Yo Kusakabe, a retired geriatrician from Osaka now working as an author, has become an unlikely voice in Japan's escalating elderly care crisis. His 2003 novel "Haiyoshin (Useless Body)" has finally been adapted into a film released last month, thrusting his once-dismissed idea into the national conversation. The story centres on a young doctor who advocates for "A-care (Amputation Care)" — the removal of paralysed or non-functional limbs from elderly patients to reduce the physical strain on overwhelmed caregivers. Though the premise sounds callous, Kusakabe argues it deserves serious consideration as Japan confronts the demographic and logistical realities of becoming the world's second-oldest society.
The film has provoked intense reactions since its theatrical debut, with online reviewers calling it simultaneously "shocking," "the year's most controversial film," and "terrifying madness." Yet Kusakabe notes the novel was deemed entirely unfilmable when first published over two decades ago, suggesting a shift in how Japanese society now engages with uncomfortable questions about care and dignity. Some critics have found merit in the film's underlying proposition. One reviewer on the cinema website eiga.com observed that while amputation might seem ruthless and unethical, the argument "had a point" worth considering. This measured reception indicates that Japan's care crisis has become sufficiently dire that even radical proposals merit thoughtful debate rather than outright dismissal.
Kusakabe frames his argument as fundamentally practical rather than inhumane. Removing paralysed limbs, he explains, would make elderly patients physically lighter and reduce the biomechanical burden on caregivers, who often suffer serious injuries from lifting and repositioning bedridden patients. In "Haiyoshin," the protagonist points to concrete difficulties: non-functional limbs dangle awkwardly, tangle in clothing, create complications during bathing, and require constant attention. "If you cut them off, a female carer would have less difficulty lifting a hefty male patient or suffer less back pain," the 70-year-old physician said. He frames the proposal as conditional on informed patient consent, emphasising that it represents an option rather than a mandate — a choice patients could make if they believe amputation would genuinely improve their quality of life and their family's capacity to care for them.
Japan's elderly care system stands on the precipice of collapse. Nearly one in three Japanese citizens are now aged 65 or older, making the nation the world's second-oldest population after Monaco. The government projects a shortage of approximately 570,000 care workers by 2040, a shortfall that threatens the entire framework of long-term care provision. Kusakabe articulates the stakes clearly: "Japan's caregiving industry isn't collapsing yet — but with elderly people requiring care predicted to keep increasing, it is heading toward breaking point." This projection extends beyond abstract demographics; it reflects in the grim frequency of what Japan terms "kaigo satsujin" — caregiving murders. An investigation by public broadcaster NHK in 2016 revealed that such tragedies were occurring roughly once every two weeks, a statistic that underscores the desperation of family members and professional carers stretched beyond human endurance.
Kusakabe draws from his own clinical experience to describe how patients themselves sometimes expressed desire for amputation. During his career as a geriatric specialist, he encountered elderly individuals whose paralysed or immobile limbs caused chronic pain, hindered movement, and sometimes convulsed unexpectedly without voluntary control. From the patient's perspective, these useless appendages represented suffering rather than functionality. The film "Haiyoshin" explores this dimension by portraying amputees experiencing initial relief from pain and discovering newfound mobility within the constraints of their condition — maneuvring wheelchairs with greater ease and engaging playfully with their environment using their remaining bodies. This visualisation raises a profound philosophical question: what constitutes dignity in end-of-life care? Kusakabe poses it starkly: "Is it to try to put your immobile arms through sleeves with great pain, or not to suffer pain at all?"
The doctor-author's critique extends beyond his controversial proposal to encompass broader failures in how Japan approaches elder care. He observes that Japanese medical practice frequently sustains life through feeding tubes and intravenous nutrition for patients aged 75 and older, heavily subsidised by insurance systems that incentivise prolonged existence over comfortable decline. Families, confronted with their parents' deterioration, often feel psychologically unable to permit natural death, interpreting any withdrawal of intervention as abandonment. "Families simply cannot bear the thought of doing nothing," Kusakabe observes, "oblivious to the possible suffering such treatment is causing them." This contrasts sharply with Scandinavian approaches, particularly in Sweden and Denmark, where palliative care standards permit and even encourage allowing elderly patients to cease eating and accept death when the body's systems naturally shut down. Kusakabe identifies a fundamental cultural rigidity: "Japan blindly believes that even those clearly better off being left to die must be kept alive and that's the absolute right thing to do," perpetuating the cycle that crushes caregivers.
He recognises, however, that Japan's social structures and cultural values may render even his radical proposal impractical. Proposing voluntary amputation assumes a level of rational autonomy and family agency that Japanese society struggles to embrace. The same cultural forces that demand life-sustaining treatment regardless of suffering also create psychological barriers to accepting such a fundamental intervention. "This inability to take a bold, rational approach probably makes something as radical as A-care a poor fit for Japan after all," Kusakabe concedes. Notably, within the film itself, the initial enthusiasm for amputation care ultimately unravels following a tragedy that shatters the protagonist's confidence in the approach, suggesting even Kusakabe acknowledges the solution's limitations.
The emergence of this film adaptation now, two decades after the novel's initial publication, reflects how acute Japan's care crisis has become. The work functions as both provocation and mirror, forcing Japanese society to articulate precisely what values should guide elderly care when resources grow scarce and demand continues mounting. Whether or not amputation ever emerges as a genuine policy option, Kusakabe's argument has succeeded in making visible the hidden costs of Japan's current approach — the physical toll on caregivers, the ambiguity around patient dignity, and the cultural unwillingness to embrace less interventionist alternatives that other developed nations have adopted. The film's controversy, then, may matter less for advancing the amputation proposal itself than for cracking open a conversation Japan has avoided: how should a society care for its elderly in ways that honour both their dignity and the humanity of those who provide that care?
