著者

松島 哲久

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.18, pp.182-188, 2000-12-15 (Released:2018-02-01)

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In this paper, I first argue from the viewpoint of philosophy that the patient's body cannot be sufficiently comprehended by the logic of the biological mechanism. In order to make this point clear, I criticize the philosophical stand of the biological mechanism. Firstly, the position of the biological mechanism views a patient's body as an object of the world, so it cannot comprehend the reality lived by the body of patient. The patient's body, the biological mechanism reveals, is an anonymous body, not the proper living body of the patient. The biological mechanism lacks the perspective of individuality. Secondly, the understanding of disease of the biological mechanism is that of being-already-objectified, so it always remains in the past aspect of time. It lacks historicity and timeness and thus ignores the life history of the patient. Following the critical argument of the biological mechanism in modern medicine I propose a new comprehension of illness. It considers the patient's body as the milieu of the auto-expression of the patient's existential suffering. The comprehension of the patient's body should be that from the viewpoint of the unity of mind and body. Moreover, taking into consideration the relationship between medical staff and the patient, the patient's body should be understood as the body-aspair (interbodility). The patient's body reflects the body of medical staff, and reciprocally the latter reflects the former. They both form the intersubjectivity and then make themselves open into the world. So we should also understand the patient's body in the socio-cultural context. Thirdly, I propose the understanding of the body as sign/metaphor. It represents the semantics of illness. I insist upon the necessity of the hermeneutics of illness to understand the meaning the patient's body auto-expresses. The metaphor of the body bears both the meaning of discrimination and the religious-symbolic meaning. So the medical staff should transcend the discriminative meaning of the patient's body to its sacred meaning. Lastly, I argue the importance of the stand of ethics. The medical staff should constantly come face to face with the patient. We need to realize the patient's rights in accordance with the patient's actual body.

著者

前野 竜太郎

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.18, pp.35-42, 2000-12-15 (Released:2018-02-01)

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We usually emphasize the objectivity of physiotherapy because of its reliability and validity. When we usually do physiotherapy, we can find out various physiotherapeutical problems in accordance with objective evaluation of the patient. We can then set up a rehabilitation goal, and sometimes we might prescribe scientific exercise for a patient. However, is that all we need? In particular, how about the great number of chronic cases? If we persist in our scientific method, we couldn't discover the whole patient. I suggest we need to use not only a rational medical rehabilitation approach but also an existential medical rehabilitation approach for chronic patients. Existential medicine means holistic medicine. Even if we can't expect improvement in the disability of all chronic patients, we must understand what their problem is as a whole patient, and be concerned about their suffering. If so, they may communicate real narratives. This promotes healing for them. It may also build confidence between patient and physiotherapist. This would be a different kind of rahabilitation based upon caring. The point I want to make is that a existential medical rehabilitation has seen a great number of chronic patients change from a suffering existence to a healing existence.

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.18, pp.43-54, 2000-12-15 (Released:2018-02-01)

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I had to have colorectal cancer surgery in April 1999, in a local general hospital in the western part of Japan. A seemingly formal process of informed consent took place in terms of the physician's disclosure and my signing of the consent form. But the physician would never make any disclosure without the presence of my husband, even though I had asked him in advance to tell me everything directly. On the consent form, there was a list of risks and complications of the proposed procedure, but there was no mention of possible alternatives. The consent form was rather archaic in that its preface stated that they demanded of a patient a full understanding of what is to be disclosed and prohibited any protestation against the hospital's medical policies in case of an insurmountable accident (which, in fact, can only be determined by a third party). My physician-oncologist forced me to sign a consent form for an angiography and an arterial injection of an anti-cancer agent in spite of my refusal three times. Also, there was deception in the process of intravenous administration of chemotherapy. I ended up refusing the prescribed regimen because of its serious side effects. The legal doctrine and the ethical, democratic idea of informed consent are two different things. The former may easily be implemented even in Japan, as physician discretion and patient incompetence can justify non-disclosure. Legally, there is no requirement for ascertaining a patient's understanding of what is disclosed, whereas the ethical requirement demands that consent is meaningless if disclosure is inadequate and not understood by the patient. Indeed, only effective dialogue between honest and caring health-care professionals and the patient can effectuate a healing process and prevention of serious medical harm.

