著者

野田 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.106-110, 2006-10-24 (Released:2018-02-01)

著者

小松 奈美子 冲永 隆子

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.23, pp.163-164, 2005-10-26 (Released:2018-02-01)

著者

船木 祝

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.1-9, 2006-10-24 (Released:2018-02-01)

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Die vorliegende Untersuchung geht der Frage nach, ob und inwiefern zwischen dem menschlichen Leben einerseits und dem Nutzen fur die Menschen andererseits eine Abwagung moglich ist. Diese Abwagung legen die stellvertretenden Positionen sowohl im japanischen Schlussbericht uber die Behandlung der menschlichen Embryonen als auch in der deutschen Stellungnahme des Nationalen Ethikrats zu therapeutischem Klonen ihrer Argumentation zugrunde. Im Gegensatz zu dieser Vorgehensweise betont Dietmar Hubner die Prioritat des Abwehrrechts menschlicher Embryonen gegenuber dem Anspruchsrecht der Wissenschaftler. Anselm Winfried Muller seinerseits weist darauf hin, dass man mehr fur Tun verantwortlich sei als fur Lassen. Bei der Embryonenforschung musse man eine grosse Verantwortlichkeit fur den Tod von Embryonen tragen als fur das Ausbleiben von moglichen Fortschritten bei Behandlungsmethoden, welche Kranken zugute kommen konnten. Daruber hinaus gibt Muller Aufschluss uber die radikale Instrumentalisierung. Aus dieser Erorterung lasst sich erkennen, dass die Menschenwurde beim Forschungsklonen starker verletzt wird als bei der verbrauchenden Embryonenforschung, da im ersteren Fall ein Embryo von vornherein nur fur die Nutzung erzeugt wird. Meine Analyse der Differenzierung sowie der Rangordnung bei den Autoren verdeutlicht, dass man nicht bei der oben genannten Abwagung bleiben darf, sondern die Probleme des Embryonenschutzes unter einem anderen Gesichtspunkt betrachten sollte.

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.24, pp.10-20, 2006-10-24 (Released:2018-02-01)

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The reason why the Japan Society of Obstetrics and Gynecology has placed severe restraints on preimplantation genetic diagnosis of embryos (PGD) since 1998 lies, except in the fear that PGD will cause discrimination against handicapped people as well as result in life screening, in the following two assertions. (A) PGD technique is still in its research phase, it has low accuracy and its safety has not been established. (B) Restraints will act as a brake on reckless applications, i.e. on commercialistic developments, of PGD. (For example, the clinical application of PGD not only to genetic diseases or recurrent spontaneous abortion due to chromosomal abnormalities, but also to genetic enhancement of mind and body on non-medical grounds) However, the former assertion is being denied by the latest study of actual results over a period of 10 years at the world's three most active PGD centers (the Reproductive Genetics Institute, in Chicago, Illinois; Saint Barnabas Medical Center, West Orange, New Jersey; and SISMER, Bologna, Italy) by Dr. Munne's team. According to Dr. Munne's article (Over a decade of experience with preimplantation genetic diagnosis: a multicenter report. Fertil Steril 82: 292-294, 2004), a total of 754 babies have been born from 4,748 PGD attempts at these three centers, with 207 pregnancies still ongoing. Five misdiagnoses following PGD practice (three cases of trisomy 21, one case of cystic fibrosis and one case of fragile-X syndrome) have been published. The safety of the PGD process is validated by the estimated number of already more than 1000 apparently healthy children born after PGD worldwide. As for the latter assertion, we are of the opinion that this ethical position and the long delay in gaining permission for a single case, discriminates against couples who undergo PGD for reasons of infertility as well as fertile couples who consider this technique for reasons of recurrent pregnancy loss or for being at risk of transmitting genetic diseases to their offspring. Considering the usefulness of PGD in alleviating the load on the mother's womb by pre-birth diagnosis, all applications of PGD based on medical grounds (such as genetic diseases or recurrent spontaneous abortion due to chromosomal abnormalities) should be approved.

