Akihito, 78, is having coronary bypass surgery at the University of Tokyo Hospital to treat a narrowed artery, the Imperial Household Agency said last week. The emperor, who had prostate surgery in 2003 and was hospitalized with pneumonia in November, was on medication after experiencing arterial problems last year.
Concerns over his health have prompted the government to consider altering the 1947 law for the world’s oldest hereditary monarchy that mandates only men succeed to the throne and requires princesses to give up their titles if they marry commoners. Akihito’s grandson Hisahito in 2006 became the first male born into the family in more than four decades, increasing the number of potential heirs to three.
“By the time he assumes the throne, he will be the imperial family,” Colin Jones, a law professor at Doshisha University in Kyoto, said of the 5-year-old prince. “You’re looking at a future where the imperial family consists of a single nuclear family. That’s problematic in that, if he doesn’t have a son, then what do you do?”
Crown Prince Naruhito, 51, is serving as regent during his father’s surgery and convalescence. Naruhito, who has one daughter, is next in line to the throne, followed by his 46- year-old brother, Prince Akishino, and nephew Hisahito.
Fueling the debate is that eight of the 23 members of the imperial family are single females who will have to marry outside the bloodline, leaving fewer people to handle traditional functions such as giving speeches and attending events. Several aristocratic families were stripped of their status after World War II, limiting the number of royal matches.
Prime Minister Yoshihiko Noda on Dec. 1 said the government should study whether princesses should be allowed to keep their status after marriage and called for a national debate.
The matter is “of great priority in assuring the stability of the activities of the imperial family,” Noda told reporters. “We are currently considering how we should move forward.”
He has made no mention of altering the law to allow women to ascend the throne. A 2005 proposal backed by then Prime Minister Junichiro Koizumi to determine succession by order of birth regardless of sex met with opposition from his Liberal Democratic Party. The plan was shelved after Akishino’s wife, Princess Kiko, became pregnant.
Without changes, there may not be a backup plan if Hisahito doesn’t have a son or is incapacitated. While the emperor’s role is mostly symbolic, Japan’s Constitution requires him to perform tasks including appointing the prime minister and promulgating laws passed by the Diet.
“Monarchies have extended families just so that there’s a source of spares,” Doshisha’s Jones said. “Over time there will be no other members of the imperial family to act as proxies.”
Akihito, the first Japanese emperor to serve from the outset under the constitution imposed by the U.S. after World War II, succeeded to the throne in 1989 after the death of his father, Emperor Hirohito.
During a typical bypass operation, a surgeon takes a blood vessel from the patient’s chest or leg and constructs a new channel to allow blood to flow to the heart, circumventing the original, clogged artery. The procedure can take three to six hours, according to the American Heart Association.
“Bypass surgery remains a very, very common procedure worldwide,” Dr. Richard Shemin, chief of cardiothoracic surgery at the Ronald Reagan UCLA Medical Center in Los Angeles, said in a phone interview. The mortality rate for young and healthy patients is less than 2 percent, while risks for older patients like the emperor may be “somewhat higher” depending on other medical conditions, Shemin said.
Akihito’s recent health problems prompted his younger son, Akishino, to suggest in November that Japan’s emperors be allowed to retire once they reach a certain age. Current law contains no such provision.
Lawmakers will need to resolve the succession issue soon, since it may be too late to do so by the time Hisahito becomes emperor, Jones said.
“They can’t just suddenly conjure up new imperials,” he said. “They’ve got to do something now.”