Imagine: you have just turned 75, and are now eligible to receive a $1000 incentive to be euthanized. Not only that, but you can enjoy a “deluxe” death, as the government is willing to splurge on your last night of life by affording you a luxury hotel room, the most gourmet last meal you can dream of, and “farewell photographs” of you and your loved ones taken by a professional photographer. This is your opportunity to avoid the ravages of old age and disease. To be promised a quick and painless death, as well as a free burial. The posters, commercials, and public outreach efforts have all been persuasive, and you are seriously considering taking this next step, one that would inevitably be your last.
This is the premise of Chie Hayakawa’s “Plan 75,” a dystopian film set in a not-too-distant future, when the Japanese government has decided that voluntary euthanasia is the best way to ease the state’s burden of caring for the elderly. While speculative, Hayakawa addresses real anxieties about an aging population in Japan—and worldwide—head-on. According to the Population Reference Bureau, Japan has “the largest percentage of older adults in the world,” with more than 28% of the population over the age of 65.[1] Comparatively, a recent article from The Cut noted that “By 2034, for the first time in U.S. history, there will be more people over 65 than under 18, and that gap will widen thereafter.”[2] North of the border, 20% of the Canadian population will be 65 or older by 2027.[3] With many of these populations aging asymmetrically, questions of medical ethics, economics, and ageism have come to the fore.
People are living longer than ever worldwide, with medical advancements over the past 160 years adding almost 40 years to the average person’s life expectancy in the U.S. alone, “from 39.4 years in 1860, to 78.9 years in 2020.”[4] However, those fortunate enough to have access to life-prolonging medical interventions may not always want them—especially if they are suffering from conditions for which healthcare has no cure. As Karen Thornber writes, “Recent developments in medicine are regularly taken for granted, so much so that in many cases, it is easier simply to receive than to decline treatment, regardless of quality of life.”[5] In other words, while people are living longer lives, they may not be experiencing better quality of life. This begs the question: should older people, and people with chronic or terminal conditions, be allowed to decide when they can die?
Although there is currently no legislation and no apparent move towards voluntary euthanasia in Japan,[6] Hayakawa’s “Plan 75” does raise important questions for countries that do have laws for medicalized deaths. There are “Death with Dignity” laws in 10 U.S. states,[7] and voluntary euthanasia—also known as “voluntary assisted dying,” “physician-assisted death,” “physician-assisted suicide,” and “medical assistance in dying”—is federally legal in Colombia, Belgium, the Netherlands, Luxembourg, and Canada.[8] In Canada, where medical assistance in dying (MAiD) became legalized in 2016,[9] the government is now deciding whether to expand MAiD’s jurisdiction to include people with mental illness. Some welcome this potential development, while others fear the slippery slope that might ensue.
Despite opening dialogues about MAiD’s inclusion of mental illness into its criteria, in February 2024, the Canadian government decided to postpone the decision for another three years.[10] Among the concerns about expanding MAiD are issues around informed consent, loneliness, and poverty. For example, “A recent study of assistance in dying for individuals with mental illness in the Netherlands found that in more than half of approved cases…many cited loneliness as an important reason for wanting to die.”[11] A global epidemic of loneliness—exacerbated by COVID-19—has left millions feeling hopeless. Increasing access to medical assistance in dying for people experiencing loneliness and poor mental health is not the solution. Systemic changes are.
