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
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
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
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
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.
著者
尾崎 恭一
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.14, pp.81-94, 1996-10-01 (Released:2018-02-01)

Not a few people in Japan are killed in active euthanasia. However, most cases are hidden, as active euthanasia is prohibited in any situation. Consequently some people are killed by immoral ways, for example involuntarily or cruelly, though they could survive with handicaps, or though they could die calmly in voluntary active euthanasia. Voluntary active euthanasia should be permitted legally, and the Involuntary one should be prohibited strictly. Why is Voluntary active euthanasia prohibited? Because people think that no one has the right of death and believe in the theory of the slippery slope. But everyone has the right of self-determination. Does this right imply that? And cannot we put the brake on unlimited killing performed under active euthanasia? In order to answer these questions, I first investigated how the right of self-determination is justified by two theories which differ from each other:social contract theory and utilitarianism. This call give an impartial solution for them. The solution is that each person has the right to decide all one's own affairs and even commit suicide if the right is not misused and makes no one unhappy. Secondly I studied the meaning of death for the dying person, especially with regard to its positive meaning, i.e. the completion of his life. It is important what he does as the last act in his life when he suffers terribly from fatal wounds or diseases. Is it morally good that doctors prolong the severe pain of the patient as long as possible? It is bad that they rob him of self-determination and his happiness. He doesn't only have the right to die,but also should exercise the right in oder to get rid of his fatal pains. Thirdly I think through the new legal systems which permit the right to die and prevent patients from misusing it. Judging from the above, these systems must be based on the principles of self-determination and state of necessity. In the case of voluntary active euthanasia, to help one commit suicide can be legally justified. However, to kill one based on the one's serious request cannot justified, but only irresponsible for the murder.
著者
加藤 太喜子
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.31, pp.33-41, 2013 (Released:2018-02-01)

Regulation for use of tissue of aborted human fetuses for research is enforced in countries and international organizations such as World Medical Association and the Council of Europe. For these parties, the use of fetal tissue is permissible when conditions prescribed by the guidelines are met. Common requirements for permissible use are ① approval by the Ethics Committee; ② determination of provision of fetal tissue after the decision of abortion; and ③ consent of the provider. Some guidelines require that the man is not rejecting, but there is also one guideline that accepts only the consent of the woman. In any guidance, the consent by woman is essential. From the perspective of systems of providing information, this paper presents a literature survey of the use of fetal tissue. It was found that ① daily, open exchange of views about provision of fetal tissue is not possible for women; ② women hope and want to know the intended use of the fetal tissue and the overall description of the research; ③ although information needed to grasp the overall idea of the research is sorely lacking, women may make decisions under pressure. On the basis of the results, people who are requested to provide information later are required to provide information that is satisfactory for decision making, instead of unsatisfactory information such as those labeled as“ being offered to know/not being offered to know”. For this reason, the current“ sufficient” explanation should be re-examined as to whether it is truly a satisfactory explanation.
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
上野 哲
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.1-6, 2004-10-18 (Released:2018-02-01)

The purpose of this paper is to contribute to making a better life in leprosariums by providing viewpoints to change leprosariums as isolation hospitals into communities of living. Although it is very hard for many residents who are advanced age and without any relatives to go off of leprosariums, the court found the isolation policy for recoverists of leprosy illegality in May 2001. Leprosariums are obliged to change, for example, homes for the aged. What I do not try to do here is to impeach someone. I make proposals, however, based on the interview to the Niirada branch school of Oku senior high school students in the Nagashima-aiseien leprosarium. The subjects of the interview meet the following two requirements: firstly they have been expected a remarkable activity out of leprosariums from their boyhood; and, secondly, they live in leprosariums again at present after the living out of leprosariums. As a consequence of the analysis, I propose attaching importance to the high regard for resident's self respect under the isolation policy and the understanding of the human relations in leprosariums, in addition to the request for substantial medical service, to better the present condition of leprosariums.
著者
児玉 正幸
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.167-175, 2003

The medical staff of Obstetrics and Gynecology Department, Kagoshima University was considering plans to conduct clinical trials to test the embryos of Duchenne muscular dystrophy patients, but they were unable to gain approval from the Japan Society of Obstetrics and Gynecology. Groups and organizations that support the handicapped pointed out that there are problems with trying to make life and death decisions based on such tests. They argued that such testing implies a desire to lower the level of social services for the handicapped and to inflame the public's prejudices. In other words, the tests are considered as another example of discrimination towards families with a history of genetic disease, in the tradition of discrimination in jobs and marriage. However, as long as the freedom of the clients (the parents of the unborn child) for whom the tests are conducted is preserved, and their right to decide what to do with the results is protected, this reproduction medical technology does not threaten the constitutional rights of the handicapped, as provided in Articles 13, 14, and 25 of the Japanese Constitution. Allowing parents to decide whether to give birth to a handicapped child is not inconsistent with a policy aimed at improving welfare services.