著者

原 敬

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.71-81, 2003-10-05 (Released:2018-02-01)

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The technology of drugs to treat physical pain has progressed and become widely available. Therefore, the number of persons terminally ill with cancer who suffer from physical pain has decreased in recent years. However, there is a fear that the treatment of such pain has become so routine, that the patient who discovers meaning through physical suffering is deprived of that meaning. It seems that the meaning attributed to physical pain by a person terminally ill with cancer differs from that of a patient after an operation. In the latter case, physical pain prevents the consciousness that faces life. On the other hand, in the case of the terminal cancer patient, pain is "the magnetic field" which fixes the consciousness that faces death. This magnetic field may fix that consciousness in such a way that it tends to face to life rather than death. It is said that for terminal cancer patients informed consent concerning pain management is as indispensable as is consent for other medical treatments. Some persons may think that there is no problem in the "routinization" of pain management, because a patient himself is holding the helm in this treatment and is able to control by his own will the physical pain which would act as a magnetic field fixing his consciousness on death, and moreover he is even able to escape the pain. However, if such treatment causes him to mistake his medical situation so as to believe that a terminally ill cancer patient can live comfortably without physical pain, informed consent is unable to be applied to him.

著者

永田 まなみ

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.82-97, 2003-10-05 (Released:2018-02-01)

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This paper discusses the debate in the Journal of Medical Ethics over the ethics of care between P. Allmark and A. Bradshaw. For the last 20 years, since C. Gilligan's work, the possibility of an ethics based on the concept of care has drawn considerable attention. Allmark argued that an ethics of care could not be based on the premise that care encompassed moral values because the word "care" itself could be applied to good or evil situations. Bradshow argued that care ethics could be comprehensible only when linked to the Judeo-Christian tradition. Allmark said that Bradshaw's care ethics had normative and descriptive points in so far as defined what should be cared for and haw it should be done, but that she did not respond to his assertion that a moral sense might not be derived from care itself, and also that her understandings about care contained philosophical and historical difficulties. Allmark is justified in arguing that, in general usage, care is a neutral term, and that as a result it can not be said to have moral overtones. Care can be used in the moral sense only if its subject and methods are clearly defined. Further, Allmark's attempt to cast doubt on Bradshaw's view of nursing care as a God-sent profession based on the Judeo-Christian tradition is acceptable from the viewpoint of modern nursing. In the context of nursing, however, it is beyond doubt that the subject of care is the sick and that the recovery of her health is intended. The discussion of care must include a very significant way of thinking by nurses in order to achieve the level of care desired, and it should rest on a foundation of respect for individual persons. The whole discussion of care in this context cannot be invalidated simply because the term "care" is also used in torture.

著者

水田 信

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.98-111, 2003-10-05 (Released:2018-02-01)

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When we talk about the 'quality of life' (QOL) we should inquire just into the 'quality' of human life. Generally speaking, a qualitative thing includes something original that has no substitute. Each person's existence is an irreplaceable life, and it has a unique value. QOL is a subject about the qualitative values of human life. The pursuit of QOL is the pursuit of a 'healthy' human life or 'happiness.' E. Fromm said that a person represents the whole human being, and that an individual is a physico-spiritual totality. He also said that the goal of a person in life is to be himself. According to Fromm, the fundamental human desire aims to conquer 'existential dichotomies,' such as 'life and death,' 'solidarity and aloneness.' Everyone shows one's answer depending on his/her character or personality. Only a 'productive character' can get happiness through its answer. That is the basic attitude by which 'human nature' and 'individuality' are brought into full play at the same time. Such a person gropes for a 'sane society'. And such a society ought to bring up sound persons. QOL as elements of a living environment are useful as conditions for happiness. However, the most important thing is the 'quality' of each one's life itself. This kind of QOL is shown by the basic attitude as 'personality.' A person who lives a well-filled life has a high quality of life. The scale of quality of life as the standard common to human beings is 'human nature,' which is also the foundation of human equality. This is the 'basis' of human rights. And each person will be the judge of the matter connected with 'happiness, making use of the activation of individuality. So, medical persons should not confuse QOL and 'social usefulness! Medical preference order is not a problem of QOL but purely a problem of medical technique.

