著者

横尾 美智代 早島 理

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.83-92, 2010-09-24 (Released:2018-02-01)

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The purpose of this research was to examine whether the bioethics of medical students changed after receiving medical science lectures. The same questionnaire survey was conducted in the 1st year, 4th year and 6th year for new medical students in 2002-2003, and their replies were analyzed. As a result, the same trends were seen in all 3 surveys as regards "progress in medicine," "progress in genetic research," and "the use of genetic diagnostic tools for intractable nervous diseases with no cure." On the other hand, as to the question "would you willingly donate a sample to genetic research if asked?" the number who gave a positive response increased with increasing years of study (P < 0.001). This suggests that although students' perception of their own problems did change, their perception of problems related to society as a whole stayed the same from the time of their admission as new students right up to sixth grader.

著者

村松 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.93-97, 2010-09-24 (Released:2018-02-01)

著者

宮下 浩明 西村 ユミ

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.98-99, 2010-09-24 (Released:2018-02-01)

著者

吉田 みつ子

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.100-102, 2010-09-24 (Released:2018-02-01)

著者

五十子 敬子

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.103-108, 2010-09-24 (Released:2018-02-01)

著者

板井 孝壱郎

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.28, pp.109-113, 2010-09-24 (Released:2018-02-01)

著者

岩崎 大

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.10-18, 2010-09-24 (Released:2018-02-01)

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In the recent trend toward patient's rights, a patient-centered approach has replaced paternalism as a professional-patient relationship. Medical staff organize a care construction based on four moral principles, namely respect for autonomy, beneficence, non-malfeasance, and justice. In particular for terminal care, patients who face their own death exhibit philosophical and religious anxiety. In medical care, this feeling is called spiritual pain. It is an existential, holistic issue that occurs in medical care. Existential philosophers claim that death limits human life though fear and anxiety. But the act of facing death can help human's find subjective truth in their lives. Jaspers thought that to find subjective truth we need existential communication in which there is no restriction and restraint. Existential communication that has a human-human relationship can be a construct of spiritual care and an aid in leading life on an individual basis.

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.28, pp.29-37, 2010-09-24 (Released:2018-02-01)

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In several areas in the world, including New York State and the State of New Jersey, one can virtually be diagnosed dead based on cardiac death criteria even if brain death occurs. In New York and New Jersey, such exemption from brain death determination is often a consequence of the accommodation of religious and moral objection to neurological death criteria. This paper aims to shed some light on the implications and problems of conscientious objection to the determination of death based on brain death. In the first place, the paper describes the background that led to the enactment of such objections in New York and New Jersey, including the initiative by some religious group. Then, the efficacy of the frequentlymentioned parallelism between conscientious objection to brain death and military service is called into question. After distinguishing between the positive and negative effects of conscientious objection to brain death, the paper argues that conscientious objection to brain death differs from objection to conventional conscription understood as a strong obligation in that the "object" of the objection is not obligation but the default death definition or the alleged singularity of human death, considering that the New York guidelines, for example, prescribe no obligation for patients or their families. In so doing, the paper questions the understanding that the essence of accommodation of conscientious objection to brain death is sincerity in limiting the free choice or self-determination in death declaration. The possible ramifications of the above conscience clause are also discussed.

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.28, pp.49-57, 2010-09-24 (Released:2018-02-01)

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Clinical ethics is enterprises to elucidate what may or may not be done in concrete clinical settings. It differs from normative or prescriptive medical ethics, as one of sub-divisions of applied ethics, which tries to establish and underpin the supreme but abstract principles applicable to medical cases. Whereas normative medical ethics chiefly concerns principles, clinical ethics does this or that particular case, if real or fictitious. Case study is the lifeblood of clinical ethics. The simpler the case at hand is, the easier we can apply any given principle to the case. A good thick case, however, is not as simple as so-called principlists might hope. To enrich clinical ethics, and to avoid reducing clinical ethics to normative medical ethics which often deals with thin cases just as exemplification of mechanical application of authorized principles, we should inquire into the fundamental features of clinical ethics and the nature of thick cases. As long as we pay attention to the fact that describing and reading a case inevitably require imagination and interpretation, each clinical ethics case is identified with a literary text. Actually what has focused on how we can legitimate our interpretation on a text is hermeneutics. A philosopher referred to a tradition or a culture as a horizon which makes it possible to interpret and understand a cultural work. But we should recognize that what to be read in clinical ethics are individual texts embedded within certain peculiar contexts rather than monumental works in capital letters. Then this article argues that the disciplinary model of clinical ethics is not ethics in general but literature.

