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The concept of total suffering is widely recognized in palliative care (PC), encompassing a range of interconnected and complex factors that collectively shape the evolving and individualized experience of a patient’s illness journey. Studies on will to live (WtL) in terminally ill patients have demonstrated its variability over time and various factors that influence these changes.
Methods
To objectively investigate the concept of total suffering and WtL; including their fluctuation over time and associations with sociodemographic, clinical, physical, and psychological symptoms in a sample of individuals with life-limiting conditions receiving PC. This multicenter Iberian study involved 3 centers in Portugal and 1 in Spain. A total of 107 individuals with life-limiting conditions consented to participate. To capture the dynamic and multifaceted components of total suffering, we had each participant completed the Edmonton Symptom Assessment Scale (ESAS) along an additional WtL visual analogue once daily over a 30-day period.
Results
WtL demonstrated various patterns over time. While some patterns reflected relative stability, other demonstrated substantive fluctuation during the course of illness. Significant correlations were observed between WtL and all other ESAS items. Moderate positive correlations were found between WtL and total ESAS score and its physical and psychological sub-scores. Spearman’s correlation coefficients between all physical and psychosocial items on the ESAS were statistically significant across all 45 correlations performed, with only 5 showing moderate strength; the remaining correlations were weaker.
Significance of results
Evidence-based understanding of WtL is critical to improving care for patients who experience suffering toward end-of-life and their families. Further research is needed to inform and refine interventions targeting total suffering.
On the 23rd and 24th of April the first round of negotiations for the Japan-Australia Economic Partnership Agreement (EPA) was held in Canberra, the Australian capital. This is the first negotiation since the telephone conversation four months ago between Prime Ministers Abe Shinzo and John Howard, in which a decision was made to begin negotiations. To avoid negative political repercussions the negotiations were scheduled to follow the Japanese General Election and were held in Australia.
The internet has become an increasingly influential medium throughout East Asia. In this article we examine the case of Kenkanryu (‘“Hating ‘The Korean Wave’“), a manga published in 2005 in hard copy, but available online as a web comic for many months prior to print publication. We argue that the content, while nationalist, xenophobic, and ‘toxic’ is only one of a number of other, media-related reasons for the sales success of this comic in Japan. Other factors are the influence of online chat groups, the web as a means of communicating and selling ideas and products, and the internet-savvy way in which supporters of the views expressed in the comic communicated with online readers. In the context of increasing fears that Japanese youth are becoming more ‘nationalistic’ we argue that it is important to examine the medium as much as the message in assessing whether we are witnessing the emergence of a significant and dangerous social movement, or something rather different.
While other articles in this course reader treat the earlier forces that created and framed Zainichi, Rumi Sakamoto's article deals with the discourse in contemporary Japan concerning Zainichi Koreans. As John Lie recognizes in his article, many Japanese still view Zainichi Koreans with racist animosity; this is also the case in cyberspace.
When I heard the sudden news of the death of North Koreans leader Kim Jong-il,I felt as if I had been struck by lightning. Since his miracle recovery from the 2008 stroke, he had been busy travelling in and outside North Korea. Both he and others around him would have been concerned about his health, and also prepared for this moment. His death must have been such a huge regret for Kim himself, who was single-mindedly focusing on keeping his public promise to open a ‘big gate’ for a ‘powerful and prosperous Korea’ by the 100th anniversary of the birth of his father, Kim Il- song in 2012. As one Japanese who has been hoping for normalization of Japan-North Korea relations for the last 10 years, I could not but grieve over the death of the leader of our neighbouring country, who, more than anyone else, hoped to realise this goal. The Japanese government and people have lost their best chance to achieve normalization. The last decade has now become a lost decade.
On August 31, President Obama delivered a speech from the White House. Because he was expected to declare the end of the Iraqi war, the entire nation focused its attention on the content to the speech. ‘Operation Iraqi Freedom is over. … We have spent over a trillion dollars on this war, often financed by borrowing from overseas. This, in turn, has short-changed investments in our own people, and contributed to record deficits.… Our most urgent task is to restore our economy, and put the millions of Americans who have lost their jobs back to work’. It marked the beginning of a new era, and under other circumstances this speech would have impressed people. The president, however looked troubled, and the atmosphere was gloomy – hardly the context for a forward-looking policy announcement; this was largely due to the severity of the economic crisis the US currently faces.
The phrase ‘sixty years of the post-war’ is often used to mean ‘60 years since the end of the war’ or ‘these past sixty years’. However, the term ‘post-war’ itself is premised on a ‘pre-war’ and a ‘wartime’. In other words, prior to the sixty years of post-war, there is the disjuncture between ‘post-war’, on the one hand, and ‘pre-war’ and ‘wartime’ on the other. For me, it is this experience of disjuncture that is the starting point of ‘post-war’.