著者

前田 義郎

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.20, pp.139-153, 2002-11-10 (Released:2018-02-01)

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The 'personhood' argument is one of the basic principles of bioethics. But various forms are possible within this principle. The high evaluation of the patient's will is one form of personalism. The superiority of a person's value over a life's value is another form. But the famous 'personhood' argument today maintains a personhood is 'a necessary condition for the right to life'. This argument is linked with 'the denial of the right to life for potential persons' and 'the criticism against the speciesism'. This argument indeed provides some guidelines for abortion and the vegetative state, but it will admit almost any cases of the recent reproductive technology, especially ES cells. So, I want to define the person again from the viewpoint of 'moral personalism'. In this paper, I want to introduce my interpretation of Kant's 'categorical imperative', and then try to define a person on the basis of it. 'A categorical imperative' can be interpreted as 'a practical categorical syllogism'. We can discover two conditions for valid categorical syllogisms. And from these conditions moral practical laws can be deduced. Then, I define 'a person' as 'one who can perform such practical reasoning and act according to it'. A person means a moral being. This definition makes a new understanding on 'autonomy' possible, too. This definition of person is made from the viewpoint of the 'faculty', not the 'actual will'. Therefore we can consider the difference between 'a human being' and 'a chimpanzee', and also can view 'a potential person' as a person potentially possessing this faculty. This argument is not based upon a necessary condition for right to life, but upon the moral value we must esteem. I believe that from this point of view we can give some guidelines to the recent reproductive technology, ES cells.

著者

大鹿 勝之

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.154-165, 2002-11-10 (Released:2018-02-01)

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If the meaning of self-determination is 'voluntary determination about one's own fate and course of action while remaining free from controlling interferences from others', the following patient decisions are comprehended as self-determination: (1) choosing unwillingly one treatment considering various circumstances; (2) choosing one treatment from choices represented by a doctor; (3) choosing one treatment from more choices than the above, getting information on various treatments from other sources than the doctor's information; (4) leaving one's own decision about treatment to the doctor. An explanation of these four situations follows:(l) an unwilling decision is self-determining, because this decision is derived from free will. With regard to (2) and (3), (3) is maybe more self-determining than (2), fer a patient gets the information through his/her own efforts. However, both are self-determining because both are voluntary decisions. (4) Though the patient gives up his/her own determination to choose the treatment, he/she decides voluntarily to give up his/her choice to the doctor. Therefore, patient decisions are self-determining in these four situations. For this reason, if self-determination is understood to be of great advantage to a patient, it needs to consider its relationship with the various situations, for example, how to inform the patient about his/her condition and various treatments, and the circumstances.

著者

田中 孝美

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.20, pp.166-173, 2002-11-10 (Released:2018-02-01)

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People living at home with chronic respiratory failure must struggle to live in the face of various difficulties and distress. But their experience has not been investigated up to now. This study focuses on the experience of people living with this chronic respiratory failure. It is also an experiment in practical nursing research. Four patients and their families agreed to be participants. The patients are sufferers of chronic respiratory failure undergoing long term oxygen therapy at home. The methods used fieldwork at such places as outpatient departments, patient group activity situations and the patients' homes. Several formal and informal interviews were also conducted over a period of six months. Through fieldwork and interviews, I endeavored to come into contact with their actual sense and experience of life. I have described the findings under three headings : "Breathing and Moving", "Living with Suffering", and "Devising Life Strategies". First, I describe the experience of "Breathing and Moving". The participants actually feel that each and every breath supports their life. They must concentrate their consciousness to breathe in order to make each movement, and choose every movement carefully. For those people living with chronic respiratory failure, the simple act of breathing becomes the primary action supporting their life. They cannot entrust their lives to their body's automatic breathing, but must always be conscious of their breath. Second, I describe the experience of "Living with Suffering": The participants find hope and courage for themselves from contact with other patients' lives. When they observe something, they perceive a meaning in it to apply their life. They face the inevitability of life, and make new efforts to live themselves. Thus they maintain their will, and resolve "I want to do this" or "I don't want to become that". Lastly, I looked at the concept of "Devising Life Strategies": There are produced from their earnest desires. The patients devise the strategies themselves through a long groping process. The strategies may be called a technique for living. However, it is important to emphasize that they do not talk freely about the Strategies to medical workers. In conclusion, those living with chronic respiratory failure live in a world experienced through their body. Understanding of their subjective experience is produced through contact between the lives of patients and that of the researcher. The world of meaning and emotion world cannot be approached merely from an objective perspective.