著者

大塚 耕太郎 酒井 明夫 浅利 宏英

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.18, pp.55-65, 2000-12-15 (Released:2018-02-01)

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Two cases of schizophrenia (A : paranoid type, B : residual type according to the ICD-10 criteria) were studied, both of which were referred from a psychiatric hospital to the surgical and psychiatric departments of a University Hospital for the treatment of physical complications. Both patients were diagnosed with cancer and surgical treatment was recommended. Although case A underwent surgery along with the full informed consent requirement, case B was treated through proxy consent by her family due to impaired capacity. The difference in competence between these patients seemed to be related to their negative symptoms, for example apaty, abulia, withdrawal, and slowed thought of case B was more severe. In addition, this case study revealed that "reduction of restriction produced by phenomenological disturbances in subjective time in chronic disease" and "coordination of medico-cultural differences between psychiatry and other medical specialties" are necessary to improve the QOL of schizophrenic patients with physical complications. It is suggested that consultation-liaison psychiatry in a broad sense, including sufficient aspects of bioethics and philosophy of medicine, would be useful for the treatment of physical complications of psychiatric patients.

著者

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.18, pp.66-77, 2000-12-15 (Released:2018-02-01)

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In 1999, the multiple organ transplantation from a heart-beating-donor was reported from Kochi Red Cross Hospital. This was the first case in Japan after the "Organ Gift Act (1997) ". The patient was transported by ambulance to the hospital on Feb. 22, 1999. The Japanese mass media should have been prudent enough not to violate the donor's privacy, such as exact age, address, family, and occupation. But they set their feet on the quiet donor's home town, and took photos and movies. Afterwards, the MHW (Ministry of Health and Welfare) and JOTNW (Japan Organ Transplant Network) forbade the direct access of the media reporters to the hospital and family members, and limited not only the streams of the non-medical information of the patient but also the medical information needed to check the correctness of the transplantation. The immediate disclosure of the medical information is essential to protect the recepients rights. Without this information, patients and families can't check the official announcements of the hospital. Their medical report might be changed by the hosptital to make it consistent with other data or reports. If so, they can know neither the accuracy of the donor's diagnosis nor the accuracy of information used to make the informed consent of the family. The Japanese mass media must make the rational guidelines to distinguish the essential medical information, needed to assess the adequacy of the choice, from non-essential information. I stress the peculiar situation of the case. This transplantation was the first heart-beating donation case in Japan except the very doubtful heart transplantation case by Wada in 1968. I think first that the donor's family must have a very strong will for the correct donation and transplantation. It is their honorable obligation to disclose enough medical data to make the medical staff protect the donor's patient rights.

著者

池辺 寧

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.18, pp.90-101, 2000-12-15 (Released:2018-02-01)

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A body has been generally considered an object to be controlled. But a person does not own his or her body. The person is defined here as having a mind-body unity. Each patient has the embodied experience of his or her illness. The life history of the patient is, so to speak, engraved on his or her body. Nurses must try to understand the patient's illness in light of the patient's own life history. From this point of view, this paper proposes that nursing is "a physical dialogue" between nurses and patients. It is true that the nurse-patient relationship is not symmetrical. But nursing is not a one-sided action. Since it connects nurses' lives with patients' lives, nursing is an interaction. Accepting a chronic illness means that patients adjust themselves to a new situation caused by illness, i. e. a new state of self. They must find for themselves some meanings in life accompanied with their illness. The role of nurses is to support them. Patients understand their illness not only mentally, but also physically. When nurses try to appreciate the meanings which patients give their sick bodies and illness, they must interpret them through the patients' physical selves. Patients expect that nurses will give them the imagination necessary for hope. Many people today hesitate to be cared for by others, because they place much value on autonomy. But no man could live without dependence on others. Caring and interdependence should be more highly valued.

