Satoshi Uematsu, 30, was sentenced to death over a 2016 mass stabbing at a care home for the mentally disabled near Tokyo; the incident left 19 dead and 26 others injured.

Uematsu – a former employee at the care facility he targeted in Sagamihara, Kanagawa Prefecture – admitted to the killings during hearings of his lay judge trial at the Yokohama District Court. During his trial, Uematsu seemed to imply that disabled persons incapable of communicating their thoughts did not deserve human rights. He claimed these individuals “create unhappiness in society.”

Uematsu reiterated his comments about severely disabled people and their families during his closing argument last month. He said he believes that the parents of the severely disabled die sooner than other parents due to the exhausting “burden” they endure caring for their children.

Presiding Judge Kiyoshi Aonuma handed down the sentence saying, “The grave consequence was incomparable to other incidents with 19 lives being taken.”

Acknowledging the accused’s criminal responsibility, Judge Aonuma added, “His way of thinking about the severely disabled is based on his experience of working (at the care home), and people can understand it. We cannot say it is a pathologic, impaired thinking.”

The high number of victims, coupled with Uematsu’s discriminatory remarks against people with disabilities, spurred prosecutors to seek the death penalty for Uematsu. The defense had argued Uematsu was mentally incompetent and should not be held criminally liable for his actions. Last month, Uematsu told the court that, whatever the outcome, he would not appeal the ruling.

According to the ruling, Uematsu fatally stabbed 19 residents and injured 24 others at the care facility. Uematsu has also been accused of binding five employees to a handrail, causing two of them injury.

Uematsu’s crime echoes a pattern of attack in Japan directly tied to the nation’s large aging population and the cost of such an imbalance on society. Japan’s significantly high elderly population strains both the government and individual citizens; nursing homes fill up, and the burden of care is then placed on families, whose lives become stressed.

An increasing number of attacks in Japan in recent years perpetrated by caretakers on the sick and elderly demonstrates the growing problem. Japan has also seen an increase in crimes committed by the elderly – in an attempt to go to prison live for free – and in suicides among the senior population.