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.28, pp.58-65, 2010-09-24 (Released:2018-02-01)

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This paper analyzes how discourse ethics and narrative ethics contribute to resolve ethical questions in the context of clinical ethics. Jonsen et al. present a practical approach to ethics case analysis in medicine. Their approach has universal value, but at the same time has some defaults: culture-specific aspect to USA, lacking perspectives of time/process, prospective guide, and communicational aspects. Habermas' discourse ethics supplies some of the deficiencies, but will hardly handle cases in which (A) the patient is lacking competence to participate in the discourse, and, (B) the patient has the ability to participate in the discourse, but at an insufficient level to perform fully rational discussion. Narrative ethics, on the other hand will sophisticate clinical ethics by supplying norms such as "Take into account the process of formation of individual's values and that of norms in a group of people," and "Compare cases and stories." It will enable clinical ethics to handle the case of patients lacking the ability to make rational discussion. Although incompetent patients cannot be handled with that meta-ethical sophistication, the question can be reset as follows: "Can we determine the story of an incompetent agent via discourse in which the agent does not participate?" By resetting this way, narrative ethics may open new horizons to consider this sort of question in the light of normative argument.

著者

宮嶋 俊一

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.28, pp.66-72, 2010-09-24 (Released:2018-02-01)

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Although modern bioethics, as a scientific discipline, was originally seen as secular rather than religious, some aspects of bioethics have developed a religious propensity over the past few years. Yasunori Ando, a Japanese religious philosopher and Masaru Ikezawa, a Japanese religious scientist, in analyzing the relationship between bioethics and religion concluded that the two are actually closely connected. Within bioethics, there is one approach that aims to generate consensus about bioethical issues when inquiring into the fundamental nature or essence of matters. The latter sometimes overlaps with religious thinking and concepts. Even though religious rights should always be defended in the public arena, religious reasons or reasoning alone cannot guarantee the validity of any assertion. Thus the dialogical bioethical aspect has an important role to play here as the interface between the two approaches can lead to fresh, new development.

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.27, pp.89-93, 2009-10-01 (Released:2018-02-01)

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In Japan, 4 children were born by posthumous reproduction from 2001 to 2004 (1 in Shikoku, 1 in Tokyo, 1 in Osaka, and 1 in Nagano). In the case in Shikoku, the Supreme Court denied the legal child-parent relationship between the child whom the wife bore using her dead husband's frozen sperm and the deceased husband. Japan does not have a law that specifies posthumous reproduction, and the Supreme Court used this lack of existing legislation to deny the child-parent relationship. I am opposed to the judgment of the Supreme Court. Posthumous reproduction should be admitted under certain conditions. Firstly, before the man dies, he has to agree to posthumous reproduction. Secondly, the man has to freeze his sperm based on his own free will. The example of Shikoku fulfills the two conditions. About 60% of the general public approve of posthumous reproduction in Japan. However, there are many dissenting opinions among obstetricians such as the Japan Society of Obstetrics and Gynecology. Japanese society has strong views about the family, which may relate to its general approval of posthumous reproduction. It may become the pressure which has it forced that a woman bears a child. I am opposed to the pressure. However, if the pressure on a woman bearing a child is refused and she wishes to perform posthumous reproduction based on her own free will, I will respect her decision.

