著者
加藤 穣
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.41-51, 2015-09-30 (Released:2018-02-01)

The objective of this paper is to discuss the reasons that some individuals in the United States refuse to be vaccinated, focusing on those reasons usually described as "conscientious." This paper discusses current compulsory vaccination practices and the most common categories of reasons objectors in the United States give for refusing vaccinations (on medical, religious, or philosophical grounds, the latter two of which are often described as conscientious reasons). Possible ways to handle refusals are examined from the perspectives of the three categories of refusals mentioned above, the particularities of vaccination within biomedical ethics, and public health ethics discussions. Although refusals based on divergent perceptions of risk are commonly classified as refusals for philosophical (personal) reasons, objectors in this category are trying to present medical reasons, which do not convince experts. Even if experts try to persuade the public by presenting scientific evidence, there remain fundamental difficulties in convincing objectors. Refusals for religious reasons are to a certain extent established historically, but few major religious groups nowadays explicitly refuse vaccinations per se. Refusals in this category are not necessarily plainly "religious." Certain refusals on religious grounds, including those based on repugnance for the use of components derived from aborted fetuses, can be avoided by technological advances in the medical field. Refusals based on philosophical reasons should be handled in more sensitive, individualized ways than they are now. The inquiry ventured in this paper is important for Japanese society in that it deals with general questions surrounding the contradictions between the autonomy principle, which is paramount in biomedical ethics, and the compulsory schema of public health policy, and asks whether and how the different qualities or characters of decisions regarding health care and public health should be translated into practice.
著者
関 修
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.33-47, 1997

1. Medical Philosophy, Ethics and Problems of Homosexuality. The various concepts of sexuality were invented by psychopathology in the late 19th Century. In the DSM-III-R of 1987, homosexuality suddenly became normal from abnormal. However transgender remains an illness, as it was before. It is only a political problem. Another important problem is about AIDS. In Japan, there is discrimination between AIDS caused by medicine and AIDS caused by other factors. 2. Homosexuality as Thought : Situation of modern French Thought. In France, The "May Revolution" of 1968 caused the foundation of a new university : Paris 8th (Vancennes). One of its founders, Rene Scherer began his first lecture on sexuality in the faculty of Philosophy. His partner, Guy Hocquenghem, founded FHAR. Recently, Red and Black-Homosexuals in France after 1968 by F.Martel was published. However, Prof. Scherer has told me it is a defective book. 3. Thought of G. Hocquenghem : concerning homosexual desire. The originality of Hocquenghem's thought seems to lie in his idea of forming "a group of subjects" through the anus. The creation of relations among others by anality stands against ideas of couples. Being homosexual is not a means to attain self-identification, but a means to be out of self, to become a foreigner. It is also an escape to an infinite drifting from a stiff identity. 4. The Voice of M. Foucault : Homosexuality as a form of existence. Foucault's thought about homosexuality summarizes two points. First, to be homosexual is not correct ; to become homosexual is correct. He takes "gay" to create a new form of existence. Therefore, he does not think coming-out to be inevitable. Secondly, his problem is to begin to love among individuals. It means that "I" is more essential than sexuality. Here there seems to be fascination for passivity. 5. Conclusion : In Japan, they say "gay" is already out of fashion : now "queer" replaces it. However, such nomenclature is only a matter of fashion. To my regret, regular studies on gayness or queerness are not carried out in Japan. Now, it is necessary to study homosexuality as thought. That means to meet various thoughts not only to introduce and imitate them but to get involved in them : to have a mind of "hospitality". That is a critically needed task in Japan.
著者
江口 聡
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.19-28, 2010-09-24 (Released:2018-02-01)

After briefly reviewing the philosophical controversy on abortion, I will introduce Don Marquis' "future-like-ours" argument and its various critiques. Marquis insists that (1) it is seriously immoral to kill us because killing deprives us of our valuable futures, and (2) a human fetus has a future like ours, therefore (3) it is seriously immoral to kill a human fetus. His argument is very simple but plausible, and not easy to rebut. Possible objections to his argument are (1) an objection from negligence of the women's viewpoint, (2) a ruductio ad absurdum objection from contraception, (3) an objection from metaethical analysis of "loss" and "deprivation", (4) an objection from personal identity and non-similarity of a fetus and us, and (5) a metaethical objection from relation of value and desire. I argue that objection (5), which relies on the desire account of value, is most powerful, if we are to account for modifications and qualifications of "desire", such that desire should be interpreted as "dispositional desire" and desires should be "rational and well-informed". But these objections also have a significant burden of philosophical justification.
著者
金谷 光子 尾曽 直美
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.93-102, 2004