著者

工藤 せい子

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.20, pp.174-183, 2002-11-10 (Released:2018-02-01)

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The purpose of this quasi-experimental study was to foster ethical sensitivity among nursing students. Nurses and nursing students face many moral and bioethical problems in clinical practice. The development of ethical sensitivity in nursing students has paralleled the development of nursing as a profession. The subjects (n=19) were students who entered the Training Course for High School Teachers of Nursing Faculty at Hirosaki University Japan in 1999. The method of this experience of death with people in their immediate circle while a small number of students had experiences of great impact. Some students were very sympathetic to the experiences of others and felt the experiences of their counterparts as their own experiences. The discussions about death were meaningful for the students. They are well motivated to be nurses in the future and therefone had to think about many kinds of death first person death, that is their own death, second person death, that is death of their relatives, and had no other choice but to be involved in many third persons deaths. They thought seriously about how to take third persons deaths and the discussion contained the essential points concerning what "death" is and "deaths of the first, second, and third persons." The discussions had a favorable impact on the students and motivated them to think more deeply about death. In concusion, discussions about death help to raise the ethical sensitivity of students.

著者

高久 史麿

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.192-203, 2002-11-10 (Released:2018-02-01)

著者

鈴木 正子

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.20, pp.204-211, 2002-11-10 (Released:2018-02-01)

著者

小林 英司

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.20, pp.212-215, 2002-11-10 (Released:2018-02-01)

著者

樫 則章

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.216-222, 2002-11-10 (Released:2018-02-01)

著者

宮越 一穂 棚橋 賓

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.223-225, 2002-11-10 (Released:2018-02-01)

著者

田村 京子

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.20, pp.1-15, 2002-11-10 (Released:2018-02-01)

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Since the "Law of Organ Transplant" was enacted in 1997, transplants of organs from brain-dead patients have been performed in Japan. I interviewed physicians working for a hospital providing organs from brain-dead patients. The results are reported here. The discussion points are as follows: 1: There are four specific physician related roles to be found in the process of extracting organs from a brain-dead patient, as follows: A physician engaged in life saving (Physician for emergency), two physicians who diagnose brain death (Neuro internal physician and neurosurgeon), two physicians who manage a donor (Anesthetists), and two physicians supporting the extraction (Anesthetists). 2: The physicians had different opinions depending on their role. In particular, the anesthetists in charge of donor management felt that good quality medical treatment was not being provided, since the medical conduct was only the same as that for ordinary patients in the Department of Anesthesiology. 3: The anesthetists really felt that death occurred upon the extraction of the heart of the brain-dead patient. 4: Because the provision of an organ in an organ providing hospital is conducted under a division system, and feedback from a transplant hospital to an organ providing hospital is not conducted, physicians from the organ providing hospital could not understand the conditions of the recipient and could thus not evaluate transplants from the braindead patient. 5: Because observance of the law is more important than medical conduct, physicians don't need to ask questions about treatment that concern them.

著者

伊東 隆雄

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.30-42, 2002-11-10 (Released:2018-02-01)

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There have been many discussions, from various positions, about what kind of care is needed with regards to terminal care for the elderly with dementia. Although it is generally thought that extraordinary treatment and care are not necessary, in reality, there is a marked tendency for excessive treatment to be performed in our country, because most physicians have difficulty accepting natural death. This is due to many physicians' strong belief that the death of a patient means a defeat for medical treatment. The elderly with dementia will not die by the disease directly, but from a complication such as pneumonia. Therefore, keeping the patient from such a complication extends a patient's life for a longer period of time. The situation of the elderly with dementia is reminiscent of the Struldbruggs in "Gulliver's Travels". In this story, these immortals must live eternally and cannot die even though they age with dementia. Furthermore, endless life-prolonging is not the purpose of terminal care. Certainly, the intellectual faculties of the elderly with dementia weaken, but, they continue to be able to maintain their emotional faculties when interacting with others. Such coexistence and feelings of emotion are basic of care and are not invasive conduct. If the medical care provider accepts the patient's death and is sympathetic to them, it is thought that appropreate medical treatment and care should be carried out naturally.

著者

小阪 康治

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.43-55, 2002-11-10 (Released:2018-02-01)

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Concerning the issue of Informed Consent, it is still common in Japan for ethical standpoints tobe easily affected by the legal viewpoint, though law and ethics should be under different jurisdictions. In the dispute about actual legal judgments, there are three points at issue. They are as follows: 1) Respecting doctors' judgments as professionals 2) Patient responsibility, based on the premise that patients can deal with their medical situation rationally 3) Respecting the understanding and judgment of individual patients Each point has its own merit and demerit, but the author thinks that the third idea, that is, respecting individual patient's understanding and judgment, is the most suitable when considering the concept of Informed Consent from the ethical point of view. Under the present situation, when we looked into prior judicial precedents, judgments have mainly been made on the basis of the first idea of respecting professionals' opinions. Furthermore, there are some cases where judgments were made from an ambiguous viewpoint, mixing the two or three points mentioned above. Under these circumstances, the author thinks that, in Japan, ethics should voice more about the issue of Informed Consent, and should make efforts to bring judgments based on Informed Consent closer to the ideal and appropriate form regardless of any legal dispute from the past.

