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.19, pp.231-233, 2001-10-20 (Released:2018-02-01)

著者

中澤 務

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.19, pp.31-41, 2001-10-20 (Released:2018-02-01)

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This article investigates a new ethical basis for prohibiting human cloning from the point of view of a child's rights, and examines the limitations of human cloning in special cases. My approach appeals to two new points. (1) We must distinguish between two intentions of human cloning. One is the intention to duplicate the same genotype as the donor for the purpose of duplicating the same phenotype of that person (the intention of duplication). The other intention is to make a baby who is related to the parent by blood, in which case human cloning is not a means to the genetic duplication (the intention of non-duplication). (2) A child has a special right, "the right to an open future" (J. Feinberg), which is the collection of autonomy rights that are in trust until the child grows up. We should prohibit human cloning done with the intention of duplication, because in this case cloning will violate the cloned child's right to an open future. However,it seems there is no clear ethical ground for prohibiting human cloning when it meets the following conditions, (1) when it is done for the purpose other than duplication (the intention of non-duplication), (2) when it is in accordance with the normal reproductive rights, (3) when there is enough reason to choose cloning. Human cloning for infertility treatment seems to meet these conditions. Regarding human cloning, we must reexamine the total ethical framework of reproductive medicine.

著者

阿保 順子

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.19, pp.42-56, 2001-10-20 (Released:2018-02-01)

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The life that people with schizophrenia experience in the acute stage is so different from ordinary people that the reality of their lives is beyond our imagination. The author presented a paper on the psychiatric nursing framework for understanding people with schizophrenia in 1995. The framework consists of two concepts. The first is the concept relative to mental-structure, the other is the process of illness. The aim of this paper is to re-construct mental-structure from the viewpoint of 'self and 'ego'. First, the construction of initial mental-structure will be described. Then similar concepts around 'self and 'ego1 are discussed. Second, the issues of 'self and 'ego' that have been described in the area of philosophy or psychology are discussed. Next 'self and 'ego' are discussed from the viewpoint of psychiatric nursing. Finally, mental-structure is re-constructed as follows; (1) 'ego' is located in the center of 'self. (2) 'self is a functional vessel that has many points of mutual effects connected with external circumstances as well as those dependent on the human body.

著者

永田 まなみ

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.19, pp.57-71, 2001-10-20 (Released:2018-02-01)

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In the 21^<st> century, as we face an unprecedented increase in the number of elderly people and a high-welfare society, care and nursing will become more important. In this article, I review the coming role of nursing specialists from the viewpoint of patient autonomy. Firstly, I propose that the trend of mutual support, while maintaining individual autonomy, will continue to spread. Thus, it is essential to respect others' lives as well as one's own for a "comfortable relationship". This is the core meaning of the concept of "Caring". "Caring", the basis of nursing, also includes interrelationship and interdependence. This should make nurses reflect on their own lives often cared for by patiants while caring for them. Secondly, while reviewing the development of nursing theory, I stress the support of patient autonomy. In clinical nursing, respect for patient autonomy in their daily lives is the most important factor in patient "comfort", although more attention is normally paid to radical problems involving life or death such as terminal care. Lastly, I mention the possibility of integrating the "ethics of justice" and the "ethics of care". When nurses deal with "patient autonomy" as professionals, the problem of "bad paternalism" (or intrusive nursing) can arise. In considering how clinical nursing ought to be, the "ethics of care" and the "ethics of justice" must be integrated. This idea may be more suitable for the age of care. "Practical knowledge" in nursing may contribute to the theoretical integration of the "ethics of justice" and the "ethics of care".

