Toward a Society Where One Can Depart Feeling Loved
Interview with Ms. Kumiko Shibata
— Kumiko Shibata, President of the Japan Transition Doula Association
In 2040, Japan will face an unprecedented era of mass death. Nearly 500,000 people will become “end-of-life refugees” with not even a proper place to pass away. In such a scenario, how will we find meaning in life? We asked Ms. Kumiko Shibata, who carries out end-of-life care activities nationwide, for her insights. (KoichiTanaka)
Working with “Dignity” as the Central Theme
— You have been warning about the “2040 problem.” Many understand that Japan is experiencing a declining birthrate and an aging society, but what comes next? In 2040, Japan will face a society of mass death unlike anything it has experienced before.
According to statistics published by the Ministry of Health, Labour and Welfare (from the “Vital Statistics” and “Future Population Estimates”), the estimated annual number of deaths in Japan in 2040 will be about 1.67 million. Of these, roughly 910,000 people will die in hospitals, 200,000 at home, and 70,000 in other settings such as care facilities. However, 490,000 people will become “end-of-life refugees” with no place to die. Yet, this issue hardly ever makes headlines.
Wanting more people to be aware that such a future is coming, I even created the film “Mitorishi”(Concept: Kumiko Shibata, Director: Mitsuhito Shiraha). It was highly acclaimed at an American film festival, winning three awards. Unfortunately, due to the COVID-19 pandemic, screening it domestically in Japan has become very difficult.
For about 30 years, I have been working with the theme of “dignity”—which in essence means promoting “dying at home.” It is only now that the Ministry of Health, Labour and Welfare is urging us to promote the “community-based integrated care system” and shift care to the home—a necessity in these challenging times. Yet, such an important message has still not reached the general public.
The Moment When Life Connects to the Next Generation
Passing on “life” to the next generation is the very reason we live, and I want to show that to our children.
I worked for McDonald’s Japan for 16 years—a workplace that prized speed and efficiency. There was even a time when I fell ill and had to be rushed to the hospital by ambulance. I was fortunate to recover, and in that moment, I thought, “This is a message to live,” which set me on the path of discovering what I was meant to do.
At that time, I recalled my father, who died when I was in elementary school. With his last words being “Thank you,” he held my hand as he passed away. I felt an incredibly luminous atmosphere in that moment, and I thought that if the world could be that beautiful, I wanted to share it with many others. That was the beginning of my journey in end-of-life care.
Later, I spent 14 years living on a remote island and then 10 years working at an end-of-life care house, during which I learned a great deal.
I believe that when we are born we receive three gifts: our body, a good heart, and a soul. While our bodies change with every moment, the energy that builds up in our soul is passed on to those around us. The late Setouchi Jakuchō spoke about this very idea. Nowadays, when someone dies in a hospital, the body is taken to the mortuary and funeral homes apply dry ice, meaning the family can no longer touch the body—or if they do, it remains cold.
At the sites where we, as Transition Doula, work, we do not keep dry ice on board 24 hours a day. This way, the body remains warm, and because family members are able to hold the deceased, it stays even warmer. For example, family members may continue to hold and touch the body until everyone has arrived, and at that moment we revisit the care process. Using the end-of-life care rituals I advocate, each family member gets to hold the deceased. By ensuring a proper farewell is observed, we provide grief care on the spot. This is what it means to “connect life.”
In Buddhism, there is a term “Rinmei Shūji” (often shortened to “Rinju”), which means “to be present at the time when life is handed over.” It is a time for the family to say their final goodbyes.
I am always moved by elementary school children—they immediately hug the deceased. In one instance, a little girl came in crying and immediately embraced her grandmother. Later, I learned that the child had only met her grandmother a handful of times. I witnessed a moment when life was passed on to the next generation.
During the end-of-life care process, memories often resurface. For instance, some couples, knowing only of the deceased husband or wife, would recount memories to us for hours. By saying farewell so carefully and without regrets, I have seen time and again that life truly connects.
Learning About Death
— What is most important so that everyone can face “that moment” with hope?
I believe it is to learn about death. I place great importance on educating families in the field. Simply asking people to “be together” during the time of passing on life doesn’t work if they do not understand death.
It is not that one must be physically present at the moment of death. Since energy is already being released, performing the end-of-life care rituals at that time is more than enough. Over 30 years, I developed a technique called “Tainai Taikan” (Inner Body Experience). Derived from introspection, we also offer training that encourages looking within one’s heart. By re-experiencing the moment of passing and redoing the end-of-life care process, the heart feels considerably lighter and free of regrets.
— Could you introduce your nationwide activities?
We have now established 54 end-of-life care stations across the country, with over 2,800 resident Transition Doula. We operate on a 24-hour basis so that we can always be there when needed.
Half of the individuals who become Transition Doula are nurses—so many already have practical field experience. Thirty percent are certified care workers. Additionally, there are many religious figures who serve as Transition Doula. I have long respected Mother Teresa and have pursued her dream, and everyone who comes together here shares that sentiment. This is why I believe volunteerism can thrive in our field.
However, regional disparities still exist, and I want more people to truly understand what being Transition Doula entails
Toward a Society Where One Can Depart Feeling Loved
— In your work, restoring human relationships seems to be the most important element.
I believe nothing is more important. Although we provide various forms of care, what we cherish most is the restoration of human relationships. We also serve as a bridge connecting the deceased with their family.
When end-of-life care is performed at home, and every family member holds the deceased, it opens up a space for all to listen to one another. This process softens hearts and greatly improves family relationships.
We live long lives—80 or 90 years—and in that final period, whether it is a year, two years, or even just ten days, we must hold our hearts in reverence and accept even our selfish needs. In that moment, money, knowledge, and everything else become meaningless.
The most important dignity remains with the individual. By ensuring that they are brought home properly and given a thoughtful farewell, that dignity comes alive. This is the new form of farewell I propose. Although we are still learning, I believe that the departed would be profoundly satisfied, feeling that they were so well cared for and held.
For those who say, “I’d rather be at home,” we arrange for flowers and set up an altar. Whether one suffers from dementia or is living alone, staying at home is possible. I believe this represents the essence of Japan’s farewell culture. Recently, even people from Korea and China have come to study Transition Doula with us.
— The experience of both loving and being loved is what remains at the end of life, isn’t it?
Our dream is to create a society in which everyone, at the end, can depart feeling loved. In that sense, even if one does not reach the moment of death in time, there is no need for sorrow—the soul continues to live. In the final 24 hours, let us give our time to the loved ones who have cared for us so diligently. Let’s pass the baton to the next generation. By doing so, our children, too, will feel loved and remain connected.
Connecting life is not a trivial matter. I hope we can create a society where everyone truly feels the weight and value of life.
Kumiko Shibata
President, General Incorporated Japan Transition Doula Association
Born in Izumo City, Shimane Prefecture. After working in private enterprises and elder care facilities, she established an end-of-life care house on a remote island for those experiencing natural death. Following 10 years of dedicated work, she founded the “Japan Transition Doula Association.” In addition to accompanying people in their final journey as Transition Doula, she also promotes the “culture of end-of-life care” through lectures. She serves as a part-time lecturer at Kibi International University and Kobe Nursing College. Her awards include the 2024 Sugiura Regional Medical Promotion Award (Sugiura Memorial Foundation), the 2017 Wisdom Contribution Award (Beijing Shifangyuan Public Welfare Foundation), and the 2007 Social Contributor Award (Social Contribution Support Foundation), among others. Her published works include “Thank You Is a word of Prayer” and “I Am an End-of-Life Care Specialist”, among others.
