A Japanese film depicting voluntary limb amputation as a response to caregiver burden has sparked widespread discussion about the challenges of caring for a rapidly ageing population.
The film Haiyoshin (Useless Body), released in Japan in May 2026, is based on a 2003 novel by former geriatric physician Yo Kusakabe and explores a fictional concept called "A-Care" (Amputation Care), in which non-functional limbs are removed to make caregiving easier for older adults with severe disabilities.
The film has attracted attention because it addresses a real issue facing Japan: a growing elderly population and an increasing shortage of caregivers.
While the concept presented in the story is fictional, it has renewed public discussion about how societies can meet the rising demand for long-term care.
Former geriatric physician and author Yo Kusakabe has attracted attention for ideas explored in his novel Haiyoshin (Useless Body), which was recently adapted into a film. The story centres on a young doctor who promotes a fictional concept called "A-Care" (Amputation Care), proposing that removing non-functional limbs from elderly patients with severe disabilities could ease the demands placed on caregivers.
Kusakabe's novel was first published in 2003. According to the author, publishers and filmmakers initially considered the subject too controversial for adaptation. More than two decades later, the story was brought to the screen by director Kohki Yoshida and released in Japanese cinemas in May 2026, reigniting debate about ageing, caregiving, and human dignity.
Speaking to Agence France-Presse (AFP), Kusakabe said the idea emerged from concerns about what could happen if the care sector reaches a critical shortage of workers. He argued that, with patient consent, reducing the physical weight and care needs associated with paralyzed limbs could lessen the workload for caregivers.
If you cut them off, a female carer would have less difficulty lifting a hefty male patient or suffer less back pain.
Yo Kusakabe, Former geriatric physician, Author of Novel Haiyoshin
Kusakabe told AFP that his proposal was never intended as a policy recommendation but as a thought experiment about how societies might respond if shortages of professional caregivers become severe. He argued that the story was designed to provoke discussion about the future of elder care rather than advocate compulsory measures.
According to Kusakabe, immobile limbs can make routine caregiving tasks more difficult, as they may complicate dressing, bathing, repositioning, and transferring patients. These practical challenges form the basis of the fictional proposal presented in the novel and film.
Japan is one of the most rapidly ageing countries in the world. According to a study, nearly 30% of the country's population is aged 65 years or older. At the same time, Japan's birth rate continues to decline, reducing the number of working-age adults available to support healthcare and social care systems.1
Japan’s care-giving industry isn’t collapsing yet – but with (the number of) elderly people requiring care predicted to keep increasing, it is heading toward breaking point.
Yo Kusakabe, Former Geriatric Physician, Author of Novel Haiyoshin
Population ageing is increasing demand for medical services, nursing care, rehabilitation, and long-term support for older adults. As life expectancy rises, more people live with chronic illnesses, frailty, dementia, and mobility limitations that require ongoing assistance.1
A report notes that the country's care workforce is struggling to keep pace with growing demand. The report highlights concerns about future shortages of professional caregivers and the increasing burden placed on family members who provide care at home.2
The central argument presented in Haiyoshin focuses on the physical demands of caring for older adults with severe mobility impairments. Daily caregiving often involves lifting, repositioning, transferring, bathing, and assisting patients with routine activities.
Kusakabe said that when his novel was first published more than 20 years ago, many believed its subject matter was too controversial to be adapted for the screen. However, the story has now reached cinemas and generated intense public discussion. Online reactions have varied widely, with some viewers describing it as one of the most controversial Japanese films of the year, while others have criticized its premise as disturbing.
In the film, the proposed "A-Care" approach is portrayed as offering benefits to some patients.
Kusakabe told AFP that during his medical career, he encountered patients whose paralyzed limbs caused persistent discomfort, spasms, or involuntary movements. He said some patients questioned why such limbs could not be removed because they felt they only complicated daily life and no longer served a useful purpose. According to Kusakabe, these experiences later influenced the fictional concept portrayed in his 2003 novel and its film adaptation.
Within the fictional narrative, the film depicts some patients experiencing greater ease of movement after amputation. Characters are shown adapting to their new circumstances, participating in recreational activities, and navigating wheelchairs with increased independence compared with their previous condition.
Is it to try to put your immobile arms through sleeves with great pain, or not to suffer pain at all? If someone desires amputation, and that makes care-giving easier for their family, and the family accepts that, then I don’t think it’s anyone’s business to interfere.
Yo Kusakabe, Former geriatric physician, Author of Novel Haiyoshin
The film raises questions about how dignity should be understood and preserved in later life.
Although Haiyoshin presents a fictional scenario, the film has drawn attention to the practical challenges associated with caring for an ageing population.
The controversy surrounding Haiyoshin has also renewed attention to broader solutions being explored in Japan, including expanding the caregiving workforce, increasing the use of robotics and assistive technologies, and developing policies aimed at supporting family caregivers and long-term care services. The fictional "A-Care" concept has generally been discussed as a narrative device intended to highlight the pressures created by demographic change rather than as a practical medical proposal.
The debate surrounding Haiyoshin highlights broader questions about how societies can provide safe, ethical, and sustainable long-term care as populations continue to age.
1. Kinoshita, S., and T. Kishimoto. “Ageing Population in Japan: Immediate Shake-Up in Healthcare Required.” QJM: An International Journal of Medicine 117, no. 12 (2024): 829–830. https://doi.org/10.1093/qjmed/hcae097.
2. Suzuki, Takao. Population Ageing in Japan and Its Impact on Society. Tokyo: Mitsui Global Strategic Studies Institute, 2023. https://www.mitsui.com/mgssi/en/report/detail/__icsFiles/afieldfile/2023/08/30/2307k_suzuki_e_2.pdf.
(Rh/SS/MSM)
