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Yoshi travels from Japan to Switzerland to die

Yoshi's motor functions are deteriorating because of a neurological disorder. He needs two sticks to walk. ©Kaoru Uda Kaoru Uda/swissinfo.ch

A Japanese man came all the way to Switzerland to die. SWI swissinfo.ch accompanied him on the final part of his journey. This is his story.  

This content was published on September 13, 2021 - 09:00

It’s a Wednesday afternoon and there is a light drizzle, not the usual early summer weather. Yoshi* appears in a wheelchair with his parents at Zurich Airport. Laboriously, with the help of two sticks, he heaves himself out of the wheelchair and climbs into a taxi that takes him to Basel.  

“I am so relieved we made it,” he says, looking out of the car window at the countryside.  

The journey came about quickly. Just two weeks ago, he decided to take this flight. A Basel-based assisted suicide organisation, lifecircle, had already given him the greenlight to come to Switzerland and end his life three years ago. He had wanted to hold off until 2022 but was forced to make the trip in June after his condition worsened.  

The deterioration in his health was as fast as it was dramatic, gaining speed like a wrecking ball rolling down a hill.  “The numbness in my throat and on my tongue got worse,” he said. “I couldn’t swallow solids anymore. I also found it difficult to move my fingers. I could feel that my life was coming to an end.” 

Assisted suicide is illegal in Japan. He had to get on the plane before he could no longer move his body, because otherwise it would have been too late. He had to convince his parents too. He wanted them to accompany him. At first, they opposed his plan.  

He suffered severe pain in his lower body during the 12-hour flight, the last chance to see the world from above. After checking in at a hotel in Basel, he lies on a reclining chair with wheels and a headrest. There is no opportunity for sightseeing in this foreign city. He stays in the hotel room, uses the bathroom, and sleeps briefly.

Settled on the recliner, he turns to his everyday companions: sleeping tablets, painkillers, and a medicine to counter numbness.  “My core muscles have deteriorated considerably,” Yoshi says. “My internal organs have less support. They touch nerves, which causes severe pain.

Recently he has been unable to sleep for more than three hours at a time. Even with sleeping tablets, he wakes up every couple of hours. As soon as they start to wear off, the pain startles him awake. 

Tablets and food supplements. Kaoru Uda / swissinfo.ch

Yoshi can only consume drinks containing food supplements, such as yoghurts or broth. He finds no pleasure in swallowing drinks just to obtain the necessary calories and nutrients to keep his body functioning.  

Refusal to live without dignity

Yoshi is a single, 40-year-old office worker. In Japan, he lived with his parents in the east of the country. The first signs of his illness manifested themselves five years go. He had constant pain in his knees and could no longer stand on tiptoe.  

An annual medical showed unusual liver values. After an examination, his doctor told him his muscles were “wasted.” The diagnosis was possible “motor neurone disease (MND).” 

MND is a rare condition that progressively destroys motor neurons that control voluntary muscles. Its most common form is amyotrophic lateral sclerosis (ALS). Sufferers lose the ability to move at will. In the end, breathing becomes difficult. Death is inevitable.

Yoshi did not get a conclusive ALS diagnosis, but ALS symptoms have gradually taken over his limbs, robbing him of the use of his hands, his abdominal area and his throat and tongue. Videos and blogs by ALS patients prompted him to think about the end of the road.

“I do not want to dissuade someone who is carrying a ventilator from continuing to fight,” Yoshi says. “But I don’t want to live without dignity.” Two years later, in April 2018, he got in touch with lifecircle. It didn’t take long for him to get approval. 

At the end of May this year, he could still walk about 200 metres with the help of sticks. He was able to work from home for the company that had employed for 13 years. And he enjoyed his mother’s homemade dinners. But those vestiges of normality evaporated as his health took a sharp turn for the worse.

No use to society 

Back in Basel, Yoshi is nervous. He is due to meet two lifecircle doctors. Even though the approval for assisted suicide has already been given, this can be rescinded if the doctors find that the patient lacks the capacity to make judgments or is under the influence of a third person.  

It is 9.30am. Yoshi leans back in his wheelchair and stares silently at the doors. Soon a doctor arrives. Her name is Erika Preisig. Yoshi answers her questions on his current condition and how he came to consider assisted suicide. He chooses his words slowly and calmly. 

