著者

服部 健司

出版者

日本生命倫理学会

雑誌

生命倫理 (ISSN:13434063)

巻号頁・発行日

vol.16, no.1, pp.178-184, 2006-09-25 (Released:2017-04-27)

参考文献数

32

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自分の健康を保持増進することを義務とする言説を批判的に吟味することが本稿の課題である。ただし、世界の諸国の保健の実情には大きな差があり、紙幅の制限上、考察をこの国をふくめた先進国に限ることにする。古典的公衆衛生から新公衆衛生運動への転回をながめたのち、健康増進をめぐる現今の言説の特徴を浮き彫りにする。それは、ヘルシズム、医学の擬似宗教化ならびに道徳化、疾病への過剰な意味の付与、日常生活の医療化、疾病の自己責任の強調、医療費削減のためのレトリックである。それぞれについての問題点をあげて検討しながら、健康を増進する義務というものがもしあるとするならば、それは国家の側にあること、ただしそれは国民に恣意的で一面的な健康像をパターナリズム的に押し付けることではなく、環境や社会資源、医療体制の整備に重点を置くものであるべきこと、つまり古典的公衆衛生が中心であるべきことを論じる。

著者

服部 健司

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.28-35, 1994-10-01 (Released:2018-02-01)

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Kant's concept of Person, connected with the concept of dignity, is one of the most influential in medical ethics. No one call the dignity of person into question. A person should not be treated merely as a means, rather as an end at any time. In founding bioethics, Prof. Engelhardt, Jr. brings this concept up in dual strains: the person in the strict sense, whose definition is purely ethical and the same as Kant's; the person in a broad sense, a compromise between the person in the strict sense and the merely biological human. His purpose to extend the concept in its use is, on the one hand, to impute some rights to humans who have not enough intellectual faculties and need moral protection, which has merit in overcoming the extreme argument made by M. Tooley; on the other hand, to release primary persons from obligations to some humans who cannot play any social roles. Were there undue burdens, rights of subordinate persons may be legitimately ignored. Freedom of the will of real persons should be prior to protection of secondary persons. Thus, not only nonperson humans but, occasionally, assumed persons may be treated merely as means. Problems are as follows. 1. who determines the order of priority among assumed persons, or when these would be degraded to nonpersons? 2. may one who does not possess inner worth be designated as a person? 3. must a merely arbitrary, subjective desire of primary persons be still respected even at the expense of secondary persons or others? Indeed, in Kant's writings we come across the radical, well-known dichotomy : Person and Sache. Apparently Formula II of the categorical imperative does not forbid persons to treat irrational beings merely as means. Yet there seems to be no better way than by regarding so: when Kant uses the concept Person, it matters little to which the nonperson human belongs, rather how we ourselves as moral agents should act in the name of Person. A extensional use of Person to judge not quite rational beings, subjectum patients, objectively (gegenstandlich) would seem to be looked upon as a misuse or abuse. The concept Person urges upon us self-consciousness as rational subjects and to make every endeavor to be what we must be through actual acts, because we are animal rationabile, not yet animal rationale.

著者

服部 健司

出版者

日本生命倫理学会

雑誌

生命倫理 (ISSN:13434063)

巻号頁・発行日

vol.25, no.1, pp.22-29, 2015-09-26 (Released:2016-11-01)

参考文献数

23

被引用文献数

2

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本稿では、臨床倫理学ケース検討における対話の意味を問い尋ねる。対話は多角的な視座から得られる断片的な情報の綜合と共有、ひいてはチーム医療の実現のためになされるという一般的な見方に批判的な再検討を 加える。その上で、対話が本来的に情報の交換や共有のためでなく、発問を通して潜在的な問題点を発見し、 対話以前に対話の参加者が各自用意していた意見をゆさぶり、新たな見方を模索するために行われるものであることを論じる。

著者

服部 健司

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.28, pp.49-57, 2010-09-24 (Released:2018-02-01)

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Clinical ethics is enterprises to elucidate what may or may not be done in concrete clinical settings. It differs from normative or prescriptive medical ethics, as one of sub-divisions of applied ethics, which tries to establish and underpin the supreme but abstract principles applicable to medical cases. Whereas normative medical ethics chiefly concerns principles, clinical ethics does this or that particular case, if real or fictitious. Case study is the lifeblood of clinical ethics. The simpler the case at hand is, the easier we can apply any given principle to the case. A good thick case, however, is not as simple as so-called principlists might hope. To enrich clinical ethics, and to avoid reducing clinical ethics to normative medical ethics which often deals with thin cases just as exemplification of mechanical application of authorized principles, we should inquire into the fundamental features of clinical ethics and the nature of thick cases. As long as we pay attention to the fact that describing and reading a case inevitably require imagination and interpretation, each clinical ethics case is identified with a literary text. Actually what has focused on how we can legitimate our interpretation on a text is hermeneutics. A philosopher referred to a tradition or a culture as a horizon which makes it possible to interpret and understand a cultural work. But we should recognize that what to be read in clinical ethics are individual texts embedded within certain peculiar contexts rather than monumental works in capital letters. Then this article argues that the disciplinary model of clinical ethics is not ethics in general but literature.