Because there may be limitations in the scientific method of discovering and treating patients' "problems," the narrative approach has become increasingly important. These limitations have been pointed out by scholars from various fields. Hermeneutic view point has it that clinical knowledge is mostly based on the doctor's assumption and differs greatly from the world in which the patients live their lives. What should those in the nursing profession choose as a means of understanding patients? There is a Social Constructionist view that understanding is obtained through "language." When the sick patient tells about the world in which he/she lives in certain words, he/she has decided not to tell in other words. Then the patient's world appears before us as he/she tells. The patient organizes his/her world through telling as well. After over three years of interviewing with Ms. K, who was stuck with her mal-treating mother, we verified what telling brought to her, and how it was connected with understanding herself. Listening to Ms. K's narrative was linked to understanding her world in which she lived her life. It also brought a certain order to her confused history. As a result, her regrettable past came to have possibility for the future, altering her mentality so much as to make it possible for her to say "I have done my best" and "I have been living so well."
著者
新山 喜嗣
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
no.25, pp.99-109, 2007-10-18

Patients with Capgras syndrome complain that real persons close to them have been replaced by identically looking imposters. This syndrome is interpreted as the total replacement of the "haecceity" that is distinct from one's attributes. Capgras syndrome suggests that possible worlds around a person come in two different series: one of possible worlds in which the attributes of the real person change in a variety of forms with his "haecceity" unchanged, and the other of possible worlds in which the "haecceity" of the real person is replaced by something else with his attributes unchanged. Possible worlds involving these two series could develop without limitations, and hence impart unlimited diversity to the variants of myself living in possible worlds. Thus, the variants in possible worlds must include some who possess both haecceity and attributes that are identical to those of others in the real world. It can thus be speculated that others in the real world are nothing but variants of myself who have turned up in the real world from possible worlds they originally inhabited. In this context, it may be assumed that I am keeping in touch with my own variants every day here in this real world. In the real world, I myself always create a singular point characterized as "I," "now," and "here". In a certain possible world, however, another person generates this singular point. As a result, I myself become the other to him. Such worlds where I turn up as the other probably include ones whose contents are exactly the same as those of the real world. Because these worlds are perfect mirror images of the real world, we mistakenly assume that they are the same one world. Because of this confusion, we see many generators of the singular points coexisting in the real world.
著者
石川 洋子
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.1-9, 2010-09-24 (Released:2018-02-01)

Advocacy in nursing, is a central concept in terms of protecting the interests and rights of patients as well as establishing and improving the expertise and social status of nurses. In fact, advocacy is a role played not only by nurses, but by all medical professionals. Advocacy is an important concept for nursing with extensive meaning and contents. Consequently, confusion can occur due to the uncertainty advocacy poses for nursing practice. Moreover, advocacy is accompanied by risk and difficulty, and there are no clear guidelines on how to implement it. It is necessary to enhance education and improve the workplace environment to practice advocacy effectively. It is also essential that nurses reconsider their values and how they support patients while collaborating with other medical professionals.
著者
佐藤 拓司
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.23, pp.97-105, 2005-10-26 (Released:2018-02-01)

This paper analyzes the notion of sexual perversion from a philosophical stance. Sexual perversion is difficult to analyze because the notion of sex is itself ambiguous and unclear. Alan Soble identifies five central distinctions within the conceptual philosophy of sex that define the concept of the sexual act as 1) involving contact with a sex organ, 2) serving a procreative function, 3) producing sexual pleasure, 4) relying on intention or purpose, 5) being defined in terms of sexual desire. However, none of these definitions is sufficient. The philosopher Thomas Nagel set out a psychological standard that remains useful today. He defined the purpose of sexual desire as one of communication among the participants. According to Nagel, sex has an overlapping system of sexual perceptions and interactions: it involves a desire that one's partner be aroused by the recognition of one's desire that he or she be aroused. Nagel's theory, known as the "communication model", proposes a purpose for the sexual act and attempts to explain the essence of perversion. It proposes that the act of blocking off the communication results in the perversion. This model has a number of problems, however. For example, it implies that sexual relations between regular partners are inferior to novel encounters because less remains to be communicated sexually. Why is such a conclusion derived? Because the communication model is built up with equivocal and ambiguous structure, it involves both external and internal moral criteria. The coexistence of both types of criteria is the source of the model's problems.
著者
加藤 穣
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.41-51, 2015