From the Japanese point of view, the 1990s and 2000s are characterised by two broad historical shifts. The first is globalization. The word has many nuances but is most often taken to mean the expansion of economic interconnectivity between countries. In 1970 just under a million Japanese went overseas; by 2000 that number had risen to nearly 18 million. Likewise, in the 1970s, China was relatively isolated, its foreign trade a mere 20 billion USD in 1978. Now it is the axis of production on which the world economy turns, with about 3 trillion dollars in total imports and exports. Globalization also signifies the more rapid movement of people, information, ideas, and cultural forms across borders. In 1986 Japanese Prime Minister Nakasone Yasuhiro made the shocking comment that “So high is the level of education in our country that Japan's is an intelligent society. Our average score is much higher than those of countries like the U.S. There are many blacks, Puerto Ricans and Mexicans in America. In consequence the average score over there is exceedingly low.” Why did he say what he was thinking? Perhaps he lacked awareness that something said in Japanese at a press conference in Japan would be picked up by the world outside Japan's borders. Japanese politicians are still gaffe-prone, but now all know their comments may be tweeted around the globe in seconds. Importantly, Japanese, Chinese, South Koreans, and others now have quick access to information about historical narratives prevalent in other societies.
It is often said that 9/11 has changed the world. Certainly, the world being swayed by the wars in Afghanistan and Iraq in the wake of that event appears to prove the saying correct.
But as far as the basic structure of today's international politics is concerned, the world underwent a drastic change when the Cold War ended. 9/11 served as a catalyst to make the structural change all the more manifest.
Sushi, not long ago a quintessentially Japanese product, has gone global. Japanese food, and sushi in particular, has experienced a surge in international popularity in recent decades. Japanese government estimates that outside of Japan there are over 20,000 Japanese restaurants, most of which either specialize in sushi or serve sushi (MAFF 2006; Council of Advisors 2007). Some estimate the number of overseas sushi bars and restaurants to be between 14,000 and 18,000 (in comparison, the number of sushi restaurants in Japan is estimated to be around 45,000) (Matsumoto 2002: 2). Sushi stores today can be found across Asia, the Americas, Europe, Russia, Africa, Oceania and the Pacific. The phenomenon has accelerated rapidly since the turn of the millennium.
I'd like to start with a big question: “can the media overcome nationalism?” I ask this because the words “national interest” have been used both casually and often in communicating everyday information. The Japanese media seemingly lack awareness that these words are used contiguously with the words “conservative swing”. What I'd like to know is the proportion of Japanese who felt angry versus those who remained calm when Korean president Lee Myung-bak visited Takeshima (Dokdo), and how that number changed when people learned that the reason for his visit was to pressure the Japanese government to take responsibility for the comfort women of the former Japanese military. But the Japanese media are uninterested in such things. As I write this, what is on my mind is the capacity (or lack thereof) of Abe Shinzo, who has been re-elected as LDP leader, to make political judgements. In the LDP's draft election pledges, the party proposed to create an official “Takeshima Day” and to continue to object to “unreasonable viewpoints” regarding comfort women issues. Abe is also calling for a revision of the Constitution and proposing the establishment of “national defense forces.” Can such a person provide an answer to such complex territorial issues and historical awareness? The editorial of Chosun Ilbo on 22nd November asked: “How can Abe meet with leaders of South Korea and China as Prime Minister, based on this election pledge?”
On September 30, 2011, an outfit named GumshoePictures uploaded on YouTube a video entitled “The True Origins of Pizza,” which, in the format of a brief documentary (3:44), reminiscent of those seen on such stations as the Discovery Channel, investigates an apparent historical puzzle: a series of speakers, from academics to a blogger and a representative of the “Korean Culinary Center,” are interviewed and advance evidence that pizza originated in Korea and had been “stolen” by Marco Polo, much as he had reputedly brought back noodles from China to Italy as spaghetti. Before we engage in an analysis of this remarkable well-produced clip, let us first encourage readers of The Asia-Pacific Journal who have yet to see this video to watch it, unencumbered by any spoilers or the authors' own opinions. At this point, viewers conveniently have a choice of watching mirrored versions: one in English, without the distraction of text crossing the screen in front of them; a version with Korean subtitles, uploaded on October 4, also by GumshoePictures; and a version with Japanese subtitles, uploaded on October 12 by “CoreanCulture.” We embed all of them below, for reception of the clip has differed according to context, and readers may wish to examine the comments on each separately: as of October 28, the first had 451,000 views and a roughly 1,400 to 200 like to dislike ratio; the second had slightly fewer views (356,000), but a strikingly different 1050 to 1,150 like to dislike ratio; while the third had 63,000 views, and an 800 to 200 like to dislike ratio:
On June 24, 2007, two US Navy minesweepers entered the small Sonai port in Yonaguni island, the westernmost Japanese island near Taiwan, on a ‘good-will visit and crew R and R’. Okinawa prefectural governor Mr. Nakaima had stated that the ‘US Navy warships should use the designated ports such as White Beach and Naha Military Port and should not use civilian ports’. He asked the Commander, US Naval Forces, Japan to voluntarily refrain from entry into Sonai port; Mr. Hokama, the mayor of Yonaguni town and its residents had also expressed opposition, but they were ignored. According to the Division Chief, North American Affairs Bureau, Ministry of Foreign Affairs, who visited the Yonaguni town office prior to the vessels' visit, ‘due to the provisions of the SOFA (Status of Forces Agreement), the heads of local public bodies have no right to reject the US minesweepers’ visit to their ports. There is no choice other than to accepti their entry into the port.'