Yoshi (right) signs the declaration of consent for the prescription of a fatal drug presented by Erika Preisig. Kaoru Uda / swissinfo.ch

In his second conversation with another doctor, Yoshi’s work comes up. “You stayed in your job until shortly before your journey?” the doctor asks, with a surprised expression. “It was very important to me to make a contribution to society. But my disease doesn’t allow me to do that anymore. I feel as though I have no value.”  

The two conversations last more than three hours. “From a medical perspective, there is no reason to oppose your assisted suicide,” the second doctor declares. Yoshi’s nervous expression eases. His assisted suicide is planned for Saturday. Today is Thursday. He wants to spend the rest of his time with his parents.  

He tells them about the appointment. They were waiting in a separate room. His mother asks once again. “Are you sure you don’t want to change your mind?” 

Unbearable pain

The disease has left Yoshi with little time left. In the evening he feels a dull discomfort in his lower body. That is a familiar warning of more severe pain to come. But this time they come in waves of unprecedented intensity. He takes more sleeping tablets than usual just to sleep. But he wakes up three hours later in excruciating pain.

“I can’t bear it any longer,” he says, turning to phone Dr. Preisig. 

Friday morning begins with an apology to his parents for having to bring the appointment forward. They are now less adamant in their opposition to his course of action.

Yoshi can no longer sit in the wheelchair. “I have to conserve my energy,” he says, hauling himself onto the edge of the bed and letting his upper body sink backwards onto the mattress. “It is less painful like this.”

He waits. He will be given a new appointment. 

“I have no Plan B or Plan C"

Why Switzerland? 

“Because I want to die with human dignity. Breathing, eating, defecating and communicating, these are the basics of life. As I can’t do these anymore, I am making the right decision to end it,” Yoshi explains.  

His family sees it differently. His mother begs. “I want you to live no matter what.” But that ignores his pain and his dignity, Yoshi says. “Patients like me don’t want to live in a vortex of pain. We don’t want our families to be so cruel.” 

Yoshi believes assisted suicide benefits society. “If a patient with an incurable illness wants to die and can end his life, then enormous medical resources can be devoted to someone else,” Yoshi says. “For me that is a very ethical act.” 

But many societies have come to a different conclusion and banned assisted suicide. “Why is the decision to give someone a ventilator acceptable? But assisted suicide isn’t?” Yoshi wonders. 

He hopes that assisted suicide for patients like him will one day be legalised in other parts of the world “so that patients can die peacefully at home".

There are three hours to go until the assisted suicide appointment. He has no doubts. “If I had a curable disease, then perhaps I would try to go on. But I have neither a Plan B nor a Plan C.”  

Last words 

It is 1.45pm on Friday, just two days after his arrival. The sun is out after days of rain. He and his parents take a taxi to the lifecircle building near Basel. Preisig is waiting for them. She takes the family to a spacious room with a single bed, a big table, and a sofa. Everything is bathed in summer sunlight. 

Yoshi sits in a wheelchair at the table and signs one paper after another, an application for a death certificate, a declaration of consent for assisted suicide and one for cremation. Then he smiles. “Thank you. I am ready,” he says.  

At 2.45pm Yoshi takes off his shoes and lies on the bed. Dr. Preisig injects a needle into the back of Yoshi’s right hand. His mother stands on his left side and strokes her son’s shoulder repeatedly and tenderly.  

It is time to say goodbye. His father says, “Thank you for all the years you lived with us. You have always been precious to us. Have fun in heaven. We’ll be there soon.” And smiles.

Yoshi returns the smile. “I will wait for you,” he promises.

The intravenous bag is filled with a fatal dose of the sedative pentobarbital natrium. Everything is prepared.  

It’s exactly 3pm. Yoshi says, “OK, then I am off!” Without hesitating, he opens the valve of the drip.  

The deadly drug flows slowly through his body. Yoshi laughs: “Is it working? I can’t feel anything,” he says in a guttural voice, perhaps to hide his nervousness. 

Thirty seconds later, there are four little breaths like snores, his last sounds. 

As Preisig had explained beforehand, he has fallen into a coma. Three minutes later, the doctor lays a stethoscope on Yoshi’s chest and checks his pupils. She says quietly: “Yes, he has gone.”  

“No pain?” asks his father. Presig lays her hand on Yoshi’s and says. “Yes, no more pain.” 

The hand is still warm. 

*name changed for the article.

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