著者

堀田 義太郎

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.24, pp.31-41, 2006-10-24 (Released:2018-02-01)

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In this paper, I examine the condition of living organ donation. In the first part, I show that the principle of voluntary donation is the key to living organ transplantation. In the second part, I examine the debate on living organ donation, especially the moral character of related donation. In the third part, I show that the need for guarantee of voluntary consent for organ donation requires an alternative living organ transplantation system. In order to guarantee the voluntariness of the living-donor, we need to choose another system that does not restrict the donor to related people. In the conclusion, it is recognized that if we should guarantee of the principle of voluntary donation, we would have to undertake this status as a potential donor. If we wouldn't undertake this status, we should refuse the organ-plant medicine itself.

著者

岩江 荘介

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.42-54, 2006-10-24 (Released:2018-02-01)

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Genetic information that results from genetic testing reflects the patient's condition, and a part of it is shared with genetic relatives of the patient. Therefore, in cases in which a patient's genetic information indicates the presence of genetic disease, his genetic relatives may suffer (or have suffered) the same disease, as well. The informational consequences of genetic testing cannot be evaded. Thus, in genetic testing, the issue of treatment of genetic relatives is of great importance. The issues of breaching of confidentiality and the duty to warn by physicians have been discussed in accepted theories of bioethics. In such theories, the duty to warn genetic of risk of disease relatives is considered a benefit to them, though this does not take into account the disadvantages to genetic relatives of being informed of disease, e.g.,, distress after being informed that they have the risk of genetic disease. In this paper, I discuss handling of such information from a viewpoint other than that of breaching of confidentiality by physicians. It is important to recognize that genetic relatives have two rights, 'to know' and 'not to know' about their risk of genetic disease. In modern medicine, we accept the principle of self-determination. But, in genetic testing, we must take account of the genetic relatives' rights at the same time. I examine how genetic relatives should participate in genetic testing.

著者

村岡 潔

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.107-114, 2005-10-26 (Released:2018-02-01)

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Etiology is the study of the cause of disease or illness. The development of bacteriology in the 19th century saw the corresponding development of "specific etiology", which postulates that infectious diseases are caused by pathogenic organisms, such as the tubercle bacillus, that invade the human body and bring about a failure of homeostasis of the human being. Specific etiology has for two centuries been the central dogma of modern medicine used to explain the causality of numerous diseases, such as infectious diseases, cancers, and genetic diseases, by using models of a unique pathogenic agent, a bacteria or virus; a cancer cell; or an "abnormal" gene as the pathogen of the disease, respectively. The aim of this paper is to criticize the role of specific etiology by examining its social role and logical weaknesses, by examining the deterministic character of the etiology, and by comparing the "pathogen-carrier" ideology derived from the etiology with the pluralistic etiology of hygiene in the 19th century. This paper concludes that specific etiology can easily mislead medical professionals and lay people in that their understanding of "pathogen-carrier" ideology results in their perceiving infected persons as dirty and dangerous as the pathogenic organism itself, with the result that the infected persons are victimized and discriminated against.

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.23, pp.115-124, 2005-10-26 (Released:2018-02-01)

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About fifty years ago, Hisayuki Omodaka set out a "philosophy of medicine" comprising three important and closely related philosophies: the philosophy of science, the philosophy of life and the philosophy of medicine. Medicine has changed dramatically since Omodaka's time, especially with the development of molecular biology, which has brought new forms of diagnosis and new therapies for patients and in turn altered humanity's view of life. The purpose of this paper is to reexamine Omodaka's philosophy of medicine to determine whether it continues to offer some benefit to modern medicine. Omodaka described the human body as having two conflicting and mutually dependent natures, one without extensibility ("α") and the other with extensibility ("β"). The former enables our bodies to be active and is the reason our bodies function harmoniously. We now know that scientific approaches describe in detail the molecular mechanisms of life, with genes having the ability, for example, to begin transcription after transcriptional factors bind to the specific binding motif located throughout the DNA. This reflects the nature of "α". Therefore, molecular biology does not necessarily deny or devalue Omodaka's philosophy of medicine. Omodaka explained that the purpose of his philosophy of medicine was to reflect the present state of medicine, clarify the principles on which that medicine was based, and try to establish better medicine for the people. As has been discussed by many authors, science does not have the ability to reflect science itself. The nature of science lies in "control", as pointed out by Henri Bergson. Therefore, in order to clarify the principles of medicine, develop better medical education and provide better medical care, scientific methods are not sufficient, and a "philosophy of medicine" is indispensable to the achievement of a better medicine.

