著者

岡本 珠代

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.21, pp.191-198, 2003-10-05 (Released:2018-02-01)

著者

岡本 珠代

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.20, pp.80-94, 2002-11-10 (Released:2018-02-01)

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Something is called a placebo when it is used to cause a favorable effect on an unknowing patient, even though it is known to have no pharmacologically effective action. A favorable effect, if any, is called a placebo effect and is referred to in a non-medical context as well, where an act of comforting or pleasing with verbal or non-verbal expressions or gestures is found successful. This latter case may be quite innocuous and need no particular justification. Ethical problems arise when placebos are used either in a clinical setting or in medical experimentation. Clinically a placebo is given to a patient at the medical practitioner's discretion without informing him/her about its use. In 1955 Henry Beecher published a study on the placebo effect. He believed he could prove the existence of a placebo effect in the 30 to 40 percent of all patients. Two camps seem to have formed differing assessments of Beecher's thesis. One literally believes a placebo is effective as a result of the mysterious process of the human mind-body relationship, while the other camp wants to dismiss the whole thesis as groundless. For the latter, placebos are a form of deception or manipulation and should not be taken seriously or used at all. Physician-ethicist Howard Brody tries to make sense of the placebo effect philosophically. He shows that a reductionist approach cannot explain it, while giving credit to anti-positivist approaches that define a person in a culturally meaningful context. He states that a good medical practitioner can cause a placebo effect without using any placebos by engaging in simple good conversation. But as to the use of placebos in double-blind controlled studies, physicians, including Brody, are usually permissive and do not question the use of placebos or non-treatment for the research subjects, who are, at the same time, patients in need of medical care. The use of placebos or non-treatment for patient-subjects contradicts the idea and practice of informed consent. Only volunteers should take part in a medical experiment. What is puzzling is why things given to the control subjects are called placebos.

著者

岡本 珠代

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.18, pp.43-54, 2000-12-15 (Released:2018-02-01)

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I had to have colorectal cancer surgery in April 1999, in a local general hospital in the western part of Japan. A seemingly formal process of informed consent took place in terms of the physician's disclosure and my signing of the consent form. But the physician would never make any disclosure without the presence of my husband, even though I had asked him in advance to tell me everything directly. On the consent form, there was a list of risks and complications of the proposed procedure, but there was no mention of possible alternatives. The consent form was rather archaic in that its preface stated that they demanded of a patient a full understanding of what is to be disclosed and prohibited any protestation against the hospital's medical policies in case of an insurmountable accident (which, in fact, can only be determined by a third party). My physician-oncologist forced me to sign a consent form for an angiography and an arterial injection of an anti-cancer agent in spite of my refusal three times. Also, there was deception in the process of intravenous administration of chemotherapy. I ended up refusing the prescribed regimen because of its serious side effects. The legal doctrine and the ethical, democratic idea of informed consent are two different things. The former may easily be implemented even in Japan, as physician discretion and patient incompetence can justify non-disclosure. Legally, there is no requirement for ascertaining a patient's understanding of what is disclosed, whereas the ethical requirement demands that consent is meaningless if disclosure is inadequate and not understood by the patient. Indeed, only effective dialogue between honest and caring health-care professionals and the patient can effectuate a healing process and prevention of serious medical harm.

著者

岡本 珠代

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.16, pp.35-45, 1998-10-01 (Released:2018-02-01)

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Casuistry derives its tradition from the medieval Catholic practice of moral discussion dealing with difficult cases (=cases in Latin, hence casuistry) which can allegedly offer ways to resolve moral dilemmas without recourse to any ethical theories or overarching ethical principles. Contemporary bioethicists such as Albert Jonsen claim that the casuistic approach pays attention to a particular case with its circumstances, analyses it, compares it with other cases and decides its moral status as to whether it is a paradigm case or subsumed under a different category. A casuist makes a stark distinction between a case-based approach and a theory-dependent approach in ethics. The principle-based theorists such as Tom Beauchamps (despite their recent affinity with coherentism) are derogatorily called principlists whose main job is to strictly and deductively apply ethical principles in their "applied ethics". The casuistic bottom-up approach is shared by communitarian ethicists whose commitment is limited only to the close relationship in the local community. One of the casuistic rules employed to decide the morality of an action is called the doctrine of double effect. It justifies an action when it is performed from a good intention, such as to stop the suffering of a terminal-stage patient, even though the actual consequence is her death which was foreseen but not willed. This doctrine is subject to an abuse, and because it could camouflage an intention to bring about a negative effect, it has to be rejected. We can learn from casuists the value of an approach to analyse individual cases with reference to paradigms. A case analysis is an effective way of teaching ethics and of resolving moral dilemmas. But we also have to employ common values applicable to everyone in a global community to guide our actions, such as respect for persons, general welfare and the democratic decision-making procedure.