著者

服部 健司

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.22, pp.155-160, 2004-10-18 (Released:2018-02-01)

著者

服部 健司

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.19, pp.151-165, 2001-10-20 (Released:2018-02-01)

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Placing the family in the center of ethical judgements, John Hardwig has proposed a duty to die. In this paper his theory is critically examined. When we were a burden on our loved family memters, we have such a duty. We should die responsibly. If we were coward and ego-centric to prolong our life, we should be accused as immoral. In an anonymous society, egoism might be plausible. However, in a loving family it is to be abandoned. It affirms our sense of who we are and endows our death with dignity to die for the sake of our loved ones' future. We would see most critics opposed to Hardwig as insufficient or out of point. Their alternative propositions are scarce of reality. Some insist the East Asian principle of autonomy is based on family-determination. Some believe the concept and practice of informed consent must, when imported, be modified so as to fit in with the Japanese family-centered biomedical ethics. When considering a duty to die, it appears we should examine more deeply what family is, what love is, and what is the architectural matter of the Japanese biomedical ethics?

著者

服部 健司

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.19, pp.223-230, 2001-10-20 (Released:2018-02-01)

著者

服部 健司

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.17, pp.11-22, 1999-10-01 (Released:2018-02-01)

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Health education that hides away senility and death is blind. Death education that talks only of death itself and the future life after death is empty. A critical synthesis of these two schools of education will be explored. In the lifestyle modification movement of modern health education, in which nurses set forth the notion of transcendent health, diseases and death are regarded as a failure or penalty for not maintaining a healthful lifestyle. This is false. Death education should be introduced into health education. The question is, in what way ? Death education as such lacks unity, in purpose, principle and method. Here we ask for a form of death education that could be harmonized with health education for everybody. Religious death education is not suitable for public health. Some look upon death education as a preparation to pass away in peace, that is good death. To set up, to evaluate and grade "Quality of Death (QOD)" -this is a parody of QOL -is problematic. Some regard death education as needed in order to live well. This is an existential narrative. Is meditation on death, however, a necessary condition of good life ? After all negative death education, in contrast to positive death education, is recommended : Education which shows the limitations of medical services and human self-control.

著者

服部 健司

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.12-23, 1998-10-01 (Released:2018-02-01)

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It is not the purpose of this paper to give a new model or definition of health concept and to legitimate it, but to reflect critically on the way to use or investigate this tempting and puzzling concept. Recently health has ballooned to be very pseudohypertrophic. It is a synonym for happiness in respect of totality and ideality. After Kant, these concepts should not be used "constitutively", but may be used only "regulatively". Health measurement is an example of misuse. Another misuse is positive health, in which QOL is frequently stressed. Originally QOL has been used in the social sciences, the social policy processes, or in clinical practices for individual patients. Positive health, in addition, tends to apply QOL to healthy persons. This abuse is due to pseudohypertrophy of health concept; health as flourishing human life or self-fulfilment. In respect of health concept, from medical philosophy to medical ethics, from the clinical to the preventive dimension, the dual transition of our concern is proposed.

著者

服部 健司

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.14, pp.69-80, 1996-10-01 (Released:2018-02-01)

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In Japan the law obliges employers to carry out an annual Health Check-up Examination for their employees. This may be effective for early detection and prevention, but could be an excessive intervention in rights and liberty of individuals, because the result of screeing is used not only for medical services, but for personnel management. Indeed no ethical problem has occured in the case of occupational diseases; nowadays the main target of workplace prevention is, however, non-occupational, chronic diseases, which are to a great extent relative to each individual private life or genes. Informed Consent is generally neglected, or rather ignored. And the priority of various alleged 'compehensive, total' health evaluations to the traditional, which has had to do with physical states of employees, is overestimated. Both in principles and in methods these should be reexamined. The socalled healthiest state is the self-realization. In this sense, health is a synonym for happiness, which is merely ideal. Not the constitutive, but the regulative use is appropriate for an ideal concept. The extent of self-enrichment or -fulfillment of each employee should not be evaluated in the workplace. The dogma of 'positive mental health', commands employees to strive for a higher, maturer mental activity. This is a mirror of shameful, discriminatory stigmatization against the mentally ill.

著者

服部健司 伊東隆雄編著

出版者

メヂカルフレンド社

巻号頁・発行日

2012

著者

服部 健司

出版者

群馬大学

雑誌

挑戦的萌芽研究

巻号頁・発行日

2007

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臨床倫理学の特異性はもっぱら個別特殊的なケースに照準を合わせたケーススタディに存する。ケーススタディの成果が豊かなものであるか貧しいかを決定する要因は、議論の仕方に先立ち、すでにケースそのものの叙法のもつ物語論的特性のうちに存する。具体的に言えば、カルテや症例報告を範型とした客観的自然科学的な視点からの記述よりも、見えない陰の部分、発せられる言葉の曖昧さ、明示あるいは暗示される意思の両義性の仄めかしをそのままに残した、多声性を含んだ文学的叙法こそが臨床倫理学ケースにふさわしい叙法である。次に問われるべきはケース解釈の妥当性をいかに確保し確証するかである。正典の妥当な釈義をいかにして得るかをめぐって興った解釈学が、その対象領域を文献一般、他者とその生、歴史へと拡張したのは一九世紀後半である。前世紀には、解釈の方法論の基礎づけという進路そのものの変更と深化が行われ、解釈学的哲学へと転回が図られた。臨床倫理学の領域での課題は、いわば共通の文化的地平上の大文字の文化の理解ではなくて、個々の人々の生きざまや迷いが描き込まれた小文字の物語としての臨床倫理学ケースの理解である。そのためには、解釈学的哲学以前の、方法論的な解釈学へとあえて意図的に後退する必要があるように思われる。客観的にではなくむしろ心理主義的、直観主義的な要素を排除するのでない仕方の解釈学でなければ、目前の小文字の物語を読み解く助けにはならないように思われる。この種の読みの技法を磨きつづけてきたのは文学であった。臨床倫理学の方法論的研究のためには、文学の哲学へと進んでいかなくてはならない。