著者

虫明 茂

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.94-98, 2009-10-01 (Released:2018-02-01)

著者

今井 道夫 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.27, pp.99-101, 2009-10-01 (Released:2018-02-01)

著者

原島 秀吉

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.102-105, 2009-10-01 (Released:2018-02-01)

著者

土屋 貴志

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.106-111, 2009-10-01 (Released:2018-02-01)

著者

川村 和美

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.27, pp.117-122, 2009-10-01 (Released:2018-02-01)

著者

杉岡 良彦

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.27, pp.13-22, 2009-10-01 (Released:2018-02-01)

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What is integrative medicine? Integrative medicine refers to the integration of modern western medicine, traditional medicine, and complementary and alternative medicine. The definition of integrative medicine states that it takes into account the whole person (body, mind, and spirit). However, the meaning of the concepts of "integration" and "spirit" is not very clear. This paper aims to clarify these concepts and introduce dimensional anthropology. Dimensional anthropology was advocated by V.E. Frankl. He regards the human being as "a somaticmental (or psychic)-spiritual oneness and wholeness." In addition, he emphasizes that only the spiritual core warrants and constitutes oneness and wholeness. He called this view of the person dimensional anthropology. Human beings are free and responsible. Frankl refutes scientific determinism or scientism because these positions neglect freedom and responsibility of human beings. Determinism or scientism is one form of nihilism. An awareness of the spiritual dimension helps us identify the "existential vacuum." It indicates the condition wherein people suffer from a sense of meaninglessness and emptiness. Logotherapy helps a person to discover the meaning of life and, as a result, the existential vacuum can be overcome. Naikan therapy may also treat the existential vacuum. The introduction of dimensional anthropology to integrative medicine enables us to arrange the types of medicine not according to their principles or methods, but according to the dimension of the person who is using these medicines. Moreover, without dimensional anthropology, integrative medicine may help nihilism prevail in medicine, for the scope of integrative medicine is so broad and it will deal with not only cure but also prevention and health promotion with western, traditional, and complementary and alternative methods. I believe that the introduction of dimensional anthropology is indispensable for integrative medicine, and we must continue to establish a better view of the person in medicine.

著者

小出 泰士

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.33-40, 2009-10-01 (Released:2018-02-01)

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As technology advances, a wider range of applications is being found for human body parts. For ethical reasons, it is urgent that we protect human beings from being harmed by these new technologies. However, in today's liberal society, based on respect for autonomy, one may be permitted to dispose freely of one's own body if one does no harm to others, or make use of human beings who are not autonomous in order to treat other patients. It is: (1) one's own body, (2) parts and products of a human body, (3) an embryo, fetus and dead body, that are protected by human dignity, not by respect for autonomy. In order to protect human beings from being harmed by the new technologies, we need a word equivalent to 'human dignity.' Thus by examining the effectiveness of the principle of human dignity in society, we will clarify the real intention of the French ideas on bioethics, which consider human dignity a fundamental spirit.

著者

屋良 朝彦

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.27, pp.41-51, 2009-10-01 (Released:2018-02-01)

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Serious accidents can be caused by inadvertent action. In particular, there are various unexpected but hazardous risks connected with medical treatment. In fact, some medical treatments have resulted in grave consequences. One typical example of this is the HIV crisis that occurred in the Japanese blood supply system. The government, doctors, nurses, other healthcare professionals and especially patients and their families were confronted with difficult decision-making against uncertain risks. The question is how to deal with unexpected and uncertain risks. The "precautionary principle" was introduced to cope with such difficulties. However, the precautionary principle is considered to be imprecise and vague when we try to apply it to real-life cases. Decision-making models are required. Healthcare professionals must work in collaboration with other healthcare professionals in multidisciplinary care teams. They must discuss cases with each other and make cooperative decisions. In the past, the doctor has often been assumed to be the most appropriate person to make the decisions. This is not so widely accepted today. Therefore we need a new model for collaborative decision-making. The aim of this article is to provide multidisciplinary care teams with a practical model for collaborative decision-making against uncertain and unexpected risks. The focus is on the process of decision-making. A paradigm case -HIV case- is presented to show how to apply the model to real-life cases. The question of the case is what kind of decision-making is possible for doctors, nurses, other healthcare professionals and hemophiliacs and their families to avoid HIV infection when the cause of the AIDS is unknown.