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)

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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

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)

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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.

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)

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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

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

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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

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

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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

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)

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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.

著者

鶴島 暁

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.29, pp.26-34, 2011-09-30 (Released:2018-02-01)

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In this paper I consider the arguments for the moral status of human embryos from a Christian viewpoint. First I address the position which claims that "the embryo at the moment of conception, i.e. at fertilization, is a person." I focus on the Vatican's strong position which argues vigorously and repeatedly for the protection of early embryos. In this paper I use the word "Vatican" to refer to the teaching authority of the Roman Catholic Church and magisterium, papal pronouncements, the Congregation for the Doctrine of the Faith, the Pontifical Academy for Life and so forth. This is because not all Catholic theologians and ethicists agree with this strong position or reject hES cell research. In this section I take a similar position to the Vatican's. Secondly, I deal with the opposing position which gives the green light to hES cell research because it does not consider the pre-embryo to be a person. And thirdly, I address the response to that criticism by the Vatican. Finally I investigate what the key question is and what kind of issue influences each argument in this debate on the moral status of embryos.

著者

山崎 真也

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.27, pp.79-88, 2009-10-01 (Released:2018-02-01)

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In this article, I examine why disagreements of diagnosis are likely to occur in psychiatric diagnosis. This problem (which I call the "reliability problem") raises the question of whether psychiatry might have real objectivity. If psychiatric doctors (specialists) give different diagnoses to the same patient, the patient would justly doubt the objectivity of the diagnoses. In addition, our expectation that psychiatry and its classification system relates to the objective world would be undermined, since the standard of classification seems to be liberally interpreted by each diagnostician. This problem has been addressed by the employment of so-called "operational diagnostic criteria." However, the following problems remain: (a) there are different operational criteria systems; (b) if several different operational criteria systems are at once applied to the same patients group, the proportions of patients with a disease vary depending on the criteria systems; and (c) because it is not shown that a particular criteria system has an advantage and validity over other criteria systems, there is no rationale for regimenting a particular criteria system. In other words, only one operational criteria system must be used uniformly by all diagnosticians before the reliability problem can be truly resolved, but this is not realistic at present. Since each diagnostician can choose any criteria system according to their preference, the reliability problem reoccurs regardless of the introduction of operational criteria. We need to continue to inquire into the reliability problem and the objectivity of psychiatry.

著者

堀井 泰明

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.23, pp.35-41, 2005-10-26 (Released:2018-02-01)

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Bioethical problems in medical care are widely discussed and debated. Because medical care must involve some degree of caring between the care-giver and the care-receiver (the patient), bioethics then must also be concerned with theories of caring. Milton Mayeroff argues that being concerned about others is an essential role for the human being; thus, he views caring existentially. He claims that caring about another human fosters self-actualization and autonomy in the acting person. This study concludes that, because people need to care for others in order for themselves to flourish, a theory of caring is the foundation to being human and to self-actualization.

著者

佐藤 岳詩

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.23-32, 2009-10-01 (Released:2018-02-01)

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Biomedical technology has realized several kinds of human enhancement. Among them, enhancement of our cognitive performance is remarkable. There are already several supplements, for example, caffeine for staying awake and DHA for better memory. However, the present drugs for enhancing our intelligence, so called smart drugs, are completely different from such supplements. Smart drugs are artificially synthetic chemicals that are used in order to improve cognitive performance. They are developed for medical use, but they similarly affect healthy persons. For example, smart drugs can improve a person's ability to pass university entrance exams. However, strong drugs have strong side-effects, and radical enhancement of intelligence gives rise to many ethical issues. Therefore, to assess the ethical implications of cognitive enhancement, in this paper, we will consider the merits and demerits of cognitive enhancement. Firstly, we will outline the current situation on cognitive enhancement. Secondly, we will consider its merits and demerits. In conclusion, we will examine whether cognitive enhancement by smart drugs is ethically admissible.

著者

串 信考

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.85-91, 2006-10-24 (Released:2018-02-01)

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This research is intended to consider ethical problems posed by the legal precedents established in cases concerning posthumous reproduction in Japan, Britain, and America. In Matsuyama, Japan, a woman gave birth through artificial insemination using the frozen sperm of her deceased husband. The undisputed facts in this case are as follows: The biological father, who was undergoing treatment for leukemia, clinically donated a sample of semen in 1998 to be preserved for artificial insemination, since said treatment had the potential of rendering him sterile. After his death in 1999, his wife gave birth to a child in 2001. The child was conceived through in vitro fertilization embryo transfer using the husband's preserved semen. The Matsuyama District Court ruled in November 2003 against recognizing the legal relationship between the deceased father and the child born from posthumous reproduction. The wife appealed this ruling. In July 2004, the Takamatsu High Court subsequently ruled in favor of recognizing the legal relationship between the deceased father and his child. I examined six cases similar to the case in Matsuyama involving posthumous reproduction. There were four such cases in Japan, one in the United States, and one in Britain. In the case in Matsuyama, Japan, relatives of the deceased husband testified in court that the wife in question intended to bear child through posthumous reproduction. In one case in Japan, a wife seeking posthumous reproduction told her doctor that she wanted to artificially inseminate her husband's mother as well. This is did not involve the cases in Britain and the United States. In Japan, the family's consent is required for the organ transplants. I believe that there is a family characteristic peculiar to the Japanese with regard to posthumous reproduction.