著者

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.19, pp.72-82, 2001-10-20 (Released:2018-02-01)

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Until recently, the western scientific methods have been viewed as the major and only valid and reliable ways to approach knowledge and understand people. Western science has developed a worldview which is in sharp contrast to that of the Far East. From the second half of the 17th to the end of the 19th century, the mechanistic Newtonian model of the universe dominated all scientific thought. Nature was viewed as not a mere machine, but in fact a very large machine. Such mechanistic philosophy was embodied in industrial society. However, the first three decades of the 20th century radically changed the whole situation in physics. At that time, Western science finally started to look to the eastern philosophies. In contrast to the mechanistic Western view, the eastern view of the world is organic. Incidentally, nursing science is a new intellectual activity. Established as recently as 50 years ago, it has occupied only a short span of time in the history of science. In the mid-1800s, Florence Nightingale called for nurses to develop an in-depth understanding of man and nature as interacting wholes. After one hundred years, Martha Rogers emerged as one of the most original thinkers in nursing. According to her "human beings are not disembodied entities, nor are they mechanical aggregates... human being is a unified whole possessing his/her own integrity and manifesting characteristics more than and different from the sum of its parts". Her model has had a significant influence on current scientific inquiry and professional nursing practice, including serving as a basis for the explication of other nursing theorists, including those of Newman, Parse, and Watson. Thus in the last part of the 20th century, the new world view has become more evident in nursing science.

著者

石井 誠士

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.19, pp.83-98, 2001-10-20 (Released:2018-02-01)

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Die europaische Medizin 1st seit der Mitte des 19. Jahrhunderts eine sich auf die mechanistische Anschauung stiitzende angewandte Naturwissenschaft geworden. So gross wie die Errungenschaften der modernen fortgeschrittenen Medizin sind doch dabei auch ihre Defizite! Viktor von Weizsacker schrieb 1926: "Es ist eine erstaunliche, aber nicht zu leugnende Tatsache, dass die gegenwartige Medizin eine eigene Lehre vom kranken Menschen nicht besitzt." Sicher lehrt heute die Medizin Erscheinungen des Krankseins, Unterscheidung von Ursachen,Folgen,Heilmitteln der Krankeheiten, aber nicht den kranken Menschen. Das grosse Defizit der modernen Medizin ist also "Abwesenheit des kranken Menschen". Wie der letzte Mensch in "Die frohliche Wissenschaft" von Nietzsche den "Gottestod" kundgab, so verkiindete Weizsacker im 20. Jahrhundert den "Krankentod". "Abwesenheit des kranken Menschen" bedeutet.dass wir nicht kranken kbnnen, dass wir das Kranksein nicht erfahren konnen. Die Krankheit ist nicht als Abnormalitat, nicht als blosse Abweichungen von einer statistisch zu erfassenden Norm, sondern als ein Geschehnis des Menschen auf dem Weg zu seinem Ziel, d. i. "eine Abhaltung von der menschlichen Bestimmungin Wachstum, Wandel, Reifen, Altern, Tod" anzusehen. Und"das wirkliche Wesen des Krankseins ist eine Not und aussert sich als eine Bitte um Hilfe" Die Not ist fur Lebende unausweichlich, denn jedes Lebende ist ein Objekt, dem ein Subjekt schon innewohnt. Es ist die Existenz, an der ihr das In-Not-Sein immer fur sich selbst fraglich wird. Ein Hautptweg, sich der Bestimmung des Menschen in seiner Not zu nahern, ist fur Weizsacker die Krankengeschichte, die Erfahrung in der Krankheit und in ihrer Geschichte. Geschichte ist "ein Zusammenhang, in dem ein Zustand aus dem, welcher ihm vorherging, nicht kausal abgeleitet werden kann". Das Kranken eines Menschen bedeutet dann nichts anderes als ein Vollzug der Selbsterschliessens der Wahrheit des Lebens. Die Biographik zielt darauf bin, die eigentliche Krankengeschichte in der Lebensgeschichte zu entdecken und umgekehrt die eigentliche Lebensgeschichte durch die Krankengeschichte hindurch sprechen zu lassen. Diese Geschichte wird nur in der "erfahrenden Einsicht in die geistbestimmte Wirklichkeit des Menschen" erfahren. Zu dieser eigentlichen Erfahrung kann "die Weggenossenschaft von Arzt und Kranken" fiihren. Die Begegnung und das Gesprach von beiden schliesst die "intensivste.ausserste, wahrste und wirklichste Wirklichkeit fur das Leben dieses Menschen oder den Tod dieses Menschen" auf. Weizsacker erblickt das Wesen dieser Weggenossenschaft eben in der Beriihrung in der Erfahrung, die "die via regia zur wirklichen Welt" ausmacht. Die Aufgabe der Medizin liegt dann darin, "dass, was im kranken Menschen geschieht, im Arzt geistig wiederholt und so seiner letzten Bestimmung zugefiihrt wird".