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)

著者

俵 敏弘 武山 佳洋 葛西 毅彦 岡本 博之 上村 修二 井上 弘行 諸原 基貴 江濱 由松

出版者

市立函館病院

雑誌

函館医学誌 = Hakodate medical journal = Hakodate medical journal (ISSN:09100725)

巻号頁・発行日

vol.42, no.1, pp.37-40, 2018-10-31

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グリホサート・界面活性剤含有除草剤(glyphosatesurfactant herbicide;GlySH)は雑草枯死目的で用いられ,入手も容易であり,本邦では自殺目的の服用が多数報告されている1)。主な中毒作用としてはグリホサートによる腎機能障害や代謝性アシドーシス,界面活性剤による粘膜刺激・消化管腐食作用,肺障害,心筋抑制等が知られている2)。 今回我々は喉頭浮腫をきたした重症グリホサート中毒を4例経験したので,その病態および治療等について,文献的考察を加えて報告する。

著者

岡本 賢吾

出版者

日本科学哲学会

雑誌

科学哲学 (ISSN:02893428)

巻号頁・発行日

vol.34, no.1, pp.7-19, 2001-05-30 (Released:2009-05-29)

参考文献数

10

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Frege's well-known thesis that arithmetic is reducible to logic leaves unexplained what is the gain of the reduction and what he means by logic in principle. First, the author contends that the real interest of the reduction consists in a form of conceptual reduction: it frees us from the ordinary naive conception of numbers as forming extremely peculiar genus and replaces it with a very general and basic conception of them. Second, it is pointed out that Frege's concept of logic involves two elements. One is based on the iteratability of the operation of abstraction and naturally leads him to accept a sort of denumerably higher order logical language. The other is based on the so-called comprehension principle. Each of the two elements could be said to be logical in some sense but they are inconsistent with each other. Still, we can learn much from his attempt to search for as extensive and global a conception of logic as possible.

著者

小林 美奈子 辻本 広紀 髙畑 りさ 矢口 義久 永生 高広 岡本 耕一 長谷 和生

出版者

一般社団法人 日本外科感染症学会

雑誌

日本外科感染症学会雑誌 (ISSN:13495755)

巻号頁・発行日

vol.16, no.4, pp.197-202, 2019-08-31 (Released:2019-09-30)

参考文献数

16

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手術時手袋の着用は,患者と医療従事者間の病原微生物の伝播経路遮断が目的である。これまでに術中に手袋損傷が起こることは諸家により報告されているが,これらの多くは開腹手術での手袋損傷である。近年,消化器外科領域において内視鏡外科手術が普及しているが,鏡視下手術での手袋損傷の検討はほとんど行われていない。そこで今回われわれは,消化器外科領域において開腹・鏡視下手術時の手袋穿孔率を比較検討した。手術時手袋1,513双,3,026枚の検討を行い,穿孔率は全体で10.9%,開腹手術11.3%,鏡視下手術10.4%であり,穿孔率に差は認められなかった(P=0.4611)。また,二重手袋着用での穿孔率は,インナー手袋5.7%,アウター手袋11.9%であり,インナーはアウターに比し有意に穿孔率が低率であった(P=0.0001)。消化器外科手術における手袋穿孔率は,鏡視下手術においても開腹手術とほぼ同率であり,血液・体液暴露予防やSSI予防の観点から鏡視下手術においても二重手袋の着用が重要であると考えられた。

著者

熊本 和宏 國友 美信 岸本 章宏 岡本 克文 倉満 晶子 宇田 哲也

出版者

一般社団法人 資源・素材学会

雑誌

Journal of MMIJ (ISSN:18816118)

巻号頁・発行日

vol.137, no.1, pp.10-16, 2021-01-31 (Released:2021-01-29)

参考文献数

31

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A new Ti smelting process via. Bi–Ti alloy is proposed. This process comprises reduction of TiCl4 to Bi–10 mol%Ti alloy by Bi–Mg alloy, precipitation of Ti-rich compound from the alloy, and vacuum distillation. In this study, we investigated the precipitation and distillation processes. In the precipitation process, the Bi–10 mol%Ti liquid alloy is cooled from 900 ℃ to 500 ℃ to precipitate Bi9Ti8 in the liquid alloy. The Bi9Ti8 is recovered by a two-step separation method: recovery of mixture of Bi9Ti8 and Bi and further removal of Bi by centrifugal filtration. We demonstrated the recovery of mixture. As the results, Ti concentration in the mixture was 31 mol%, and the Ti yield was about 45 %. Because the remained liquid alloy after the recovery contains a large amount of Bi9Ti8, it is required to reuse the remained alloy in the precipitation process. Assuming the reuse of remained alloy, the material flow of the process was designed based on the experimental results. The centrifugal filtration of the mixture of Bi9Ti8 and Bi was also carried out at 500 ℃. By the centrifugal filtration at 50 G, alloys with a size of 1.5 mm were obtained, and the Ti concentration in the alloys was increased from 31 mol% to 40 mol%. Vacuum distillation of alloy powder and ingot was demonstrated. The distillation rate was enhanced when using the powder than when using alloy ingot as a starting material.

