著者

池谷 健 本田 勝紀 西河内 靖泰

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.106-117, 1999-10-01 (Released:2018-02-01)

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A 62 year old man died of SAH at an Okinawan hospital in Dec. 1996, and his kidneys were transplanted after his death by consent of one daughter. Afterwards other members of his family, i. e. his wife, his son and his three other daughters, went to court over the inappropriate therapy and donation. We were asked to check a copy of his clinical chart tendered by the hospital, the letter of complaint of his family members, and the questionnaire to the hospital and answers from the director of the hospital. We pointed out 3 major issues : (1) Did he receive reasonable treatment? Was his brain death diagnosed correctly?, (2) Was the informed-consent of his family members for his organ transplantation stated clearly?, and (3) Did the co-ordinators give adequate information and make valid agreement? Did they confirm the donor's will? Did they confirm consensus of the family for donation? We cannot find out rational answers to the questions above. The patient was a mentally handicapped person, and the doctors abandoned his treatment soon after his arrival to the hospital. Once the opinion of his organ donation was made by one daughter 3 days after his admission, the doctors ignored any wish against donation by other family members. We believe that the happiness of the donor family is one of the most essential factor for organ transplantation to plant its roots in Japan. In this case, the family got no happiness but serious confusion. This case could be an extraordinary case, but because we have only a few means to check up the adequacy of organ donation in this country, this might not be an exceptional case. The difficulty to access medical data by the family must be dissolved immediately.

著者

本田 勝紀

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.144-155, 1999-10-01 (Released:2018-02-01)

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Some cases of "brain death"-heart transplantetion in Japan have been performed in 1999 after a long- period of time following the Wada scandal of 1967. The problems of whether "brain death" is the termination of human life or not have not been solved medically, socially or ethically, even though the new organ transplantation law, including the description-a brain-dead body, was enforced during a brief discussion in 1997. The main reason was that the authorized Takeuchi criteria of the Ministry and Welfare in 1985, and 1997 together, stated that brain death is not a concept on death, but a clinical concept on statistical study on brain-death cases of our country. So, the "brain-dead" person in transplantation is the weaker patient compared with the recipient patient. In 1996, Professor Abe was arrested for the accidental homocide of a hemophilia patient injected with non-heated blood. The patient later died of AIDS after the injections. Professor Abe routinely carried out these types of injections till the middle of 1985 through a subordinate doctor of Teikyo University. I think that Professor Abe is the weakest person compared with the AIDS patient, who was supported by patients groups, lawyers, public prosecuters and the mass media. Being a specialist on blood medicine, he could know the risk of blood from the USA possibly comtaminated with AIDS, reading the some new English articles 10 years ago, but he never discontinued the use of the blood therapy. The reason was that at that time, there was no consensus on the non-heated blood for hemophilia as the origin of "AIDS", medically (no strong arguments on the blood were done for the origin of the AIDS in the blood group meeting, and so strong debate was done on the strict relation between the serological findings and fatal signs of AIDS patient in the infection group meeting), socially, and legally. And secondly blood therapy was the only routine method to treat the bleeding of hemophilia. Thirdly this legal and fanatic investigation against Prof. Abe was performed 10 years after the injection based on long years of medical data. He is the victim of irrationalism and fascism in the medical society including both doctors and patients of our country, because in Europe and American countries where the more strict discussions on the relation between the blood use and AIDS signs have been continued these 10 years medically, socially and legally, no arrest of the clinical doctors has been found in the investigation till now.

著者

本田 勝紀

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.107-120, 1996-10-01 (Released:2018-02-01)

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In Japan, medical and social consensus on why brain death is the termination of human life? has not been obtained since the first heart transplantation by Dr. Wada in 1968. Discussions were concentrated on the diagnosis of brain death of an alive drown donor and operational indication (with the technical problems) of the recipient patient.Historically patient rights have not been established in medicine in Japan, so we studied 8 kidney(1 pancreas) transplantation cases from brain-dead patients including Tsukuba case* based on newspaper informations for these 10 years. The basic diseases were:brain contusions 4,subarachnoidal bleeding 1,a bee-toxin shock 1.cerebrovascular disease (dementia) 1,and unknown 1. The finai explanations on the critical conditions were:will soon die 2,near brain death 3,brain death 2,and unknown 1. According to the most authorized Takeuchi report on Brain Death, the concept of brain death is just clinical,and the definition is irreversible dysfunction of total brain. Indeed, many reports on brain-dead patients demonstrate that they are not dead, because of body movement (spinal nerve action), secretions of pituitary hormones, alterations of brain Xray-findings, and delivery of brain-dead pregnant women. By analyzing of our cases, we summarize that (1)before brain death was djagnosed, almost all families were told that patients would soon die, and the main subject of treatment was converted to preparation for transplantation. (2)the most ethically important problem was found in Tsukuba case, which showed the discrimination of psychohandi-caped patient in consent and treatment policy-abandonment of resuscitation. Obtaining no chances of discussion with those doctors, we accused the operators and neurosurgeons as committing murder of the donors, but still now, no decision for or against criminal prosecution has been announced these 10 years

著者

長坂 昌人 本田 勝紀 松崎 健三

出版者

一般社団法人 日本不整脈心電学会

雑誌

心電図 (ISSN:02851660)

巻号頁・発行日

vol.3, no.3, pp.353-359, 1983-05-31 (Released:2010-09-09)

参考文献数

34

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東大第1内科に入院して低Na血症を示した患者48例の心電図を, 血清Na濃度が≦130mEq/lの時とそれ以上の時との間で比較した。その際血清Na濃度と血清K濃度とは相関がなかった。同一患者での比較であるので血清Na濃度の変動の幅は小さかったが, 低Na血症時にRR間隔は短縮し, 第II誘導でのP波の幅が延長した。その他の測定値には有意の差がなかった。P幅の延長は心筋細胞電位において媒液Na濃度を低下させると興奮伝導速度が低下することに対応する。RR短縮は歩調取り細胞の自発興奮は低Na媒液で, 緩徐化または不変とされているのでそれからは説明できない。むしろ交感神経末端でのカテコラミソの取込みの抑制, 放出の増大の影響を考えるべきと思われた。このことは房室伝導においても低Na媒液は延長させるという成績に対し, 臨床心電図では不変か若しくは促進していることと関係あるかも知れない。なお心室内伝導に関しては脚ブロック型等の延長傾向を示す例が見られた。そのうちの1例は低Na血症の解消と共に脚ブロック型も改善した。