著者

石崎 智子

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.19, pp.115-125, 2001-10-20 (Released:2018-02-01)

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Since the middle of the 20th century, the medical work site has been presenting a. rapid change brought about by rapid progress of the medical technology on the basis of modernization of western medical science or biological science. The development of such medical science has put the present medical care in the change of tide. This medical situation has forced us to ask ourselves what identity of nursing. I have thought as follows. Conventionally, those who have been engaged in nursing tended to think it being in "the place of nursing" to attend at a clinical work site. The behavior for nursing care of such "work site" has been unconsciously done as premise. However,is the true "place" of nursing there? Is the identity of nursing secured only by it being in such "work site of nursing"? A main subject is the trial which is going to reconstruct the identity of nursing by reflecting upon "the place of nursing". Because, I want to offer the true nursing care which has being a patient and has respected his after being. The practice of nursing is created through human relations between those engaged in nursing and patient. Although, this place is not produced from the manualized work site of nursing. One over, this place is constructed from the both-direction - this vivid relation -, between a person engaged in nursing and patient. It could be caught as "a place of the relation as the present existence" which has just lived. In order to recatch of the conception of the identity of nursing, it must be concerned with this "place of the relation as existence" in consciousness with "the intelletual practice of nursing". It is important that the identity of nursing is based on this "place" of nursing.

著者

池谷 健

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.19, pp.126-135, 2001-10-20 (Released:2018-02-01)

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Compared with the first Kochi case in March 1999, information about two other cases, the second case in Tokyo in May and the third case in Miyagi in July, decreased drastically. This restriction may be due to the infringement on privacy in the first case. It is important to discuss at the time of the transplants, whether their brain death was unavoidable, or was there some way to save the patient. It is indispensable not only to promote organ transplantation from brain dead persons, but also to advance emergency treatment procedures for the people who first administer treatment. In these 3 cases, as for the persons in charge of emergency treatment of the donors, ant the persons who diagnosed the preceding clinical and legal brain deaths of the donors, we have no information except for the first case. As for the details of the donorcard, it was reported only in the second case. The background diseases were explained immediately only in the third case which was a traffic accident. The family's comments about the organ-donation and each transplant result, weren't reported except in the second case, one year later. Perhaps the coordinators of the Japan Organ Transplant Network (JOTNW) could not establish good relations with the families. The mass media, JOTNW, and the MHW (Ministry of Health and Welfare) must put these problems in order, disclose them, and entrust the result to the good sense of the national public. Without accurate information, the donor families cannot freely talk about their thoughts to the public. Now the MHW has enforced a new committee in a perfectly locked room to verify organ transplantation, as if the leakage of the information were the problem. As a result, the right of the people to know, to discuss, and to decide is deprived, and donor's families cannot express their thinking about the process of organ transplantation.

