On July 26, 2016, in Kanagawa, Japan, a man entered a residential care facility for persons with disabilities and proceeded from room to room, stabbing the sleeping residents with knives. Nineteen were killed and twenty-six others injured, many severely. It would emerge that the man, a former employee at the facility, had previously hand-delivered a letter to the Japanese government in which he claimed that the world would be better off if persons with disabilities could be euthanized, calling them a burden on society, the economy, and their caregivers.

Writer-director Chie Hayakawa has said that she was thinking of this incident (and Japan’s alarming slide toward more and more extreme ideologies of “self-responsibility”) while making Plan 75. The film’s opening scene depicts a similar incident—the aftermath of a killing spree at a Japanese nursing home. The perpetrator, in voiceover, tells us that the elderly are a burden on Japan. Sometime after this incident, we learn, Japan passes the “Plan 75” bill, which allows for euthanasia of anyone over 75 with their consent (and offers the person or their family $1000 for participating).

State-sponsored euthanasia is nothing new in dystopian sci-fi—it featured in the background of Children of Men and was a tipping point for the main character in Lois Lowry’s famous YA novel The Giver. What makes it different and much more chilling this time around is the way that it’s presented with a relentless (and entirely realistic) sense of cheerfulness and inevitability. And the way that everyone just seems to go along with it as the new normal, with the exception of a brave few who angrily turn off the TV advertising the plan and throw tomatoes at one of the sales associates. This is “self-responsibility” and self-sacrifice taken to their most extreme conclusions.

Plan 75 began as a short film in the 2018 omnibus Ten Years Japan, a collection of films by different Japanese directors on the theme of Japan ten years in the future. That version of Plan 75 did not leave much of an impression—it felt more like a thought experiment, or a somewhat polished student project. The feature film version, though, is an entirely different creation—confident, beautifully crafted, and mostly avoiding the pitfalls of overt sentimentality. More than anything, it is horrifyingly real. It might be classified as sci-fi or dystopia, but the world depicted in this film is very familiar, dancing on a thin line between a society where euthanizing the elderly seems completely normal and one where it doesn’t.

We follow four main characters in this not-so-distant world: Michiko (Chieko Baishō), a 78-year-old woman who gradually comes to see that the world has left her no choice but to participate in Plan 75; Hiromu (Hayato Isomura), a sweet-faced sales associate tasked with convincing seniors to sign up for Plan 75; Yōko (Yumi Kawai), a telephone “counselor” who makes sure clients who’ve signed up for Plan 75 don’t back out; and Maria (Stefanie Arianne), a Filipina caregiver who takes on the darker labor involved in the Plan 75 project because she needs to send money home to her family.

The depiction of how Plan 75 is executed is, I have no doubt, exactly how it would play out in Japan today. There are cheerful banners advertising the service everywhere. Family and friends are getting in on the deal, and voicing opposition to it seems like rocking the boat. Sales associates set up their tables near homeless encampments in the park and offer hot meals to the desperate before gently offering them a brochure. People are recruited into the plan not through coercion or violence, but simply through the fact that it’s unavoidable, and because their other options are limited.

Like any horrifying plan trying to seem compassionate, Plan 75 goes to great lengths to emphasize that this is all the “choice” of the elderly person who opts in. But it isn’t a choice, of course. It is, for many people, their only option other than a slow death by starvation or freezing to death on the streets. As we follow Michiko, we see all her other lifelines gradually slip away. The hotel where she works as a housekeeper lays off all of its elderly workers after one of them collapses during her shift. Her apartment building is set for demolition, and no other apartments will take her on because of her age. She cannot get another job. She has no family to support her. Heartbreakingly, her involvement with Plan 75 is the first place that she seems to experience something approaching compassion, having lost her only real source of human connection when she lost her job.

Many have called Plan 75 a gut punch and talked of the moments that made them cry. The film is certainly moving—it was the simple moments of kindness and human connection in a callous world that made me well up. But really, my main reaction to the film was rage. Because this world feels frighteningly close. An actual “Plan 75” bill may not be in place, but in the current climate, I have no doubt that it has been considered by some lawmakers, and that, as the director herself discovered in conversations with elderly people, some would happily volunteer for it, so fully have they absorbed the idea that anyone who is not “productive” is a burden on society.

And yet Plan 75 is not nihilistic or unrelentingly grim. By structuring the film around four different people with different roles, the filmmakers allow us to see how the architects of Plan 75 have worked so hard to strip any sense of humanity away from anyone involved with the project. “Counselors” are not permitted to meet clients in person. Sales associates cannot manage the cases of anyone who is even distantly related to them. Those who handle the bodies and the belongings are kept separate from clients while they’re still alive and are told not to speak to each other.

But everyone breaks the rules. The counselor spends time with Michiko and seems to genuinely enjoy it. The sales associate gets involved with his uncle’s case. The caregiver-turned-disposal team member helps someone dispose of a body in a more dignified way. And Michiko, in her own way, manages to hold on to her dignity at the end. If there’s any hope to be found in this frightening and not-so-implausible future, it’s that people can still, against all odds, refuse to see each other merely as numbers or tasks.

Though every performance is solid, the film really belongs to Baishō, who made a name for herself in the “Tora-san” films of Yoji Yamada. She is mesmerizing as Michiko, particularly in a cinematic landscape where the inner lives of women over a certain age are so rarely on display. Every line on her face tells a story. Her stoic expression very occasionally lights up with hope or joy, and it’s a beautiful thing to see. The inherent cruelty of Plan 75 is told almost entirely through Michiko’s face and body—exhausted, doggedly determined, but seen by society as simply a burden, when she’s seen at all. In addition to little moments of humanity, it’s Michiko’s warm, solid presence that keeps the film from slipping into unrelenting bleakness.

Plan 75 thankfully never gets too heavy-handed with its messaging—it’s content to simply let us observe the characters’ pain and occasional ambivalence. But there’s a brief moment when telephone counselor Yōko, gradually overcome by the horror of her job, suddenly turns and looks, for just a second, directly at us, her gaze accusing. It’s a bit of a cheat, but it works. That, for me, was the biggest gut punch of the film.