著者

田村 恵子

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.25, pp.142-145, 2007-10-18 (Released:2018-02-01)

著者

浅井 篤

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.146-151, 2007-10-18 (Released:2018-02-01)

著者

西村 高宏

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.153-156, 2007-10-18 (Released:2018-02-01)

著者

田辺 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.25, pp.1-10, 2007-10-18 (Released:2018-02-01)

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In the history of medicine as well as in the modern clinical setting, conflicts between two contrastive models of explanation have been observed, the "pathogenic model" and the "recovery model". The pathogenic model focuses on how the pathological process is generated, and has its theoretical background based on the modern mechanistic view of nature. The recovery model focuses on how the recovery process occurs, and has its origin in the ancient Hippocratic school and teleological standpoint. In the context of modern science, the recovery model has always been criticized as a vitalistic and non-rational way of thinking. Some clinicians, however, have reported beneficial effects of certain symptoms. For instance, clinicians may use two different descriptions in the treatment of a fever: 1) the fever should be brought down because it is harmful to the body, or 2) the fever has a beneficial effect on the course of disease. Much research suggests that fever both benefits and harms the body. Therefore, clinical judgments will be based on assessments of these two aspects. Antagonism of the two models is one of the most fundamental themes in the history of medical theory. Hippocrates often referred to the "vis medicatrix naturae" and insisted upon the benefit of symptoms. On the other hand, scientists of the 17th century denied the existence of a "vis medicatrix naturae". To solve this conflict and obtain a basic theory of a model of recovery, we examined the concept of the norm with reference to the philosophy of G. Canguilhem.

著者

田代 志門

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.21-29, 2007-10-18 (Released:2018-02-01)

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The purpose of this paper is to clarify the logical construction of Robert J. Levine's model for the distinction between research and therapy. Levine's model has been adopted in well-known ethical guidelines such as the Belmont Report (1979) and the CIOMS guidelines (1993). Levine introduced into research ethics two theoretical models, the intent-based model and the approval-based model, for the distinction between research and therapy. He also recommended that physician-investigators deal with "innovative therapy" as research, which should be reviewed by IRBs. Levine criticized two assumptions which were largely shared in the medical community in the 1960's. Some physician-investigators thought that it was impossible to distinguish research from therapy because all medical practice was in a sense experimental. Others thought we should distinguish therapeutic research from non-therapeutic research and that the former can be conducted according to relatively relaxed standards. This was also the standpoint of the Declaration of Helsinki in 1964. These assumptions interfered with effective regulation of clinical research. Levine's model introduced a new perspective into research ethics and became a foundation of the contemporary regulation of clinical research. The purpose of this paper is not only to reconstruct past discussion and share its heritage but also to obtain suggestions for the regulation of clinical research in Japan.

著者

山本 史華

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.31-39, 2007-10-18 (Released:2018-02-01)

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Few of the current guidelines on clinical research mention ex post issues. For example, the Declaration of Helsinki includes as such an issue only its 30th Article and note. As for concrete ethical requirements, that is, Informed Consent, Assessment of Risks and Benefits and Selection of Subjects, the chief aim covers all aspects of applying the regulations to the preconditions. Emphasis was for a long time focused on how ethical principles regulate ex ante issues. In recent years, based on reflection on this situation, the need for ex post ethics has gradually become clear. Patricia A. King notes, in Belmont Revisited, that fairness requires specific compensatory justice and procedural justice, both of which were ignored in the Belmont Report. This paper aims to construct the idea of ex post ethics, which we call aftercare ethics, through examination of the principles of biomedical ethics. Chapter 1 confirms the fact that compensation and free medical treatment for accidental injury or damage are extremely rare in guidelines for clinical research. In Chapter 2, we address the problems of the emotions of the injured and the compensation. The reason why they were absent from clinical research is examined. In Chapter 3, it is shown that if we reinterpret the principles of respect for persons and of justice, we can see that the ethical necessity referred to in the preceding chapter can be derived from the said principles. Finally, in Chapter 4, we present the basic idea of aftercare ethics.

