1. Denmark was with Japan and Israel until May 1990, when it passed a law recognizing brain death. Nakayama, T. Nōshi to zōki ishoku [Brain death and organ transplant]. Tokyo: Saimaru shuppansha, 1989:276.Google Scholar

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4. A special investigative examination of the Japan Bar Association found that Wada could be charged with murder on two counts: that the recipient's illness was not so serious as to require transplant surgery and that the donor's death was caused by his being deprived of proper medical treatment while in Wada's care. See Tachibana, T. Nōshi sairon [Brain death reconsidered]. Tokyo: Chūōkōronsha, 1988:265–83.Google Scholar

5. The Japan Medical Association did not express support for brain death and organ transplant as long as it was headed by Takemi Tarō, known for his vehement opposition on the grounds that transplant surgery does not properly belong to the practice of medicine. Since his retirement, however, the desire of younger physicians to incorporate this technology has inspired new initiatives. See note 1. Nakayama, . 1989:15–6.Google Scholar

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14. Because heart and liver transplant surgery are unavailable in Japan, a growing number of people go abroad for these services, but only the wealthy or those financed by a public fund drive are able to exercise this option. The Royal Brisbane Hospital, Brisbane, Australia, is a frequent site for pediatric liver transplant, mostly carried out for children suffering from biliary atresia. The prospective patient proceeds by receiving a diagnosis specifying that transplant surgery is the only option. The patient's history is sent to the hospital, which then decides whether to admit. Upon procuring a 6-month visa, the patient and family move to Brisbane, where they locate housing. When the fee is paid, they commence waiting for a donor organ to become available. The fee is AUD $110,000; this represents the actual cost for the operation and the cost of transporting the organ. Neither the hospital nor the operating surgeon receive any special fees. See note 1. Nakayama, . 1989:15Google Scholar. As of April 1989, 20 Japanese children had received liver transplant surgery abroad; of those, 13 operations were performed in Australia and the remainder in Canada and the United States. See note 1. Nakayama, . 1989:254–5. Since about the beginning of 1990, the number of pediatric liver transplants carried out overseas has decreased, due to the development within Japan of techniques for live donor partial liver transplants.Google Scholar

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17. The SCCBDOT even includes a member from the former Yasukuni Shrine committee, novelist Sono Ayako.

18. The public hearings are conducted in the following manner. The Ministry of Health and Welfare (MHW) places a notice of the hearing in newspapers, including a call for those who wish to address the Committee to submit short drafts of their intended speeches for advance review. Six to eight persons are allowed to speak at each meeting. Members of the public wishing to attend but not to speak at the hearings are chosen from among those sending MHW their names, occupations, and other personal details. These various precautions make it possible for the MHW to monitor the range of view put before the Committee.

19. Nōshi rinchō, saishū tōshin. Asahi shinbun 1992; 01. 23:p. 1.Google Scholar

20. Besides the individuals and organizations named below, there is an ecumenical organization considering brain death and organ transplant called the Group to Consider Religion and Medical Treatment (Iryō to Shūkyō o Kangaeru Kai), headed by Professor Hinohara Shigeaki, president of Seiroka University of Nursing. The Buddhist Information Center (Bukkyō Jōhō Sentaa) conducts consultations on the brain death and organ transplant issue in connection with its sponsorship of hospices.

21. Deakin is head of the Group to Consider Life and Death (Sei to Shi o Kangaeru Kai).

22. I am indebted to Professor Margaret Lock for providing me with copies of these articles.

23. Jōdo, Shinshū kyōgaku kenkyūjo. 1989. Iryō to shūkyō [Medical treatment and religion]. Kyoto: Honganji, 1989.Google Scholar

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28. Kimura, R. Inochi o kangaeru [Thinking of life]. Tokyo: Nihon hyoronsha, 1987Google Scholar. Namihira, E. Nōshi, zōki ishoku, gan kokuchi [Brain death, organ transplant, notification of cancer diagnosis]. Tokyo: Fukubu shoten, 1988Google Scholar. Yonemoto, S. Sentan iryo kakumei [The revolution in advanced medical treatment]. Tokyo: Chuokoronsha, 1988Google Scholar. See note 6. Nudeshima, . 1991.Google Scholar

