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Paper short abstract:

In the debate about the legislation of passive euthanasia, Living Wills are treated as a means of self-determination in medical decision-making. However, drawing on empirical data I will show that the Living Will is used as a tool to avoid interpersonal conflicts at the deathbed.

Paper long abstract:

With improvements in medical healthcare and hygiene, and the spread of medical technologies death and dying became more and more a medical event, taking place in the hospital. These new technologies made it possible to save lives, for example by using defibrillation or mechanical ventilation. Thus, using all means available to prolong a patient's life as long as possible became the norm. However, these new technologies also produced new medical conditions such as patients in an irreversible coma. This led to the question, whether life-prolongation with all means available is always desirable.

Since 1976 the Japan Society for Euthanasia - renamed as Society for Death with Dignity in 1983 - questions the practice of so called "meaningless life prolongation" and campaigns for a legal recognition of the right to die and Living Wills. In their rhetoric, Living Wills are treated as a means of patient autonomy, intended to em-power patients and permit physician to withhold life-sustaining treatments.

Living Wills have become increasingly common in the last decades and since 2012 the Japanese parliament has been debating about the legislation of Living Wills and (passive) euthanasia. But how does the individual make the decision to sign a Living Will and what kind of meaning is ascribed to it?

Drawing on qualitative interviews, I argue that for the individual the Living Will is a tool to take precautions like arranging the own funeral and buying a grave. One of the main concerns is to avoid conflicts between either relatives or relatives and the physician at the deathbed. Overall, the interpretations of Living Wills by my interviewees reflect their notion of self, their experiences with illness and death and how they perceive their relationships with others. Information about the medical situations for which the living will is written, play a minor role in the decision-making process.