著者

日笠 晴香

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.41-50, 2007-10-18 (Released:2018-02-01)

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Advance directives are statements made beforehand by a person who was competent at the time about the care he/she wishes to receive if he/she were to become incompetent in the future. They are thus means of determining the patient's will when surrogate decision-making is needed. However, difficult problems may arise if advance directives conflict with the interests of the patient as judged by the people around him/her. This paper will explore this issue, focusing on advance directives of dementia patients. Theorists have varying opinions on the advance directives provided by dementia patients when they were competent. R. Dworkin argues that if someone has made a prior expression that "I will refuse any medical treatment at the terminal stage of dementia", we should not give the person any treatment at all. In contrast, R. Dresser asserts that "a dementia patient is a 'different person' from the person who made the advance directive", so that advance directives should be overridden if the current benefits of treatment the dementia patient may obtain are greater than the burden resulting from it. M. Quante asserts that advance directives should be respected as long as they do not cause actual pain or harm to dementia patients. The differences between these assertions are, in my view, based on differing views regarding the "personality" of incompetent dementia patients. Dementia patients have lost their personalities, according to Dworkin and Quante, while they have a "different personality" according to Dresser. However, a dementia patient and the person he/she used to be cannot be completely severed, for he/she is a being who lives one human life. Therefore, in order to make decisions on behalf of the patient, I suggest the need to distinguish him/her from the person who he/she used to be while at the same time regarding him/her as a person who lives one human life.

著者

遠矢 和希

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.51-60, 2007-10-18 (Released:2018-02-01)

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In Japan, the Council for the Ministry of Health, Labour, and Welfare recognized the right of children born by DI (Donor Insemination) to knowledge of their blood relationships, in the final report in 2003. This right will become a significant issue, because the report admitted the legality of reproduction by an egg donor. It goes without saying that the right to knowledge of blood relationships is important, since genetic knowledge has medical, psychological, and social effects. In the Japanese adoption system, the family registers makes it possible for adopted children to determine their blood relationships when they get older. But DI children can not know the information, so there is an imbalance in family register system between DI resulted children and adopted children. How do we solve this imbalance and retain the rights of donor offspring? In this paper, I consider the current situation in Japan and cases of other foreign countries as reference.

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.25, pp.91-98, 2007-10-18 (Released:2018-02-01)

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The main envisioned contribution of professional ethics education for nurses has been that it offers a clear and concrete antithesis to the previous professional ethics education methodology, according to which it was supposed that nurses would be able to make correct ethical judgments if a set of given standards were applied to clinical problems. It was assumed that students who became medical professionals would be able to make ethical judgments in the clinical workplace if the general principles of these standards were clarified. On this basis, students were taught the principles of these standards as part of their training. The antithesis by professional ethics education for nurses was to spotlight caring which had been ignored because a change to a clear knowledge of science had been impossible. Specifically, case studies were adopted as a method of education, and emphasized the following four points: (1) stimulating moral imagination, (2) recognizing ethical issues, (3) developing analytical skills, and (4) tolerating disagreements and ambiguities. However, in practice, professional ethics education for nurses based on case studies supplies the training of proof, rather than the training of creativity and flexibility. In this paper, I propose the possibility of use of case methods in place of case studies. Case methods offer the possibility of going beyond the limitations of case studies, since they require training in unfettered judgment unrelated to occupational evaluations.

