July 6, 2022

Kodokushi: Japan’s problem with the old and isolated

The ethics of pressuring the elderly to have wearable devices


One consequence of the Covid-19 pandemic in Japan appears to be an increase in kodokushi or solitary deaths. An article in BMC Medical Ethics describes the problem and reviews possible solutions and ethical complications.

With its low birth rate, small families, and rapidly ageing population, Japan has a serious problem with social isolation of the elderly. Reliable statistics are scarce, but in 2003 in Tokyo, there were 1,451 cases of kodokushi; by 2018, that figure had nearly tripled to 3,882.

The new Japanese Prime minister even appointed a “minister for loneliness”, Tetsushi Sakamoto, in February. There are companies which specialise in the grisly business of cleaning up houses or flats where people died alone. Sometimes they are discovered months later.

The journal article evaluates technological fixes. One solution to the social isolation of the elderly is a wearable gadget which transmits information about their well-being to a monitoring agency and also allows them to ask for help if they are in distress.

Should this be mandatory? Given the cost of cleaning after kodokushi, landlords may demand that elderly people wear it as a condition of their lease. This should be avoided, the authors believe:

This is likely to hamper the effectiveness of the resulting system and to the extent that compliance failures are associated with social inequalities, is likely to produce the worst outcomes for the most socially vulnerable.

It would also trespass upon their dignity:

legal or contractual requirements the use of wearables promote adversarial relationships in which intrusive monitoring is instituted to advance the interests of more advantaged parties—such as property owners seeking to preserve the value of their assets—without adequate regard for the autonomy, privacy and personhood of individuals in an already vulnerable population.

They conclude that wearables appear to be a necessity in an ageing population, but they should be used carefully:

Wearable devices provide hold promise as a promising platform for reducing solitary deaths and for linking socially isolated individuals to a broader range of health and social services. But these technologies cannot be effectively deployed in these populations on terms that respect older persons without considerable social support. This support includes closing the digital divide, tailoring devices to user preferences, supporting the ability of users to generate value from these devices and ensuring that there is proper governance of the information they produce.

Michael Cook is editor of BioEdge

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