著者

中條 雅美 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.18, pp.102-112, 2000-12-15 (Released:2018-02-01)

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Informed Consent for medical treatment has been argued as being not only a doctors obligation but also patients' rights to obtain their desired "quality of life". Nowadays nurses are beginning to have a role in Informed Consent. We, nurses, expect that this role should exist to enhance the patients' rights. So we believe this role is needed. But especially in medical treatment, this responsibility of nurses remains ambiguous. So I expect the law should define clearly a nurses responsibility about medical treatments. Though much literature refers to the doctors obligation, there is little referring to the obligation of nurses. As a legal requirement of medicine, nurses as well as doctors must make an effort to explain the treatment appropriately and to gain the patients' understanding. But this dose not state the nurses' obligation clearly. The purpose of this paper is to define what the nurses' role in Informed Consent for medical treatments should be. So I tried to interpret the nurses' legal obligation in Informed Consent for medical treatments. And then, I tried to compare the role of legal interpretation with that of my own experienced. As a result, I found that the nurses' role does not have the responsibility for Informed Consent in principle. But if nurses practice only this legal role, they can't carry out the essential role of nursing, which is to assist so that patients can live a better life. I found that to be able to interpret the role has an obligation to pay attention to Informed Consent about medical treatments. According to this obligation, despite the legal interpretation, nurses would be able to carry out the essential role of nursing. This role would then be equal to a nurse's ethical position which is to bean, advocate of patients. Consequently, in my view, nurses must carry out the role of Informed Consent for medical treatments from an ethical position, while at the same time understanding the law in which they practice.

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.18, pp.113-121, 2000-12-15 (Released:2018-02-01)

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In the Informed Consent, there are some exceptional cases in which the explanation to a patient is not required. They are the cases of a patient in the unconscious state where the confirmation to the patient is not possible and the cases in which little risk is expected and the explanation is not required though the patient's agreement is necessary. These cases are well known in general, but considering the present situation such as remarkable progress in technology and diversification of the situation, general concern only to these cases is not sufficient. In this report, 8 judicial precedents in the past, which decided the Informed Consent unnecessary, have been critically reviewed, and the cases which didn't require the explanation have been classified in more detail. In the 8 examples, the author found that there were three types of cases. First, there were some cases that the author regards it as suitable not to explain a patient. Secondly, there were some cases that the decision of non-violation of the Informed Consent was correct at that time, but the situation has changed due to the remarkable progress in medical sciences and they need to obtain the patient's Informed Consent at present. Lastly, there were some decisions which did not understand the idea of the Informed Consent at all and the reasons for the decisions were not clear.

著者

後藤 雄太

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.18, pp.122-133, 2000-12-15 (Released:2018-02-01)

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In recent years, with the spreading thought of "the right to know" and "self-determination", it seems that more Japanese people want to be told of their diagnosis of cancer. So a growing number of Japanese doctors tell their patients that they are suffering from cancer. Now, most Japanese tend to think that not informing patients of their diagnosis of cancer implies telling a lie and an untruth, a deception, a trick, a lack of a relationship of mutual trust, etc. In this paper, however, I argue that refusing to inform patients of their diagnosis of cancer can be advantageous depending on the circumstances, in opposition to the current thought of the times. For humans can naturally have the knowledge of the time of one's death, though they are never informed of it by others. We don't necessarily need to give the objective/scientific knowledge priority over the natural knowledge. Essentially, death cannot be controlled by one's own will power. Leaving a matter of life and death to Nature that transcends man's own will power can also be a style of accepting one's death.

著者

盛永 審一郎

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.17, pp.237-243, 1999-10-01 (Released:2018-02-01)

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This report concerns a method of the final terminal medical treatment. Recently, the viewpoint of the "death of the second person" has been discussed. Firstly, the general idea of the "death of the second person" was explained in comparison with that of the "death of the third person". The "death of the third person" means a functional physical stop. And the "death of the second person" means the death of the "person" existing in face-to-face relations. However, the "Patient-Physician Relationship" must be the "relation of the second person" so that a patient may be considered a person. Secondly, in light of modern medical treatment, whether these relations could be realized or not was examined, but modern medical treatment has put too much emphasis on the current era of technology and systematic organization. Therefore, it seems impossible to adopt the idea of the second person to the "Patient-Physician Relationship." Thirdly, an attempt to present an ideal model of the "Patient-Physician Relationship" in which such an idea can be realized as a moral framework was examined. In other words, a model that incorporates all of the important ethical appeals that result from human relationships was considered. However, this moral framework must result in the neglect of the person himself. Fourthly, it was asked what will be done in medical treatment regarding the limitation of natural science. It is not that medical treatment is a substitute for religion. We must recognize that modern medical treatment is "powerlessness" Under this recognition, according to Jaspers' interpretation, the meaning of Hippocrates' proposition " latros philosophos isotheos" becomes clear.

