Good Death Among Elderly Japanese Americans in Hawaii

The purpose of this focused ethnographic study was to describe the patterns of a good death held by elderly Japanese Americans living in Hawaii. Eighteen "healthy active" elderly Japanese Americans were interviewed individually. In addition, supplementary data, such as interviews with experts and field observations were collected for triangulation of the data. Four themes were derived from 1224 keywords, 56 categories, and 13 patterns. These were: being a burden to the family, process of life and death, individual views on death, and Japanese culture in Hawaii. Being a burden to the family was the largest concern in the participants' idea of dying a good death. Having secure financial resources were key for adequate preparation. The elderly Japanese Americans believed that suffering at the end-of-life should be avoided in order to achieve a good death. Their concept of suffering included: unmanageable pain, being ill for a long time, and being bedridden. Several participants preferred a sudden type of death because they would not have to suffer and not be burdens their family. Contentment in life was also an important aspect of a good death. There was a common belief that the way a person lived was connected with the way he/she died. A number of the participants preferred to die in their own home. Hospitals and retirement homes were other alternatives for the place of death. Individual views on death contributed to establish the concept of good death among elderly Japanese American participants. They shared similar attitudes toward death which were a part of life and inevitable. These attitudes were influenced by religious beliefs and past experiences with death. Different generations of elderly Japanese Americans had different views. The Shin-Issei (first generation who immigrated after World War II) and the Nisei (second generation) held more Japanese views compared to the Sansei (third generation) who were more acculturated. Although the Japanese American parents and children might have different views on life and death, the importance of close family relations and family support was passed on to younger generations