著者
森 禎徳
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.33, pp.10-20, 2015-09-30 (Released:2018-02-01)

Withholding medical treatment to neonates born with congenital diseases has been prevailed in many countries since the 1970s. In Japan, several guidelines have been established that classify the cases in which we are permitted to withhold life-prolonging treatment. Nonetheless, no definite social consensus has been reached about whether and how withholding treatment because of disability can be ethically valid. Our aim in this study was to clarify the standards of withholding medical treatment to handicapped neonates that are ethically justifiable. First, we point out that withholding treatment to infants is essentially different from ordinary cases because the infant patients utterly lack autonomy. Then, we argue that "intolerable suffering," "quality of life," and even "the best interest" can never compensate for the lack of autonomy. These principles are inadequate for the standard we seek because objective validity is required for the criterion to justify selective nontreatment of infants with handicaps but aforementioned principles can acquire only subjective and individual validity. Consequently, we examined the justifiability of deciding selective nontreatment, which can be both ethical and feasible, claiming the importance of changing our point of view from an individual to a social level, and of a decision-making system based on a broad consensus, not on personal will. Meanwhile, we propose introducing palliative care for terminally ill neonates in order to provide them with dignified end-of-life phase.
著者
森 禎徳
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.31, pp.1-10, 2013 (Released:2018-02-01)

In this study, we first state that, although the majority of patients access complementary and alternative medicine (CAM) for the purpose of medical treatment or therapy, most conventional medical professionals(especially physicians) believe“ Evidence-Based Medicine (EBM)” to be the only legitimate principle and tend to hold CAM in contempt. Furthermore, we point out that the deficiency of legal regulations for CAM causes a serious problem that a vast number of patients depend on ineffective or even unsafe CAM. Stemming from this, we stress the importance of introducing particular regulatory frameworks for CAM as“ medicine.” Then, we argue for the significant benefits produced by regarding CAM as a part of the field of medicine and enumerate the conditions necessary to utilize CAM effectively within the current medical system, considering the advantages as well as the limitations of EBM. In conclusion, we emphasize the necessity of“ Medical Pluralism” to ensure the safe and effective use of CAM to properly respond to the health needs of patients. Conventional medicine based on EBM is reliable but still limited in many ways. Therefore, a lot of patients are dissatisfied with current medical care in Japan. As far as we accept these facts, we must recognize that“ Medical Pluralism” can be the essential idea which enables the integration of CAM and EBM into the holistic medical care system truly required by patients.
著者
森 禎徳
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.25, pp.81-90, 2007-10-18 (Released:2018-02-01)

Under the banner of "structural reform without sanctuaries", the government is attempting to promote the introduction of market principles into the medical care system. Although the primary purpose of this reform is to reduce the total national medical expenses, it is also expected that the market mechanism will contribute to the improvement of medical services. However, if we consider the managed care system in America, it is clearly evident that the deregulation of the medical care system produces numerous adverse effects and that the market mechanism does not work as expected. From an ethical point of view, the most serious problem is that excessive deregulation leads to the corruption of medical quality and "social exclusion" of the vulnerable; this is because market principles, by definition, do not include any ethical norms in the regulation of the market itself. Considering the supposed nature of the medical care system, we should control the power of market principles. The national medical care system must be considered as a public issue, and not as a matter of "self-interest"; therefore, it requires the higher principle of "fairness" as its moral foundation.