著者

近藤 誠

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.244-256, 1999-10-01 (Released:2018-02-01)

著者

千原 明

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.257-259, 1999-10-01 (Released:2018-02-01)

著者

奈倉 道隆

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.260-265, 1999-10-01 (Released:2018-02-01)

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With remarkable developments in palliative care, we can surely control the physical pain of patients with serious disease. However, it may be more painful for patients to live with the fear of death as they wait for death to finally occur. The sense of life harbored in Japanese is quite different from that of western countries where life is based on modern science. Many Japanese patients with incurable diseases prefer not to undergo aggressive treatments which can only delay the time of death. Many Japanese are averse to the organ transplans from brain dead donors, because they believe that body is tightly associated with the soul and can hardly recognize that brain death is real death. Patients in the terminal state develop not only an independent mind which seelks maturity as a human being, but also a dependent mind which fears isolation from other people. They usually hesitate to request anything in order not to trouble others, while at the same time, they also want others to comply with all their request. Japanese people don't like to complain about the fear of death, because they have their own culture in which one's death becomes honorable if he/she accepts it as a natural process. Therefore, Japanese patients tend to suppress their fear of death and some manifest physical symptoms as a result. Most Japanese patients don't intend to express theemselves after they perceive that death is coming. They would like to continue their usual way of living until death, and wish to die without suffering during their sleep.

著者

高畑 明尚

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.95-105, 1999 (Released:2018-06-19)

著者

坪井 雅史

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.18, pp.1-11, 2000-12-15 (Released:2018-02-01)

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In recent years, 'narrative' has become a matter of remarkable concern in many research areas. Bioethics is one of these areas. It is said, "one of the recent developments in the field of bioethics has been an engagement with narrative". In health care, each patients' illness narrative, the medical staffs' listening of the story, and making a narrative that can provide richly rendered ethics cases, etc., are significant practices that attract our attention. If we want to understand moral problems in health care, it is helpful to use a literary account that places issues in a context of the lives and activities of particular characters. In philosophy and ethics, narratives deserve attention from those who research the relationship between the narrative, personal identity, and moral reasoning. Personalist moral philosophers, especially, who criticize the impartialist system of moral reasoning, have conjoined the narrative and ethics. The critical method of narrative studies can assist the analysis of moral problems. On the grounds of such research, a concern with the nature of narrative should be of pivotal concern to bioethics because the ethics case is central to the discipline. I make clear, in this paper, the significance of narrative in philosophy, health care, ethics and bioethics, and then discuss why we should use the narrative in the study of bioethics.

著者

盛永 審一郎

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.18, pp.12-23, 2000-12-15 (Released:2018-02-01)

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Pre-implantation diagnosis (PDG) is a new technique which makes it possible to investigate hereditary diseases and chromosomal defects of an embryo produced by in vitro fertilization (IVF) prior to its implantation into a woman's uterus. Embryos with unwanted genetic characteristics can then be destroyed, and only 'healthy embryos' implanted. PDG thereby is offered to couples at high risk for having children with genetic disorders. This technique is already available as a service for those couples in developed countries. In Germany, PDG is implicitly prohibited by the Embryo Protection Act (Gesetz zum Schutz von Embryonen =ESchG). Because of this under the ESchG, it is an offense to fertilise a human egg for any purpose other than to start a pregnancy in the woman who produced the egg. Also, no embryo research is permitted and the removal of a totipotent cell is prohibited. Under the ESchG, the embryo attains full moral status at conception. However, German Criminal Code (s. 218) surprisingly allows interruption of a pregnancy up to the first 12 weeks, and up to birth, where there is a risk to the woman's life, or a risk of serious physical or mental injury to the woman. In practice, the risk of mental injury to the woman is interpreted to encompass abortion following pre-natal diagnosis. There are some arguments which recognize the application of this new technique without amending the law. For example, the report of the German Medical Association takes the view that there are no differences between pre-natal and pre-implantation diagnosis, if PDG is performed on a embryo at the non-totipotent cell stage (2000). But is it a woman's right to select abortion on eugenic grounds, compatible with the view that human zygotes have moral status? In this paper I will try to discuss those ethical issues which are specific to, or intensified by, pre-implantation diagnosis.