The objective of this paper is to discuss the reasons that some individuals in the United States refuse to be vaccinated, focusing on those reasons usually described as "conscientious." This paper discusses current compulsory vaccination practices and the most common categories of reasons objectors in the United States give for refusing vaccinations (on medical, religious, or philosophical grounds, the latter two of which are often described as conscientious reasons). Possible ways to handle refusals are examined from the perspectives of the three categories of refusals mentioned above, the particularities of vaccination within biomedical ethics, and public health ethics discussions. Although refusals based on divergent perceptions of risk are commonly classified as refusals for philosophical (personal) reasons, objectors in this category are trying to present medical reasons, which do not convince experts. Even if experts try to persuade the public by presenting scientific evidence, there remain fundamental difficulties in convincing objectors. Refusals for religious reasons are to a certain extent established historically, but few major religious groups nowadays explicitly refuse vaccinations per se. Refusals in this category are not necessarily plainly "religious." Certain refusals on religious grounds, including those based on repugnance for the use of components derived from aborted fetuses, can be avoided by technological advances in the medical field. Refusals based on philosophical reasons should be handled in more sensitive, individualized ways than they are now. The inquiry ventured in this paper is important for Japanese society in that it deals with general questions surrounding the contradictions between the autonomy principle, which is paramount in biomedical ethics, and the compulsory schema of public health policy, and asks whether and how the different qualities or characters of decisions regarding health care and public health should be translated into practice.
著者
長田 蔵人
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.27, pp.60-68, 2009-10-01 (Released:2018-02-01)

We usually recognize instinctively that it is unreasonable to be blamed for something beyond our control or expectations, and that we should be morally evaluated in terms of motives or intensions, which are insusceptible to luck. On the other hand, however, we admit in many cases that luck exerts some influence on agents' moral evaluations. This inconsistency has long been discussed as the problem of 'moral luck'. This paper shows that the same inconsistency can be found in our attitude toward medical malpractice, and considers how to deal with it. According to D. Dickenson, who introduced the concept of moral luck into discussions of medical ethics, bad luck in medical accidents means doctors' misfortune of being blamed for inevitable accidents that occur beyond their control. Medical malpractice, which is caused by negligence and therefore can be prevented, is thus excluded from her consideration. Contrary to this, this paper argues that even regarding cases of negligence, if there are structural, technical factors that can induce such negligence, anybody could make medical errors, and it is in this sense that there exists moral luck in the cases of malpractice. This consideration leads us to the following conclusions; (1) even in the cases of negligence, it may be unreasonable to inflict criminal punishment on doctors, for we cannot clearly distinguish according to criminal law between cases of vicious negligence and those of mere moral luck; (2) a criminal suit is not a proper means to investigate what really occurs in medical malpractice.
著者
杉岡 良彦
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.61-70, 2007-10-18 (Released:2018-02-01)

Dr. Makoto Kondo, a radiologist at Keio University, has suggested that one should not fight against cancer. His arguable claims are that (1) cancer screening is ineffective and that (2) cancer is divided into two categories: true cancer and pseudo-cancer ("gan-modoki" in Japanese). The former has a strong potential to be invasive and has already reached the invasive state on detection by screening. The latter is noninvasive and therefore the affected patients need not undergo medical treatment unless they exhibit some symptoms. Kondo highlights the evidence provided by medicine and informs us of how poor its basis is. It should be noted that he reached this conclusion through in-depth reflection on findings regarding cancer, without submitting to the opinions of the authorities. From the perspective of philosophy of medicine, we may state that his attitude is that of a philosopher. However, he also discourages patients who believe that cancer screening and treatment are effective. On the other hand, Dr. Toru Abo, an immunologist and a professor at Niigata University, has developed a theory regarding the close relationship between the autonomic nervous system and the immune system, and maintains that cancer can be cured by activation of the latter. In contrast to the claims of Kondo, many of Abo's claims lack medical evidence, but he offers hope to patients. Kondo's theory is based on positivism, and he does not raise the hope of patients. Kondo's position is very effective in revealing the insubstantial basis of medical science, but he confronts patients with nihilism, while Abo offers hope without considering the fact humans are mortal. Based on the opinions of these two doctors, we can reflect on the limits of application of positivism in medicine and the importance of the optimism that patients display and their individual initiative.
著者
有馬 斉
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.71-80, 2007-10-18 (Released:2018-02-01)