著者

今井 竜也

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.23, pp.125-130, 2005-10-26 (Released:2018-02-01)

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Article 3 of Japan's Organ Transplant Law requires the national and local governments to work to foster public understanding of transplantation medicine. This requirement, however, has not been adequately fulfilled. Consequently, public awareness and understanding of organ transplantation are not necessarily widespread. As a result of this context, organ transplants from living donors are rapidly increasing in Japan. Kidney transplants from living donors performed in Japan to date number more than 1,500, and these, along with liver transplants from living donors, are becoming common. At the same time, developments such as debate over the nominative donations to relatives and organ-swap transplants are stimulating reconsideration of existing concepts of organ transplantation. This article examines the current organ donation environment in Japan and proposes a direction for Japan to take in future.

著者

朝倉 輝一

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.23, pp.131-134, 2005-10-26 (Released:2018-02-01)

著者

樫 則章

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.135-138, 2005-10-26 (Released:2018-02-01)

著者

丸本 百合子

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.23, pp.139-144, 2005-10-26 (Released:2018-02-01)

著者

齋藤 有紀子

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.23, pp.145-149, 2005-10-26 (Released:2018-02-01)

著者

立岩 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.23, pp.151-155, 2005-10-26 (Released:2018-02-01)

著者

奈良 雅俊

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.157-161, 2005-10-26 (Released:2018-02-01)

著者

浜町 久美子

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.23, pp.11-21, 2005-10-26 (Released:2018-02-01)

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According to Faden and Beauchamp, informed consent is a process of communication between a patient and a physician that results in the patient's authorization to undergo a specific medical intervention. The Japanese Medical Association, however, defines informed consent as "explanation by physicians and agreement by patients". Using the JMA definition, informed consent has been practiced by many physicians and patients in Japan. Not all patients, however, are satisfied with this method of decision making. The purpose of this paper is to discuss how this communication should be undertaken among stakeholders concerned with medical decision making. In the first part of this paper, two methods of communication are analyzed, one based on the JMA interpretation and the other based on Faden and Beauchamp. In the former, communication consists of a physician's explanation and the patient's consent. In the latter, communication is undertaken through the physician's recommendations and presentation of reasons why the patient should take the physician's advice, the physician's understanding of the patient's concerns and interests, the physician's explanations, and the patient's consent. In the second part of the paper, these two methods of communication are compared with actual cases of informed consent in health care. The paper then demonstrates that the two methods of communication are insufficient in the case of opposing opinions among stakeholders or when stakeholders have no understanding of each others' interests. The paper concludes that it is necessary for communication in health care to take place in two steps. The first involves uncovering the stakeholders' interests. The second involves determining the best solution based on those interests. It is a so-called consensus building process that incorporates these two important communication steps.

著者

勝山 貴美子

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.23, pp.23-33, 2005-10-26 (Released:2018-02-01)

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In December 2001, the Ministry of Health, Labor and Welfare issued a policy document titled "A Grand Design for the Promotion of Use of Information Technology in Health". The document describes a number of scenarios to be realized over a period of five years involving the provision and use of health services by means of information technology. Goals include the deployment of an electronic health record system to 60% of all hospitals with more than 400 beds.In order to promote such efforts, policies are needed to ensure the security of information and the protection of privacy. A law protecting personal information was passed in 2003 and came into effect in 2005. This paper discusses this law and examines its meaning, its significance, and its potential problems. The increased gathering and use of information in medical care environments does not always lead to more patient-centered care. Satisfaction with the gathering and protection of this information is important to patient outcome and may affect the ability of the physician and other medical staff to elicit patients' concerns, consider patients' psychosocial needs, and involve patients in treatment decision making, all of these being communication techniques that fall under the umbrella of "patient-centered" care.

