Kodama) One of the keywords that came up during the exchange of opinions was "VSED" (voluntary stopping eating and drinking). Since euthanasia is not permitted in Taiwan, some people are choosing to withhold nutrition and water as a way to legally end their life. The value of viewing VSED as a "good way to die" is also spreading. During the exchange of opinions, one doctor said that he receives consultations about VSED once a week, which made me realize how different it is from Japan.
--Is VSED not seen very often in Japan?
(Kodama) It's not that it doesn't exist at all, but at least at the university hospital level, I don't think it's a big problem yet. In countries other than Taiwan, there is debate about whether euthanasia should be considered illegal and VSED should be considered legal.
-What did you think, Sawamura-san?
(Sawamura) I was impressed by a story I heard from a social worker about how to deal with elderly people with no relatives. In Taiwan, when elderly people with no relatives find it difficult to continue living alone, they somehow find their family and relatives, even if it means asking the police for help. I learned that in Taiwan, just like in Japan, the culture of relying on family and relatives in old age is deeply rooted.
(Kodama) I heard that in cases where you are "without relatives," you have to prove that you really have no family. The law is set up so that if you have family, they cannot make decisions for you. For example, if you have family overseas and are unable to contact them, this can cause problems with decision-making.
Buddhist Tzu Chi Foundation
-On November 22nd, you visited the Buddhist Tzu Chi Foundation (hereinafter referred to as "Tzu Chi"), one of the world's leading Buddhist NGOs, and related facilities. What were your impressions throughout the visit?
(Kodama) Tzu Chi currently covers a comprehensive range of activities including education, medical care, culture, and volunteer work. A local volunteer introduced me to Tzu Chi, which helped me understand more about the organization. I thought it was amazing that the private mutual aid system that started as a religious-based organization in the Hualien region has coexisted with the government's public aid system, forming a network throughout Taiwan, and has survived to this day.
(Sawamura) I was interested in the values of the people involved with Tzu Chi. Tzu Chi actively provides disaster relief both in Japan and overseas, and in the case of the Noto Peninsula earthquake that occurred in Japan in 2024, they went to the site to provide support two days after the incident. I heard that these activities of Tzu Chi are basically carried out by volunteers, and that even rushing to the site is at one's own expense. Perhaps the awareness of social participation is fundamentally different from that in Japan.
Buddhist Tzu Chi General Hospital
―仏教慈済総合病院では、緩和ケア病棟でＡＣＰ（アドバンス・ケア・プランニング）(*1)について調査されたということで、お話を伺って印象に残ったことはありますか。
(Sawamura) A palliative care specialist spoke about "Compassionate Communities." In Taiwan, they are promoting the creation of local communities where citizens support each other when they face hardships such as aging, illness, and death. I learned a lot from the fact that there is a movement for the entire community to support the end of life.
(Kodama) The Compassion Community started in the United States, right? It was originally a public health idea aimed at promoting the health of a group, and the idea was to promote palliative care throughout the town. The talk I heard at Buddhist Tzu Chi General Hospital this time was about creating a society that is friendly not only to palliative care but also to the elderly and people with dementia, which I personally thought was a very good idea.
(*1) ACP (Advance Care Planning): A discussion between the individual, their family, medical professionals, and others regarding future medical care and treatment.
Buddhist Tzu Chi University
-At Tzu Chi University, you exchanged ideas with researchers from the Institute of Religion and Humanities. Did you gain any new insights?
（児玉）献体の話が興味深かったです。仏教慈済大学は、献体（*２）が有名だと聞いていたのですが、現在約４万人が死後の献体登録をしているというお話もあり、想像以上に発達していました。なかなか日本ではないものだと思いました。これもボランティア精神や宗教の力が関係しているんでしょうね。
(Sawamura) I also learned a lot about the changes in funerals in Taiwan. From burial to cremation, and now more people are choosing natural burials, so the culture seems to be changing rapidly. People who want natural burials register their intentions in a system provided by Taipei City. Such systems are useful when considering how to create systems in Japan.
(*2) Body donation: Providing a body after death as teaching material for anatomical studies. Tzu Chi University also uses donated bodies for surgical training.
In the next part, we will share what we learned at Taipei General Hospital, Xingyi Clinic, and Veterans General Hospital, which we visited on November 23rd.
