Presentation Information
[SY-88-01]From DNR to Psychiatric Euthanasia: Ethical Asymmetries and Cultural Normalization
*Itsuo Asai (Heart Clinic Medical Corporation(Japan))
Keywords:
Euthanasia,Active,Mental Disorders/therapy,Cultural Characteristics,Ethics,Clinical,Biopolitics
The global expansion of euthanasia frameworks into psychiatric care raises urgent ethical and cultural questions. While jurisdictions such as the Netherlands, Belgium, Canada, Spain, Colombia, and Luxembourg now permit euthanasia for persistent psychiatric suffering, the normalization process varies across institutional and cultural settings.This presentation begins with a comparison between Do Not Resuscitate (DNR) orders and psychiatric euthanasia, highlighting ethical asymmetries. Somatic DNR is typically bounded by formal criteria and legal clarity, whereas psychiatric euthanasia often operates under vague or inconsistent standards. Drawing on official data from the Dutch Regional Review Committees and Health Canada’s MAiD reports, we demonstrate that psychiatric euthanasia has increased markedly in systems where procedural clarity exists without equivalent ethical depth.Japan presents a distinct case. Despite lacking psychiatric DNR protocols, cultural patterns of institutional obedience, social harmony, and the suppression of dissenting voices may lead to the rapid routinization of psychiatric euthanasia if legalized. In such a context, procedural safeguards may function more as mechanisms of compliance than as spaces for moral deliberation. We draw on Michel Foucault’s concept of biopolitics, which explains how institutions govern life “not by telling people what to do, but by defining what is normal, healthy, or valuable—and organizing life accordingly.” When psychiatric suffering is processed through eligibility algorithms and legal templates, care itself risks becoming a technocratic act of exclusion.Guided also by Arendt’s “banality of evil” and Kleinman’s “moral listening,” we argue that psychiatric euthanasia is not merely a clinical or legal issue, but a cultural and ethical one. Policymakers, review boards, and clinicians must look beyond procedural legality and engage in culturally grounded ethical reflection. What counts as care—and who decides—remains not only a clinical concern, but a global moral imperative.