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30. The Japan Academy of Sciences in 1987 prepared a report stating its affirmation of brain death and organ transplant, but under pressure from scholars in the social sciences and humanities, that support was withdrawn from the published report. Mainichi shinbun 1987; Oct. 3Google Scholar. Yomiuri shinbun 1987; Oct. 21.Google Scholar Its report of 22 May 1991, “Conclusions on Brain Death” (Noshi mondai no matome), was similarly inconclusive, stopping short of affirming or denying the equation of brain death with the death of the human person. Editorials following the issuance of the report suggested that the restrained position of the Academy came about as a result of strong rank-and- file opposition and the membership in the Academy of a powerful member of the SCCBDOT, ProfessorWataru, MoriYomiuri shinbun 1991; Jun. 25.Google Scholar

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39. As of January 1990, no women were serving on the Medical Ethics Board of any Japanese hospital. Kodineta, honso. Asahi shinbun 1990; 01. 31 (evening edition).Google Scholar

40. Similar views were expressed by Dr. Mori Wataru, informal vice chair of the SCCBDOT, past president of the University of Tokyo, and a pathologist. According to Dr. Mori, Japan's feudal past was rocked by the student riots of the 1960s, when there arose a mass desire for public participation. Since then, people have become reluctant to entrust their affairs to the professionals, and thus the status of professionals is in decline. For this reason, the public hesitates to give physicians approval for organ transplant, because this would accord the medical profession more authority than it presently possesses and more than its declining prestige warrants (personal communication, 21 January 1991).

41. Within this discourse, the United States is the principal representative of the western world.

42. Takeshi, U, Yonezo, N. Noshi, doko ni, ika ni mondai wa aru ka? Yappari, nihon wa nihon dokuji de, teisho subeki da to omoun desu. Bukkyō bessatsu 4 (1990):5.Google Scholar

43. A common criticism of the present stalemate by proponents of organ transplant.

44. Abe, T. Watakushi wa noshi ni hantai sura [I oppose brain death]. Bukkyo bessatsu 4 (1990):89.Google Scholar

45. Itami's film shows that the way of life supporting the formerly protracted liturgies of birth and death is passing away so that the sentiments and moral visions of communal order formerly support- ing them seem no more than sentimental anachronisms.

46. See note 6. Nudeshima, . 1990. This summary of Nudeshima's important work is necessarily brief. He also presented a valuable historical treatment of the development of the debate, an examina- tion of the relation to the problem of gift giving customs, and a powerful statement of the need for development of associated medical services such as counselling, transplant coordination, and education of physicians in ethics.Google Scholar

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50. Nakamura, H. Bukkyōgo daijiten [A dictionary of Buddhist terms]. Tokyo: Tokyo shoseki, 1981:273, 641, 710, 773, 1071, 1305.Google Scholar Other Theravada texts, as well as some attributed to Nagarjuna and thus intermediate between Theravada and Mahayana attribute greater significance to breath than to longevity. See note 48. Ikeda, . 1988: part 1.Google Scholar Both the concept of the kalala and the tripartite analysis of life in terms of longevity, heat, and consciousness show that there exists in Buddhist thought some attention to the constituents of physical existence. This physical approach to analysis of human existence represents a minor theme within the tradition, however, by comparison with the much greater attention given to analysis in terms of the five “aggregates” or “groups” (skandhas; Japanese: un). According to the Visuddhi-Magga (chapter xiv) and also to the Abhidharmakosa-sastra, the human being is composed of five types of aggregates: form, sensation, perception, predisposition, and consciousness. The aggregates play an integral role in the central idea of dependent co-arising (pratitya samutpada), which serves to explain the workings of karma and forms the basis of a path to liberation from karma. By contrast, the physical kalala and so forth play no such role in other doctrines and do not occupy nearly so important a position in the religion as a whole. The skandhas are linked to analysis of attachment, the central problem of Buddhism. Humanity becomes attached to the illusion of an essential whole existing beyond the component parts. Although it may be convenient or useful to attach a name to such an object as a chariot, to mention only the most renowned of the parables used to illustrate this idea, it is an illusion to imagine that a chariot has any unchanging essence beyond the sum of its parts. Sangharakshita, . A Survey of Buddhism. Boulder, Colorado: Shambala, 1980:86–7. The purpose of breaking down objects to their constituent parts is to demonstrate that there exists no unchanging essence, only composites. Because all composites are subject to endless cycles of birth, decay, and death, attachment is foolish, and one should seek liberation from them.Google Scholar

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