著者

山路 法宏 岡本 信行 塩川 智 川野 誠矢 櫻井 宏信

出版者

一般社団法人 資源・素材学会

雑誌

Journal of MMIJ (ISSN:18816118)

巻号頁・発行日

vol.135, no.6, pp.42-51, 2019-06-30 (Released:2019-06-28)

参考文献数

10

被引用文献数

3 9

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Seafloor Polymetallic Sulphides (PMS) is deep sea mineral that is confirmed to exist within Japanese exclusive economic zones and expected to develop as a new supply source for Japan. However, deep sea minerals including PMS have not been commercially developed so far, although various countries are eagerly working it. Japan Oil, Gas and Metals National Corporation (JOGMEC) has been commissioned by Ministry of Economy, Trade and Industry (METI) to conduct practical study on PMS for commercialization. As part of the efforts, JOGMEC implemented “Excavating and Ore-lifting Pilot Test” from the middle of August to end of September 2017. In the test, JOGMEC succeeded in consecutive lifting of ore and sea water in a state of solid-liquid flow from a depth of approximately 1,600m for the first time in the world. Through the test, it became clear that there are still many technical challenges left to be resolved for development of PMS such as improvement in durability of equipment, system optimization, adjustability of ore grain size and slurry concentration and so on. JOGMEC will continue efforts aimed at commercialization of PMS from a long-term perspective.

著者

岡本 源太

出版者

美学会

雑誌

美学 (ISSN:05200962)

巻号頁・発行日

vol.67, no.2, pp.85, 2016 (Released:2018-01-01)

著者

岡本 源太

出版者

美学会

雑誌

美学 (ISSN:05200962)

巻号頁・発行日

vol.64, no.1, pp.15-25, 2013-06-30 (Released:2017-05-22)

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Selon Erwin Panofsky, c'est a la Renaissance qu'est apparue l'idee de temps <<destructeuro>>, Kronos, represents par la figure d'un vieillard ails avec ses attributs sinistres: la faux, un corps decharne, etc. Cette idee correspond, semble-t-il, a la nouvelle sensibilite a l'egard de la vicissitude des choses, comme on peut le voir notamment darts les traites d'art de l'epoque. Dans cette optique, j'examine l'esthetique de Leon Battista Alberti (1404-1472) a l'aube de la Renaissance puis a sa fin, de Giordano Bruno (1548-1600). A relire leurs comedies telles que le Momus d'Alberti ou bien le Candelaio de Bruno, on percoit immediatement qu'ils montrent avec ironie comment les hommes ou encore les dieux ignorent l'instabilite du temps a cause de l'apparence trompeuse d'une permanence des choses. De ce point de vue, l'art ne semble etre qu'une fiction trompeuse. Mais, en meme temps, ces auteurs donnent a l'art un nouveau statut: Alberti suggere que la peinture est une forme du savoir prete a detroner la vieille philosophie, Bruno identifie la vraie peinture avec la vraie philosophie. Le nouveau statut de l'art face aux vicissitudes des choses est etroitement lie a l'argumentation albertienne sur l'ornamentum et au concept brunien de vinculum.

著者

岡本 源太

出版者

美学会

雑誌

美学 (ISSN:05200962)

巻号頁・発行日

vol.61, no.2, pp.13-24, 2010-12-31 (Released:2017-05-22)

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Dans le De gli eroici furori (1585), Giordano Bruno (1548-1600) interprete la fable d'Acteon, mythe grec d'un chasseur metamorphose en cerf par Artemis (Diane) au bain et dechiquete par sa propre meute, comme destin de ceux qui cherchent a voir la verite divine. Pour cerner l'enjeu de cette interpretation, qui constitue certainement l'un des points forts du De gli eroici furori, le mieux est d'examiner comment Bruno fait face au petrarquisme a travers la variation de la figure d'Acteon. Car, a la Renaissance, la figure d'Acteon se diffusait comme allegorie de la melancolie amoureuse petrarquiste. Mon hypothese est que l'interpretation brunienne de la fable d'Acteon met en cause la conception petrarquiste de l'art comme activite melancolique. Selon Bruno, l'art n'est pas l'activite melancolique qui tente de perpetuer l'aimee, mais le processus des <<vicissitudes>> comme la metamorphose d'Acteon le suggere.

著者

岡本 源太

出版者

美学会

雑誌

美学 (ISSN:05200962)

巻号頁・発行日

vol.60, no.2, pp.138, 2009-12-31 (Released:2017-05-22)

著者

岡本 源太

出版者

美学会

雑誌

美学 (ISSN:05200962)

巻号頁・発行日

vol.57, no.3, pp.58, 2006-12-31 (Released:2017-05-22)

著者

岡本 充弘

出版者

公益財団法人 史学会

雑誌

史学雑誌 (ISSN:00182478)

巻号頁・発行日

vol.107, no.1, pp.112-118, 1998-01-20 (Released:2017-11-30)