The Japan News by The Yomiuri Shimbun
2 doctors held over assisted death of woman with ALS
KYOTO — Two medical doctors have been arrested on suspicion of assisting the death of a Kyoto woman with amyotrophic lateral sclerosis, or ALS, at her request through the administration of lethal drugs.
The Kyoto prefectural police arrested Yoshikazu Okubo, a former technical official at the Health, Labor and Welfare Ministry, from Sendai and Naoki Yamamoto, a doctor from Minato Ward, Tokyo, on July 23.
Okubo, 42, and Yamamoto, 43, were not the attending physicians of the 51-year-old woman, who was receiving care for her incurable ALS at her home in Nakagyo Ward, Kyoto.
The doctors are believed to have become acquainted with her through social media, the police said.
The two are suspected of administering lethal drugs at her request at about 5:30 p.m. on Nov. 30 last year.
The woman lived alone and received around-the-clock care. A caregiver was present on the day of the incident, but was in a separate room when the two doctors visited, the police said. Shortly after they left, the caregiver found her in an unconscious state.
Her attending physician was contacted by the caregiver and called an ambulance. The patient was then transported to a hospital where she died at about 8:10 p.m., the police said. An autopsy performed by the prefectural police revealed high levels of drugs in her body, and she was found to have died from drug poisoning.
She used a computer that could be operated using eye movements and had posted on Twitter and blogs about her desire to die, according to the police. Police searched her computer to find who had been in contact with her and identified the suspects.
Okubo had written in his blog and on Twitter that euthanasia should be tolerated, investigation sources said.
More than ¥1 million was deposited into Yamamoto’s bank account by the woman prior to the incident, according to the police, who are examining the possibility that the money was received as payment.
“Anyone who finds difficulty in living life every day because of having contracted an intractable disease could be eased by having a dose of a drug administered or being given an injection,” Okubo wrote on his blog in May last year.
ALS is a progressive, intractable disease in which patients gradually lose control of most of their muscles as the nerves that move the body develop abnormalities. The progression of the disease varies greatly from person to person, and no fundamental treatment has been found.
In the blog he started at least six years ago, Okubo wrote, “I can somehow understand ALS patients saying they are in ‘living hell.’”
“It is just insensitive for anyone unrelated to the disease to tell the patients to ‘live longer in expectation of future [progress in] medicine,’” he also wrote, arguing for the necessity of euthanasia.
According to the sources, Okubo, a Sendai resident originally from Hokkaido, worked as a technical official at the Health, Labor and Welfare Ministry after graduating from the medical department of Hirosaki University in Hirosaki, Aomori Prefecture.
He quit the job about 10 years ago and opened a respiratory medicine and mental health clinic in Natori, Ibaraki Prefecture, in 2018. His wife is former House of Representatives member Miyo Okubo, 43, the sources said.
Okubo was engaged in home-based care of patients in the terminal phase of the disease. He wrote on the clinic’s homepage that he wanted to be a doctor who supports those hoping to concentrate on treatment as well as those who think it is time to discontinue treatment.
Yamamoto runs a urology clinic in Tokyo.
According to the clinic’s website, the clinic provides home-visit treatment and the service is provided by advance reservation only.
Okubo and Yamamoto coauthored an e-book titled “Atsukai ni Komatta Koreisha wo ‘Karasu’ Gijutsu” (Technique to “weed out” the troublesome elderly) in 2015.
The patient was administered the same drugs used by overseas organizations that help patients with intractable diseases to commit suicide, according to the police.
The Kyoto prefectural police suspect the drug was administered via a gastric tube, which was used to feed the victim as she was unable to swallow. The police are investigating how the suspects obtained the drug.
The sedative is designated as a psychotropic drug in Japan and is not on the market, but the drug is available in Switzerland, where assisted suicide for patients with intractable diseases is legal.
Euthanasia refers to actions taken to hasten the death of patients, including the terminally ill, through specific measures such as the administration of pharmaceuticals for the purpose of helping people end their pain.
While some countries have legalized such actions, Japan does not have statutory provisions for euthanasia. Therefore, life-ending actions, even with the consent of the patient, could fall under criminal statutes, including murder, murder at the victim’s request and assisted suicide.
The first time a doctor in Japan was found guilty of murder for performing euthanasia was in 1991, involving an incident at Tokai University Hospital in Kanagawa Prefecture. The Yokohama District Court established four conditions for allowing euthanasia: the patient is suffering from intolerable physical pain; the patient’s death is inevitable and imminent; there are no alternative measures for alleviating or relieving the physical pain; and the patient shows a clear desire to die.
These conditions set a precedent for adjudication in subsequent cases.
In 1998, a 58-year-old patient hospitalized at Kawasaki Kyodo Hospital in Kawasaki died after their breathing tube was removed and a muscle relaxant was administered. The doctor accused of murder asserted that the patient’s death was dignified and the actions were not illegal. The doctor’s appeal went all the way to the Supreme Court, but the doctor was found guilty for reasons including that the life-ending decision was flawed.
Later, papers pertaining to a murder case were sent to prosecutors regarding two doctors at Imizu City Hospital in Toyama Prefecture after they disconnected ventilators of seven patients, including people with terminal cancer. The Toyama District Public Prosecutors Office dismissed the case in 2009, saying that the actions of the physicians were not intended to hasten the death of the patients or directly end their lives.
In all these cases, the patients’ primary doctors committed the acts at their respective medical facilities.
The latest case is significantly different as physicians other than the primary doctor allegedly administered drugs to kill the patient at the residence of the deceased.
The Kyoto prefectural police said they do not believe the case qualifies as euthanasia for reasons including that the patient’s death was not imminent, the two doctors were not her primary physicians and money was passed to one of the physicians.