著者

菊永 淳 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.35, 2017

著者

新田 あゆみ

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.38, pp.57-64, 2020 (Released:2022-07-20)

著者

古田 真弥子 宮脇 美保子

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.38, pp.31-40, 2020 (Released:2022-07-20)

著者

澤田 愛子

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.3, pp.71-82, 1985-07-05 (Released:2018-02-01)

著者

霜田 求

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.31-45, 2003-10-05 (Released:2018-02-01)

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This paper aims to elucidate some ethical and social issues raised by designing life and to examine them in connection with eugenics. Advanced medical technology has made possible some methods of designing life, such as sperm/egg or embryo selection, germline genetic modification and the production of life by cloning. The subject of our investigation is germline genetic modification or manipulation, especially the enhancement of capabilities or traits of children at the request of their prospective parents. "The voluntary choice of the individual" is both a main argument justifying that form of intervention and also a strong ground for supporting the "new eugenics," which is distinguished from old, state-sponsored eugenics. On the one hand, new eugenics is a body of thought and practices based on the premise that the choice of a "desirable quality" is part of the reproductive freedom of an individual as a consumer or client. This type of new eugenics is closely related to the way of redesigning society sought by Neoliberalism, which values the self-determination of the individual, the free-market and deregulation. On the other hand, new eugenics is an attempt at improving the gene pool of future generations by remodelling human beings, and it advocates a new evolution of humankind. In some arguments presented by new eugenics to justify germline genetic enhancement, serious ethical and social problems are found, namely a distortion of the way of relating to others, discrimination against disabled people, harmful effects on children etc. So we should severely scrutinize the connection between that form of technology and new eugenics.

著者

小西 達也

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.30, pp.11-19, 2012-09-30 (Released:2018-02-01)

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In this article, I define spiritual care as the "support of the careseeker's subjective/spiritual life." Spiritual care is provided for people in spiritual crises, where their existing foundational/core beliefs are dysfunctional in their situation. Such people are required to let go of their existing dysfunctional foundational/ core beliefs, and to continue their subjective lives without their foundational/core beliefs until new ones have been developed. The spiritual care should support the careseekers in such process. In this article,"the provision of 'Ba'(space/opportunity) for the careseekers' belief-free inner-exploration/self-expression" is proposed as a definition of the spiritual care. This definition can be described also as "the support of the careseekers' subjective/spiritual lives." This definition coincides with the spiritual care that the author has actually provided in his clinical practice, which means that this definition works in the actual clinical setting. Further, it is also shown that the Clinical Pastoral Education program mainly provided in the United States, which is considered to invite their students to be free from their own beliefs by becoming conscious of their beliefs, is effective as training for the ones to provide such spiritual care. Lastly, it is expounded that the proposed definition has affinity with some of the existing definitions of spiritual care widely known by people in the Japanese medical clinical setting.

著者

丸橋 裕

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.30, pp.40-51, 2012-09-30 (Released:2018-02-01)

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Viktor von Weizsacker's significance as an originator of "anthropological medicine" and as a critic of medicine oriented solely to the scientific-biological standpoint encourages us in the present critical situation caused in connection with many problems in medical ethics to seek an adequate paradigm of medical ethics in his works. True, he wrote no systematic ethics of anthropological medicine as such. But his 'Euthanasia' and Experiments on Human Beings (1947) was a salient contribution to the foundation of that field, since in it he asserts that the real, though invisible, defendant on the Nuremberg bench was no particular doctor, but the general spirit of scientific-biological medicine, and declares his guiding principle that the solidarity and mutuality of doctor and patient should guide medical practice. Therefore, in this article I intend to describe the origin of the medical ethics inherent in Weizsacker's "Medical Anthropology" (Medizinische Anthropologie) where he formulates the concepts of solidarity and mutuality. First I try to show clearly how he proves, with the help of the principle of solidarity, that there was no "as such justification" for the 'euthanasia' and human experiments Nazi doctors had put into practice, and further how he tested, in every morally doubtful case, whether it complied with the law of mutuality. Secondly I will clarify in what kind of context medical practice must occur under the law of solidarity, if one is taking the law of mutuality seriously in the association between doctor and patient. And thirdly after showing that the concept of "the solidarity of death" tends to reduce various aspects of the personal and social structure of death to an abstract common denominator, I will consider the meaning of Weizsacker's utterance that the order of life is a fusion of "the solidarity of death" and "the mutuality of life."

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.18, pp.78-89, 2000-12-15 (Released:2018-02-01)

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In the fields of medical service, the death of patients is regarded as a failure of medical care. Patients have rights to live and exercise their rights during the therapeutic process, so the therapist should respect their rights and perform medical care with all his energy in order to save the patients' life. As a result, medical care shows a marked tendency toward excessive intervention in order to prevent patients' death. In psychiatry, there are many patients who attempt suicide. Psychiatrists should encourage them to give up the idea of attempting suicide. To help patients avoid suicide, restrictions shoild be placed on therapeutic interventions such as psychological, pharmacological and physical restrictions. Most patients will give up suicide with appropriate treatment. But only a few psychotic patients think themselves to be not alive already. They are dead mentally and socially, but not dead only physically yet. There is deep discrepancy between their mind and body. They cannot die a natural death about their body, so attempt suicide as a linkage between their dead-mind and living-body to recall their lost identity again. Excessive intervention in order to prevent them from suicide will bring them more severe despair. They think they are deprived of their death, and believe they cannot only live but also die. We must know the facts and give patients the chance to recognize their true wishes to live, and we should try to look for some pieces of hope through alternative excessive restrictions.

著者

養老 孟司

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.17, pp.179-183, 1999-10-01 (Released:2018-02-01)