In “Plan 75,” the film’s protagonist, Michi, is a working woman in her 70s. Michi loses her job as a hotel cleaner following the death of an older employee during a shift. The employers, we learn, are concerned about the optics of employing older women who may be in poor health. After becoming unemployed, Michi loses touch with her work friends, struggles to find a new job, and is evicted. It is at this time, when she finds herself unemployed, lonely, and on the verge of homelessness that she decides to pursue Plan 75. Her situation is not the stuff of dystopian cinema. Global inflation has placed significant strain on economies around the world, resulting in transnational housing crises and rising levels of homelessness. Healthcare systems are overwhelmed with staffing shortages and mounting medical needs. These systemic issues have made life itself hard to sustain, particularly for those with low socioeconomic status, disability, and mental illness—many of whom are also Indigenous and people of color.[12]
In Canada, a country known for its social welfare system, MAiD has become one of the most viable options for people living in poverty with chronic health issues. For instance, Amir Farsoud, a disabled Canadian man, lost access to affordable housing last year, and was prepared to use MAiD to avoid homelessness. Fortunately for Farsoud, a Toronto reporter got wind of his situation. His story went viral, and a GoFundMe campaign was set up, raising over $60,000, and allowing him to find new housing.[13] According to Farsoud, he told his doctor that although he had medical concerns, the primary reason for which he was seeking MAiD was economic. “The doctor approved Amir for MAID under grounds of ‘unbearable suffering’ – which means that after a 90-day assessment and waiting period, he could be euthanized.”[14] Farsoud’s situation is not unique.[15]
Poverty is driving more Canadians towards MAiD, and a significant number of Canadians believe that poverty alone should warrant access to assisted death. According to a 2023 poll, “If a Canadian’s only affliction was ‘poverty,’ 27 per cent said they would be fine with legalizing that person’s access to MAID.”[16] While expanding MAiD in Canada—and creating national programs for voluntary euthanasia elsewhere— is a serious concern for many, perhaps more unsettling is the lack of infrastructure to support those in need. Medical assistance in dying should not be a “quick fix” for systemic issues like lack of affordable housing or health care. And yet, “Plan 75” is such a powerful film because it shows us how quickly societies can become immune to empathy as they prioritize economics over human life.
Works Cited
[1] “Countries with the Oldest Populations in the World.” Population Reference Bureau, March 23, 2020. https://www.prb.org/resources/countries-with-the-oldest-populations-in-the-world/
[2] Jezer-Morton, Kathryn. “Raising Kids is the ‘Best Job in the World.’ Why is Caring for the Elderly the Worst?” The Cut, September 13, 2023. https://www.thecut.com/2023/09/how-will-we-care-for-our-parents-elder-care-crisis.html
[3] Stokes, Deborah. “Aging in place: How Baby Boomers are breaking Canada’s real estate market.” National Post, January 26, 2022. https://nationalpost.com/news/canada/why-baby-boomers-are-breaking-the-real-estate-market-in-canada
[4] https://www.statista.com/statistics/1040079/life-expectancy-united-states-all-time/
[5] Thornber, Karen Laura. Global Healing: Literature, Advocacy, Care. Leiden: Brill, 2020. 90.
[6] Asai, Atsushi, et al. “Japan should initiate the discussion on voluntary assisted dying legislation now.” BMC Medical Ethics 24.5 (2023): 1-10.
[7] Haring, Chris. “Medical Aid in Dying as An End-of-Life Option Offers Death with Dignity.” Death with Dignity, March 29, 2023. https://deathwithdignity.org/news/2023/03/3-29-23-senior-guide/#:~:text=That%20is%20euthanasia%2C%20which%20is,and%20prescribes%20the%20medication%3B%20however%2C
[8] “Legislative Background: Medical Assistance in Dying (Bill C-14, as Assented to on June 17, 2016).” Government of Canada, February 2, 2023.
[9] Ibid.
[10] “The Government of Canada Introduces Legislation to Delay Medical Assistance in Dying Expansion by 3 Years.” Government of Canada, February 1, 2024.
[11] “Legislative Background: Medical Assistance in Dying (Bill C-14, as Assented to on June 17, 2016).” Government of Canada, February 2, 2023.
[12] Tanatarova, Elmira. “Disabled Canadian Man celebrates his ‘deathaversary’ a year on from the day he was supposed to die…” The Daily Mail, May 14, 2024. https://www.dailymail.co.uk/femail/article-13413075/Disabled-Canadian-euthanasia-programme.html
[13] Ibid.
[14] For context, while MAiD requires a 90-day waiting period, “waiting lists for social housing in Ontario can be over a decade.” See: https://www.dailymail.co.uk/femail/article-13413075/Disabled-Canadian-euthanasia-programme.html
[15] For more stories like Amir’s about the challenges for Canadians with disabilities living in poverty, see: https://www.cbc.ca/radio/thecurrent/maid-poverty-disability-1.6687453, https://globalnews.ca/news/9176485/poverty-canadians-disabilities-medically-assisted-death/, https://nationalpost.com/news/canada/canada-maid-assisted-suicide-homeless.
[16] Hopper, Tristin. “One third of Canadians fine with prescribing assisted suicide for homelessness.” National Post, May 16, 2023. https://nationalpost.com/news/canada/canada-maid-assisted-suicide-homeless
Cover Image: “Plan 75” Poster from KimStim, reproduced with permission from artist.