著者

松川 俊夫

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.56-66, 2002-11-10 (Released:2018-02-01)

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The concept of 'imperfect duty (or right)' is forgotten in modern ethics. But this concept is very efficient for medical ethics. For example, if we examine the duties of a physician and the rights of a patient by giving our eyes to imperfect duties and rights, we can get a clue to the fine understanding of the physician-patient relationship. Now that paternalism in the physician-patient relationship is said to be rejected, the autonomy of the patient is a kind of trump card. And many bioethicists and laymen adjudge that the physician-patient relationship must base itself on the 'contract.' But Japanese 'SEKEN1 ('the world' or the traditional Japanese human relationship) between a physician and a patient postulates one sort of physician's paternalism. And the physician-patient relationship based on a contract would bring some moral hazard to a physician. We must understand what is the moral problem in the physician-patient relationship, and the examination of imperfect duties (and rights) will lead us to the solution of that. In many respects, we follow the study of the history of ideas on the imperfect duty in Millard Schumaker's "Sharing without Reckoning."

著者

宮坂 道夫

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.67-79, 2002-11-10 (Released:2018-02-01)

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In this paper, I will inquire about justice theories with regard to the public policy of assisted reproduction (AR). In the first part, I will criticize the classic four-principle-based frameworks of American bioethics. Firstly, it is not all-embracing, because it rejects any "communitarian" argument dependent on substantial common values such as human dignity. Secondly, it is not neutral, because practical advantage is given to liberal argument that permits any kind of AR. These liberal points of view are further analyzed as follows. (1) They impose empirical demonstrations on the autonomy-based negation of AR, (2) They permit the harm/benefit-based argument dependent on medical habits which are basically affirmative for AR, (3) They have traditionally concentrated on distributiv e justice, that is, nothing is discussed about newly developed AR, until it becomes a social resource. I will then introduce categorical and methodological expansions of justice theory as follows: (1) When we establish another category, which I call 'resourcification justice', in justice theory by questioning 'on what basis the health care service is justifiable', it will allow us to identify the nature of the conflict over AR. (2) When we adopt the two Rawlsian principles of justice only formally, rejecting any material premise, they require us to identify justly who is the worst off in the context of AR. Furthermore, the only guiding principle of fairness requires us to adopt a methodological justice, which I call 'narrativejustice', in that identification. This does not allow us to take ourselves only in the public context of policy makers and the worst off. It requires us to take ourselves at the same time in the private context of the narrator and the narratee.

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

道又 利 黒澤 美枝

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.109-122, 2002-11-10 (Released:2018-02-01)

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Evidence-Based Medicine (EBM)can be defined as a procedure to evaluate objectively the clinical efficacy of treatment from the viewpoint of a statistical appropriateness. It can also illustrate guidelines for diagnosis and treatment, make the most sophisticated up to date system of medical applications shared by medical professionals beyond individual and cultural difference, and finally, aim at standardization of medicine. As an ethical viewpoint, EBM may be able to provide more positive and essential informed consent by showing better evidence of the treatment to patients. EBM also meets social needs by allocating medical resources effectively, for it can supply, from the very beginning, the most effective treatment. Even in clinical cases, in which the etiology or pathology is unknown, or symptomatology is too complex or multidimensional, EBM can give an active guideline for the treatment to physicians, concentrating only on the efficacy of clinical application, temporarily neglecting the etiological factors. As the only principle to justify medical intervention is the risk/profit ratio, it is extremely important to evaluate usefulness of treatment objectively before introducing the treatment method. Concerning this point, EBM can provide the foundation for medical ethics. Especially in psychiatry, because of difficulty in identifying etiological factors, EBM has a very important role in ethical consideration. However, on the other hand, the popularization of EBM could possibly offer various problems. We must take note of the easy use of EBM as a manual-book, overconfidence or misunderstanding of its "objectivity", neglecting the notion of "Comprehension" (Jaspers K) and related psychopathology, and alteration of patient-physician relationships evoked by a preponderance of objective data.

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?