On 18 September 2009, a person using the online name of ‘xegnojw’ posted a four-minute video on YouTube entitled ‘Japanese Racists Hoot Down Korean Tourists in Tsushima’. It depicted members of a Japanese nationalist group harassing Korean tourists on Tsushima, a Japanese island 138 km from Fukuoka and 50km from Busan. This island has been attracting attention from Japanese nationalists because of the increasing presence of Korean tourists and Korean investment since the 2002 opening of high-speed ferry service between Busan and Tsushima. Nationalist campaigns over the island intensified when Korea's Masan City adopted the ‘Tsushima Day’ bill in 2005, claiming that Tsushima should be a Korean territory, thereby countering Shimane prefecture's ‘Takeshima Day’, establishing Japanese claim to Korea's Dokdo island. The YouTube video in question captured several flag-holding Japanese men and women yelling: ‘Go home, Koreans!' and ‘We won't allow a Korean invasion!' at tourists fresh off the ferry from Busan. Though not physically violent, the atmosphere was tense and disturbing.
As a study of the influence and nature of popular nationalism in Japan, this article examines the relationship between nationalism and history in Kobayashi Yoshinori's bestselling manga comic, Sensoron (On War, 1998). Sensoron heralded the recent trend of nationalistic manga targeted at younger generations and has been instrumental in popularizing the ideas of new-generation rightists and historical revisionists over the last decade. Kobayashi explains his strategy as “using the language of daily life in order to discuss politics and ideas”, adding that he created Sensoron as “something that intellectuals cannot write — something that young people find pleasure to read and get completely absorbed in, and yet is not light but deep”. He also emphasizes that what he writes is based on the “common sense of common folks (shomin no joshiki)”. Such an anti-elitist strategy, along with constant caricaturizing of academics, journalists, political activists and politicians as “uncool old men (dasai oyaji)” as well as his well-constructed and marketed charismatic personality, has proved very successful. Indeed, via the popular medium of manga, Kobayashi has ostensibly “created a discourse that is more influential than that of any other “theorist” in the 1990s”.
Since his war legislation has failed to gain public support, Prime Minister Abe has suddenly brought up the China Threat as a last resort. However, a rational analysis of reality reveals that the theory is unfounded.
On July 21, 2015 a defence white paper was published. Unusually, it contained an addenda with a statement inserted at the end of a section on China: “China has been building new offshore platforms and other facilities on the Chinese side of the Japan-China median line in the East China Sea since June 2013. Japan has repeatedly lodged protests against China's unilateral development and demanded the termination of such works.”
To many, the 2015 Japan-South Korea agreement to finally settle the Korean “comfort women” issue came as a surprise. For over two decades Japan's wartime military sexual slavery remained the single most contentious issue dividing Japan and South Korea, severely affecting the bilateral relations and even becoming a concern for the US, which saw the tension between two of its allies in the Asia Pacific as troublesome. The 2015 comfort women agreement has promised that, with Japan's one billion yen funding to assist the survivors together with a sincere apology, the “comfort women” issue will be “finally and irrevocably” resolved. While some media hailed this as a landmark resolution and an opening of a new, more positive era for Japan-Korea relations, it has also provoked a deep sense of dissatisfaction and anger among “comfort women” advocacy groups, feminists and the former Korean “comfort women” themselves. It seems clear that the state-state “agreement” (made without any consultation with the survivors) will not restore “dignity and honour” to the victims. After all, one of the origins of current antagonisms surrounding the “comfort women” issue is another state-state deal, the 1965 Japan-ROK Basic Relations Treaty, which failed to address the “comfort women” and closed the door on individual redress claims. The recent agreement is not the end of the “comfort women” issue – especially for the survivors.
Denigrating women who survived comfort station internment is critical to protecting the historical record of the Japanese military and the contemporary reputation of the Japanese government, as Nishino Rumiko and Nogawa Motokazu make clear in these two articles. They describe recent efforts from a range of quarters to ‘injure the victims all over again, rubbing salt in their wounds and violating their human rights’. Recent attacks on survivors include Japanese newspaper companies retracting and publicly disavowing reportage that uses the term ‘sexual slavery’, Japanese politicians equating the fabricated writings of a man (Yoshida Seiji) with the actual historical experience of female victims and the documentary record, and the prime minister tacitly suggesting that claims lodged by survivors in the international sphere hurt the feelings of the Japanese populous and damage its pride.