In moral discourse, people often appeal to emotion as opposed to reason. This is particularly true when they discuss the moral status of the use of new biomedical technology. Sometimes we may be unable to articulate an argument against organ transplantation from a brain-dead person, host surrogacy, human embryonic stem cell research, etc; we may then only say that "these acts are disgusting." What exactly do we mean when we say that someone's act is "disgusting"? In the first half of this paper, I shall distinguish three cases: (1) a person who seeks to reach a "reflective equilibrium;" (2) a communitarianist; and (3) a moral realist, each of whom may appeal to emotions in his or her own way. The purpose of the latter half of the paper is to examine and refute the manner in which moral realists appeal to emotion. Consider, for example, incest, cannibalism, rape and murder. It may seem that these acts are objectively evil, and that they provoke a negative emotional reaction. These facts might lead one to believe a realistic idea that human beings are biologically equipped with a special kind of emotion whose function is to detect objectively existing moral evilness. In order to show a fallacy involved in this inference, I shall point to a fact that has been reported in the literature of empirical psychology.
著者
伊藤 幸郎
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.69-75, 2004-10-18 (Released:2018-02-01)

What is meant when a doctor says, "You are healthy" after the health examination? Is it possible to diagnose a person to be healthy? In fact, this question comes from a confusion between science and values. Health is not a scientific term but a value-laden, normative concept. So your doctor can only say "I couldn't find any disease," not "You are healthy." Clinical medicine textbooks describe many diseases, but they never give a working definition of "health". There are many diseases to be diagnosed but only one "health." "Health" is unique for each person and stands outside any medical investigations. When one tries to define health he will tend to fall into a circular discussion: Health is an absence of diseases and disease is a lack of health. One typical definition of health has been given by the WHO (1946). The WHO defined health as a state of complete physical, mental and social well-being. Some critics say that the WHO definition merely replaced the word "health" with "well-being." Many philosophers have proposed non-circular, positive definitions of health. However, like the WHO, they eventually fall into theories of happiness, which are very important, but cannot be applied to medicine as science. In contrast to clinical, the textbooks of public health education have rich descriptions of health. Public health officers also stress the importance of health. As shown in the slogan "health promotion," the health and disease of a population is recognized as a quantitative concept which may increase or decrease. In conclusion, health examinations don't diagnose a person as being healthy. All we can do is a massscreening of diseases. The true meaning of health depends on each person's view of happiness and as such, it is not a pure medical problem.
著者
菅原 潤
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.24, pp.21-30, 2006-10-24 (Released:2018-02-01)

The German philosopher Juergen Habermas, who emphasizes the significance of communicative rationality in constructing social theories, has recently made active proposals in bioethics. To the extent that he insists on duties analogous to moral ones with regard to the moral status of animals, he remains in step with the opinions of some English-speaking ethical theorists. Indeed his acceptance of communications between men and other animals is consistent in part with the position of Peter Singer, who represents such opinions and objects to differentiating between humans and animals with reference to moral duties. However, Habermas fears that valuing various lives only for their sensible capacities, regardless of special differences, might result in assignment of priority to the lives of healthy higher animals over those of handicapped babies, and therefore maintains that we are after all different from the other animals in moral status. This conclusion by Habermas is built on the philosophical edifice of Max Horkheimer and Theodor W. Adorno, the author of the Dialectic of enlightenment, in accordance with the idea that we should not instrumentalize the living activities of humen beings. This is why he insists that research in reproductive medicine should be carefully considered. Accordingly, his attitude toward bioethics results in a kind of anthropocentrism, though we must not overlook the need for expansion of communicative relasions between humans and other animal species. The opinions of Habermas on bioethics have affected the ethics of nature, as outlined by Angelika Krebs and Martin Seel under the influence of Frankfurt School in the contemporary Germany.