Traditional Japanese customs regarding health and health care are very different from the medical mores of Westerners. The concept of “hazukashii” or shame, is linked to all aspects of Japanese life: family, business and health. Great importance is placed on achieving success and maintaining health and close family ties. Poor health can be a very shameful experience for the Japanese and great care is taken to approach a patient and the patient's family about illness in a blameless, indirect way. For example, the concept of “ shikata ga nai” which means “it cannot be helped” is often used to explain a case of terminal illness.

Shintoism and Buddhism

The Japanese approach to health and health care stem largely from religious and philosophical beliefs. The dominant faiths in Japan are Shintoism and Buddhism and most Japanese believe in both. Shintoism is an ancient religion based on the belief that the gods are represented in natural surroundings such as rivers, trees and mountains with shrines built to honor these gods. One of the most important ways to show respect for the gods upon entering a shrine is by washing your hands. Cleanliness is akin to spiritual purity. According to Shintoism, illness and disease are considered unclean and impure. Buddhism, however, treats aging and illness as a natural process and many Japanese embrace Buddhism later in life. End of life treatment and funeral rituals are often practiced according to Buddhist beliefs in Japan.

Confucianism and Filial piety

Embedded in Confucianism are the codes of ethics that dictate familial and social order in Japan. One of the principles of Confucianism is a concept called “filial piety” in which it becomes the duty of the children to care for parents in their old age. Therefore, it is expected for children to play an important role in taking care of parents who have fallen ill and it is considered shameful to the family if a parent is placed in a care facility.

Traditional Forms of Japanese Medicine

Traditional Japanese healing uses different forms of medicine from the West. Though today Western medicine is widely practiced in Japan, a combination of traditional and Western medicine is common. Japanese believe that much illness stems from the interruption of the flow of Qi, translating roughly to "energy." Kampo is a very popular form of healing that uses medicinal herbs to restore the flow of Qi. Another traditional Japanese therapy is Shiatsu massage in which pressure is applied to specific points on the body, also with the aim of restoring Qi. Acupuncture is also practiced by inserting needles into specific points of the body for the release of toxins and for pain-relief.

The Mind-Body Connection and Heart Transplants

The Japanese believe in an integral mind-body connection. The notion of declaring a person brain-dead whose heart is still beating is a very contradictory concept to the Japanese. The Japanese believe that the spirit, called “kokoro”, is located in the thorax. As the West began to practice heart transplants by harvesting hearts from brain-dead donors, the Japanese rejected the practice because of its potential to disturb the donor's spiritual center. A Japanese doctor was even arrested in 1968 for performing heart surgery and for more than 30 years, the practice was outlawed in Japan. Western medical practices have slowly begun to influence the Japanese and as of the late 1990s heart donation from brain-dead donors was legalized.