• 🏆 Ranked 20th in the 2022 Kinokuniya Humanities Award

  The Kinokuniya Humanities Award is a Japanese book prize organized by Kinokuniya, one of Japan’s leading large bookstore chains, highlighting outstanding humanities titles each year.

Preface

In the various settings of our daily lives, we are often cast into categories that generalize our very existence—”human,” “Japanese,” “man,” “woman,” “Baby Boomer,” or “Gen Z.” Whether these labels are imposed by others or embraced by our own choice, we live our lives being explained through them.

*Human beings are creatures of imagination.*

*Generation Z holds values utterly different from those of the Baby Boomers.*

And so it goes.

What is striking is that these categories almost always carry a set of values and ethics—expectations of how one “ought” to be or act once inside that category.

*”Humans are meant to help one another.”*

*”If you are a man, don’t cry; if you are a woman, look after the home.”*

*”If you are sick, you should remain quiet and stay at home.”*

To name oneself or another through a category is, in essence, to take on—or to force upon someone—the entire apparatus of values and ethics attached to it. Certainly, once we confront these values, we can resist them. When such resistance spreads, the very definition and value of the category itself may transform. Yet, the very possibility of resistance or transformation exists only because those values and ethics were tethered there in the first place.

This holds true for medicine, the focus of this book. Max Weber, in *Science as a Vocation*, described the values shared by medicine—one such category of academic discipline—as follows:

The general ‘presupposition’ of the medical enterprise is stated trivially in the assertion that medical science has the task of maintaining life as such and of diminishing suffering as such to the greatest possible degree.

Citing these words, Weber notes that even when a terminally ill patient begs to be allowed to die, “the presuppositions of medicine, and the penal code, prevent the physician from relinquishing his therapeutic efforts”. Yet, he then moves to suspend that very premise:

Whether life is worth while living and when–this question is not asked by medicine.

I want to focus on Weber’s firm assertion that no discipline, medicine included, can provide an answer to life’s most essential question: “What shall we do, and how shall we live?” . Following his logic, the act of preserving life or alleviating suffering does not, by necessity, have to be the way of living for each of us.

If scholarship cannot tell individuals what they should do or how they should live, then what is its purpose? Weber finds the answer in clarity.

If someone declares that “A is God,” the task of scholarship is to make as clear as possible *why “*A” functions as God for that person. It is not the task of scholarship to prove whether A is “truly” God, or whether A is objectively valuable.

Naturally, those who commit themselves to a discipline do so on the premise that their work has value. I, too, believe in the value of my own field, anthropology. However, whether anthropology possesses such value cannot be proven by any objective, external metric.

And yet, among all disciplines, medicine is the one that most easily oversteps the boundaries Weber set. This is because medicine is built upon the premise of “saving lives.” Medicine imposes the assumption that preserving life is inherently valuable—even upon the person being saved. Moreover, this premise is often shared unquestioningly by the patient, for the simple reason that, in most cases, people do not wish to die.

By the latter half of the 20th century, however, this life-saving premise began to be questioned. There are two primary reasons for this. First, the medical premise of saving lives began to seep into every corner of our daily existence with unprecedented force, wielding health as an unassailable morality. Second, the evolution of medical technology made it possible to save lives to a degree never before imagined, resulting in a society where people live significantly longer.

It is worth noting that it is physicians themselves who are casting doubt on this premise. For instance, Petr Skrabanek—a doctor and former editorial board member of *The Lancet*—wrote with biting irony in his 1994 book “Death of Humane Medicine: And the Rise of Coercive Healthism” about how the medical community scrutinizes the myriad risks hidden in our diet:

It seems that if you eat, you die

Regarding the second point, Naoki Nagō, a physician practicing in Japan—one of the world’s leading countries for longevity—observes:

Japan has achieved health and longevity at the highest level in the world. There was once a politician who, during a budget debate over supercomputer development, famously asked, “Is being second place not good enough?” But regarding health and longevity, we have moved past “Is second place not good enough?” to a state of “Is even first place still not good enough?” And apparently, even first place is not enough. One can only say that something has gone awry. (translated from the original Japanese edition)

Medicine, in principle, should not answer the question of how we should live. Yet, when it brandishes terms like “health,” “prevention,” and “precious life”—accompanied by “correct knowledge” adorned with statistics and warnings of the “difficult life” that awaits those who fall ill—the medical ethic of life-saving easily becomes the governing ethic of our individual lives—Eat this way to stay healthy; exercise like this; interact with people like this; use this technology to live even longer.

One might ask: *What is wrong with that?* But when this ethic runs unchecked, it eventually collides with the inescapable fate of being human: “People fall ill, and people die.”

With these concerns in mind, I wish to carefully untangle the value of medicine from the value of living as a human being. I will depict the process by which preventive medicine—rooted in epidemiological statistics—becomes internalized by individuals(Part 1), and examine the language and underlying philosophy that seeks to save those who nonetheless fall into crisis (Part3). Finally, I want to pose a question about how “this very ‘I’” is generated, alongside a reflection on the nature of time.

I write this book in the hope that it reaches those who feel a sense of unease toward the “rightness” championed by our risk-management society—and that it may help bring clarity to that very unease.