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.18, pp.24-34, 2000-12-15 (Released:2018-02-01)

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In the case of organ transplantation of a cadaver, the donor's family members may say "He/She is still alive in recipient's body" in order to make redeeming sense out of their tragic experience. Is this statement derived from mere personal emotion? Or is it acknowledged as truth? In fact, as long as an organ is regarded as a mere spare part, the donor is dead. But, if an organ is regarded as a person, can it rightly be said that the donor is alive? Locke says, "upon separation of this little finger, should this consciousness go along with the little finger, and leave the rest of the body,'tis evident the little finger would be the person, the same person." Though this opinion may be unacceptable, substituting organ for the little finger in this sentence, consciousness goes along with the organ, therefore it would be the person. From the point of view of that consciousness is caused by the brain, it is nonsense. But from the standpoint of the donor's family, it is not absurd to conceive the donor's character in an organ which is implanted into a recipient. Furthermore, if the recipient should be conscious of the donor's memory, character, and so on, it seems that the organ has psychic and social qualities. So is it possible to admit that an organ is a person? If so, this has a grave consequence. If an organ is regarded as a person, it follows that the recipient recognizes the other person in his/her body, and then, it is impossible to distinguish the recepient from the donor by body alone. In order that the recipient may be identical as the same person before transplantation without becoming two or more persons, an organ must not be a person.

著者

武内 克也

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.163-170, 1999-10-01 (Released:2018-02-01)

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We will discuss a case involving a patient with dissociative disorder who has been in bed due to "lumbago" for the last 20 years starting at 32 years of age. Pain in this patient, differing from general "pain" associated with the presence of a specific organic base, lacked an organic base, and the mechanism of the pain was unclear. However, this symptom was similar to conventional pain with respect to invasibeness, limitation of activity and reduction of objective QOL. However, the patient did not consider the limitation of activity an important issue. There was a marked "dissociation between QOL as subjective satisfaction and objective QOL". With respect to this aspect, a relationship between "pain and QOL" in this patient significantly differed from that in patients with other physical diseases. In this patient, "pain"appeared as a conversion symptom as an unconscious strategy to relieve intolerable stress. Therefore, it was speculated that relief of pain may lead the patient to an inconsistent status of "strategy for strategy ".causing an aporia that a new successful strategy causes the patient recurrent intolerable pain. Therefore, in this patient, a "coping strategy" to prevent pain rather than improve pain should be established. A system that facilitates "positive and aggressive posture and management against pain" must be prepared from both individual and environmental perspectives. Psychiatric vulnerability in this patient may give the patient a marked handicap with respect to "improvement in QOL". However, it is suggested that an approach such as psychological therapy may relieve "pain" without an organic base, resulting in the disappearance of a dissociation between improvement of objective QOL and subjective satisfaction.

著者

石谷 邦彦

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.17, pp.184-196, 1999-10-01 (Released:2018-02-01)

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In 1997, the American Medical Association conducted a large-scale national survey of physician-assisted suicide and euthanasia. This survey showed that a surprising 6% of the member physicians of the As-sociation had met requests from patients for assistance with suicide or euthanasia at least once. Most of these patients had terminal cancer, and the doctors who had carried out assisted suicide and euthanasia were generally not familiar with palliative care. The problem of physi-cianassisted suicide and euthanasia has become a general trend among developed countries for the past decade. To help solve this problem, palliative care is beginning to be considered in the light of psycho-oncology. Since the late 1980s, many studies have reported that cancer patients' wish to die comes largely from their depression, lack of social support, and pain that is not controlled well. Palliative care specialists think that if palliative care gains substantial popularity, it will make physician-assisted suicide and euthanasia less frequent.

著者

季羽 倭文子

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.17, pp.197-202, 1999-10-01 (Released:2018-02-01)