著者

岡本 天晴 櫻庭 和典

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.15, pp.72-84, 1997-09-20 (Released:2018-02-01)

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The massive earthquake that hit the Hanshin region in January 1995 caused 6425 deaths and over 40,000 casualties. Major public utilities were cut off, so medical practitioners found medical activities extremely difficult. Rescue operations by the self-defence forces failed to function properly. This disaster has called attention to the importance of Triage regarding medical services in such large-scale disasters. Triage comes from French, and was brought into English during the First World War, and was used in classifying the wounded. The definitions of Triage are 1. Classifying the injured by the seriousness of their external injuries or illness. 2. Deciding on the order of superiority for treatment. Let us consider the ethics of Triage from the following two aspects. a. The Means : In times of crises such as a war or a large-scale disaster,traditional medical ethics do not apply. Limited medical resources will mean that a capable Triage Officer should independently and speedily sort (i.e. triage) patients based on high-quality initial diagnosis, and decide on the order in which they will be treated. The ethics will be based upon the fact that Triage is the means for attaining the maximum happiness for the maximum number of people. The appropriatenss of the means will be subject to change depending upon the situation. Therefore Triage is a process modified repeatedly. b. Education : For an inexperienced doctor, it is an ethically difficult mission to classify numerous patients in a way that is different from daily practice. There are also doctors who emphasize that practice drills for medical services in times of large-scale disasters is aiding and abetting war, and that classifying numerous patients is inhumane. Doctors know little about Trige, and the general public is uninterested, so once a disaster strikes there is major chaos. It is therefore desirable to train capable Triage leaders and at the same time have the man on the street undergo training to be ready for large-scale disasters, and have an understanding of Triage. By doing this, disaster survivors will be aware that there are many patients around them whose treatment requires priority, and they will be able to engage themselves in volunteer activities or await their turn for treatment whih understanding. In this manner, it is possible to acknowledge the high ethics of Triage in neighbourly love, or regional unity, which is needed in times of large-scale disasters.

著者

岡本 天晴

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.13, pp.178-181, 1995-10-01 (Released:2018-02-01)

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"Informed-Consent" is a concept which has been developed and is functioning at the medical world in the United States. The concept is the patient-centered, valuing the rights of patients. On the other hand, the medical concept in Japan has still been based on so-called "Paternalism" which regards all the medical acts of doctors. People in general in this nation are indifferent mainly because of the lack of public awareness, and prevailing traditional attitude-undirected doctors and dependent and patients. Much discussion in Japan on the matter these days seems rather superficial, without solving the basic problems, there are differences of Japan-American culture, educational system, quality of medical treatment etc. On introducing and practicing "Informed-Consent" to Japan, as a Buddhist philosopher, the another feels the necessity to preserve "trust and empathy-relationship" between patients and doctors by gradual attitudinal change on both sides. My concern is result of the overly rapid introduction of the idea which may lead us to social problems seen in the States such as constant legal disputes overemphasizing the rights and duties of the medical treatment. The another therefore, calls the attention of medical practitioners to re-evaluate the Buddhistic concept of "Hohben (Sk.upaya)" which implies acts of "Deep Wisdom and Compassion" on the doctors' side to guide patients mentally and physically.

著者

岡本 天晴

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.12, pp.111-117, 1994-10-01 (Released:2018-02-01)

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The distinction between general education classes and specialized classes has been discarded in the amendment of regulations for university curriculum (July 1,1991). As a result, universities can now draw up their own curricula. However, the amendment also stipulates that universities "must give specialized education to the students as well as to take appropriate measures to enhance broad knowledge and comprehensive ability to make decisions and to enrich the humanity of the students." Philosophy classes, as a part of the curriculum, should also be given at medical schools in line with the ministry's policy on curriculum compilation. Generally speaking, students take philosophy classes merely as one of the liberal arts classes (history of philosophy, introduction to philosophy etc.). The goal of the classes is to show students the various issues concerning philosophy. But it is also, if not more,important for medical students to acquire "broad knowledge" as is stipulated above: That is to say, to be familiar with the philosophical ways of thinking and to appreciate the world of philosophy, in itself, so that students develop the ability to see problems and to solve them on their own. Science, medical science included, has developed remarkably and has benefited people in many aspects. On the other hand,however, it has also over-defined and over-simplified the human existence to a point where science how endangers the very existence of human beings. We have become suspicious of the optimistic view that one day science and technology will solve all the contradictions of modern civilization. It is philosophy, based on liberal ideas, spirit and above all, human love that would enable people to evaluate modern civilization for what it is and to question the raison d'etre of human existence. I would like to discuss the role of philosophy taught in medical schools as an important part of general knowledge, and also to illustrate what the students might face in taking such classes.

著者

岡本 天晴

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.11, pp.26-35, 1993-10-01 (Released:2018-02-01)

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In the United States, the number of organ transplant cases has been rapidly increasing over the past fifteen years. Consequently, there has been a shortage of organs available for transplant operations so various measures have been sought to promote organ donations. For instance, many states have adopted a system where the reverse side of the driver's license functions as a donor card. The license holder along with two witnesses sign the consent making it possible for the license holder to donate his or her organs. Despite such schemes, however,the supply of organs has not met demands. As a result, there were instances where money changed hands to secure organs. Considered unethical, organ sales where eventually banned by law. In The United States, it is considered a moral and worthy act to voluntarily donate one's organs for science. A noticeable contrast to this can be found in Europe where organ donations are done on a contract basis. This reflects cultural-anthropological differences between the U. S. and Europe. In the case of Japan, people have great apprehensions about taking organs from the dead. This is due partly to a cultural background based on Confucianism; and partly to the on-going debate on defining what exactly constitutes "brain death". In addition, the act of giving in Japan has always had the element of mutual exchange; unilateral gift-giving without any form of reciprocation is unthinkable-which makes securing organs for transplant operations much more difficult. Japanese doctors, therefore, are required to call upon the people to donate organs as a gesture of good will. With these differing concepts of gift-giving in mind, taking the example of organ donations, I would like to discuss from a philosophical stand point what it means "to provide"or "to give" to someone. I also intend to expand my discussion to include western notions of "a gift" as a concept compatible with the idea of "charity" and "solidarity". Comparing these with the Buddhist concept of "dana", I would like to discuss "compassion", "bodhisativa-yana" (the way in which to attain enlightment), "dana-paramita" (discipline in training how to impart sacred doctorines to others), "atoma-paritoyaga" (the throwing away of the ego), "the field of good fortune", "repaying kindness" and "veneration". (Incidently, the English word donate stems from the Sanskrit dana.) By comparing these concepts, I would like to discuss methods of giving, the attitudes of those who accept and furthermore, the "things" that are givable and acceptable. By doing so, I hope that I shall be able to clarify the differences between the west and Japan regarding the notion of organ donations.

著者

岡本 天晴

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.5, pp.61-77, 1987-07-10 (Released:2018-02-01)