著者

佐藤 労

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.111-115, 2006-10-24 (Released:2018-02-01)

著者

藤野 昭宏 藤江 良郎 安松 聖高 吉田 真一

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.24, pp.123-127, 2006-10-24 (Released:2018-02-01)

著者

宮越 一穂

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.132, 2006-10-24 (Released:2018-02-01)

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.24, pp.133, 2006-10-24 (Released:2018-02-01)

著者

森下 直貴

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.134, 2006-10-24 (Released:2018-02-01)

著者

松岡 悦子

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.24, pp.55-63, 2006-10-24 (Released:2018-02-01)

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How philosophy and social sciences are reconcilable in the field of bioethics has long been a disputed theme. The former tries to find universal values among different human beings, believing there should be, whereas the latter presupposes diversity of values and morals among the different people of the world. The notions of informed consent and autonomy in bioethics, originating in the US, have now been disseminated to other parts of the world. But are they to be applied universally to every moral situation and to all people who have notions of family, community, illness etc quite apart from those in the west? This paper provides criticisms from social scientists toward traditional bioethics, saying that it fails to provide social and cultural contexts surrounding ethical dilemmas. If bioethics is to be seen as providing health care ethics based on "universal" human values, it should also accommodate the particular values and needs of those who have been underrepresented up until now. One way to mediate between a particular human culture and a universal ethical framework would be to employ ethnography as a means to reflect upon its own cultural assumptions and eventually fill in the gaps between cultural particulars and universal human values.

著者

田村 京子

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.24, pp.64-74, 2006-10-24 (Released:2018-02-01)

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In July 2005, I investigated the conditions of the dental ethics committees of 29 universities and dental colleges in Japan. Of these, 16 responded to questions sent to them. In this report, I consider the problems pertaining to these dental ethics committees. Some committees are composed of members who are either dental specialists, or dental specialists and natural scientists. However, according to the criteria of the guidelines drafted by the Board of Bioethics and Security of the Ministry of Education, Culture, Sports, Science, and Technology, there must be at least one external member and one female member on each such committees. In response to the question concerning the ethical problems involved in the process of review of dental research conducted on human subjects, these committees stated that they have almost no such problems. I suspect that the committees' members are unfamiliar with eminent declarations such as, the WMA Declaration of Helsinki and other guidelines, and are not sensitive to ethical issues,; therefore, their review process is thus probably not fair. Such committees also appear insensitive to the ethics of dental education, since they do not provide guidance to students in collecting extracted teeth with informed consent. On the other hand, the ethics committees that follow the criteria of guidelines are sensitive to internal issues, e.g., how the committees are authorized and what qualities are required of members. There is thus a gap in quality among committees. However, this investigation does not clarify the sorts of problems that should be considered ethical. An increase in review of ethical committees is expected. I believe that it is important for such committees to communicate with eath other in clarifying ethical issues, eliminate the gap in quality among committees, and adequately consider their authority and obligations as well as, the requirements concerning the qualities of their members.

著者

工藤 せい子 五十嵐 靖彦

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.24, pp.75-84, 2006-10-24 (Released:2018-02-01)

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The purpose of this study was to attempt to determine general ideas for addressing ethical issues in nursing practice. The author interviewed nurses who had experienced cases involving care and related ethical issues. The interview data were analyzed using qualitative research methods. The subjects of analysis were the following three cases: 1. A client who was transferred to the hospital for reoperation but died shortly before operation; 2. A client who was in and out of the hospital for more than 10years because of incurable illness; and 3. A client whose last wish was fulfilled in the form of a Christmas party. Analysis showed that ideas for addressing ethical issues converged into two categories. The first included ethical issues, including "role as the client's advocate," "coordination between the client's wishes and the doctor's policy," and "paternalism and maternalism". The other category included issues related to caring, including "learning from the client," "formation of a strong bond resulting from mutual relationship," "involvement as a team," and "departure from medical rules". There were, in addition, three keys to addressing ethical issues that did not fit into either category: "hope for peaceful settlement of affairs," "hope for successful communication," and "wish to be treated indulgently". These three keys are useful both in care for patients and addressing ethical issues.

著者

今井 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.24, pp.92-98, 2006-10-24 (Released:2018-02-01)

著者

藤野 昭宏

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.99-100, 2006-10-24 (Released:2018-02-01)

著者

岡田 尊司

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.24, pp.101-105, 2006-10-24 (Released:2018-02-01)