著者

朝倉 輝一

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.23, pp.43-53, 2005-10-26 (Released:2018-02-01)

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Nurses often face ethical dilemmas involving issues of conscience and responsibility. Etymologically, "conscience" (συνειδησιs, conscientia) involves getting to know meaning of one's own act together with the internalized other. In order for a person to protect his or her identity when exposed to danger, conscience is "the internal surveillance organization" which judges orders according to his or her subjective restraint-norm" in relation to a specific act and features "a cognitive element and an influence-element". Not only does it mean the internal moral sense for distinguishing right from wrong freedom of an inside, but also it is inevitably accompanied by an external act in some form, such as an act or an omission. It is possible, however, that one's appeal to conscience makes a wrong decision because of incorrect information, groundless belief etc. But nurses should be allowed to refuse to carry out particular treatment or procedures based on personal appeal to conscience. Therefore the nurse appealing to conscience must undertake a step-by-step process of justification in order to fulfill a duty of care by carefully considering the patient's safety and welfare, based on acceptance of consequence and exact information. Administrators must discern whether the nurse appealing to conscience makes judgment based on appropriate knowledge and correct information and whether the proposed result is safe and acceptable. If so, administrators have a duty to support that result.Although the appeal to conscience is a fundamental right and can reveal someone's dishonesty (the whistle-blowing), it is not positively accepted in Japan. The dignity of each person's identity cannot be protected only by nurse's appeal to conscience. Consequently nursing practice committees or other ethics committees should discuss this and similar issues which include refusal based on a nurse's appeal to conscience.

著者

山中 恵利子

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.23, pp.55-63, 2005-10-26 (Released:2018-02-01)

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The purpose of this paper is to examine the construction of a world of subjective meaning for Mr. A, who experienced depression in middle age. As a methodological tool, I use the theory of relevance advanced by Alfred Schutz. This paper first examines how Schutz' theory explains how, in social constructivist terms, "subjective reality turns into objective reality," and clarifies the temporal status of internal time consciousness. The paper then examines Schutz' construct of different sets of interests, or relevances: topical, interpretive, and motivational.In conversations between Mr. A and the author over four years, Mr. A's "narrative" changed. According to the theory of relevance, major changes of subject are seen in the evolution of Mr. A's statements from "I cannot go to work," "I am labeled as someone who cannot succeed in work," and "I feel tense at work" to such statements as "I want to break free from this vicious circle." By examining such statements the theory of relevance is able to clarify the meaning in epoche how Mr. A perceives the problems that he faces and how he attempts to deal with them. The author shows how Schutz' concept of relevance, as an intersubjective category, is able to reduce the distance between the actor and the observer. Using the concept of relevance, the author shows that an interviewer or hearer will come to an interpretive understanding of a speaker producing meaning compositions, by way of contrapuntal analysis, while, as if an accompanist, the hearer stands close to the speaker.

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.23, pp.65-75, 2005-10-26 (Released:2018-02-01)

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Generally speaking, it is existential pain, that is, spiritual pain, that distresses terminal patients to the very end. But spiritual pain isn't a concern only to terminal patients. It's fundamentally a concern that all people, as mortal beings, must address. This paper examines the search for spiritual relief. A key concept in this search is the "turning of outlook on life and death". This means that a thorough realization of the certainty of death becomes an unconditional affirmation of life. The reality of death invalidates any "meaning" or "value" that we place on our lives. At first glance, this invalidation seems to result in a negative situation. But a thorough realization of the certainty of death evidences "something beyond human power" that refuses to be given "meaning" or "value" by human beings. This "something beyond human power" is "life itself", or the "being itself" that we tend to miss in daily life. In the sense stated above a thorough realization of the certainty of death is something special. Recent thinking is that terminal patients can reconfirm the meaning or value of their lives through "narrative" . This paper, however, proposes that spiritual pain is a important clue to "something that can't be described" and therefore eliminates the need to ascribe "meaning" or "value". This paper proposes that there is no answer to the question "What is the meaning of life (or death)?" and that spiritual pain cannot be relieved by seeking the answer to this question. Paradoxically, spiritual relief can be found by living with the uncertainty of death and the mystery of life, not by removing these through "narrative".