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.19, pp.136-150, 2001-10-20 (Released:2018-02-01)

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How should we treat intersexual individuals? It has been standard pediatric practice to recommend surgery for infants with ambiguous genitalia or loss of panis. In females, any large clitoris is to be reduced or removed. In males with less than an adequate penis, the preferred surgical approach is sex reassignment. This management philosophy is based on 2 beliefs: (1) individuals are psychosexually neutral at birth and (2) healthy psychosexual development is dependent on the appearence of the genitals. This philosophy was strongly supported by the classical and well-known "John/Joan" case. But reports of the success of John/Joan were premature and wrong. Diamond and Sigmundson recently reported that John failed to identify as a female, and she had in fact chosen to resume life as John. They conclude that the evidence seems overwhelming that humans are not psychosexually neutral. If they are correct, we need a new philosophy for dealing with intersexual individuals. I propose that we have to realise that there are several limitations in our capacity to clinically manage intersexuality. At first.it appears impossible to draw any distinct, line between males and females. And we are unable to predict with confidence the gender that an intersexed newborn will settle into during adulthood. And finally, it is unlikely that surgical reassignment will ever truly "normalize" an individual. In accordance with these limitations, we have to be more careful when undergoing gender reassignment for infants with traumatized genitalia.

著者

品川 信良

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.134-143, 2000-12-15 (Released:2018-02-01)

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This is the Second Part of a speech which was delivered in the 18th Annual Meeting of Japanese Association for Philosophical and Ethical Researches in Medicine held in October, 1999, and the author discussed here bioeethical issues alone. In the First Part of this speech the author discussed the medico-ethical issues which are omitted in this paper but have already been published (in Reference 1). Main topics dealt with in this paper are: 1. American bioethics as one of the postwar American dreams 2. Critical appraisal on American bioethics: American bioethics at the Cross-roads 3. Bioethics and environmental ethics 4. Eastern and Western bioethics: Asian and Euro-American bioethics 5. Fundamental principles of bioethics 6. Standardization and globalization in bioethics 7. "Genoethics" and "phenoethics" (Reference 15) Topics discussed in the First Part of this speech and already published in Reference 1 were: 1. General education in premedical course of senior high schools before and during World War II 2. The Foundation of Ministry of Health and Welfare in 1938 under the strong leadership of Japanese Army for the preparation and promotion of war : the principal functions of MHW were an increase in population, prohibition of induced abortion and contraception, control of pulmonary tuberculosis, veneral diseases and trachoma conjunctivitis 3. Ethical Code of Japan Medical Association and of Physicians during WWE 4. Influence of American Occupation Troops on medical education and practice in post-war Japan 5. Main trends in medical science and practice in post-war Japan 6. War responsibilities and war crimes judged at Tokyo War Crimes Trials 7. From period of National Eugenic Law (1941) which prohibited induced abortion and contraception to the years of Eugenic Protective Law (1948) which semi-liberated induced abortion and contraception

著者

加藤 尚武

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.144-153, 2000-12-15 (Released:2018-02-01)

著者

清水 昭美

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.18, pp.154-161, 2000-12-15 (Released:2018-02-01)

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Medical care is for patients themselves. In studying a subject of "How should Medical Staff Consider Patients' Bodies?", we have to remember past mistakes such as strict isolation of patients with Hansen's disease from society under the Leprosy Prevention Act and involuntary sterilization carried out against those patients without any authorization by laws. Needless to say, it is not allowed that medical staff make injury to patients' bodies or extract internal organs of patients or handicapped parsons for the convenience and benefit of persons who take care of patients and who manage hospitals. Patients' bodies must be respected. Aren't patients' bodies deemed as training subjects in education of medical students? There exists the fact that experiments were made on human bodies in clinical cases, which infringe on the human rights of patients. An attitude that focuses on only the benefit of medical staff makes it difficult to focus on the needs of patients. The worse the patients' condition becomes, the more they go on asking for relief, give an example for their lives. Moreover, the more serious the patients' condition becomes, the more difficult it is for them to ask for relief. Although patients with persistent disturbances of consciousness lose their means to communicate their intention through words or other physical expression, they continue to ask nurses and other medical staff for relief. It is desirable for nurses, being in a position closest to patients to make efforts to consider what patients are trying to ask for through their physical expression, since they unable to speak. Further more, nurses should try to notice what patients are asking for, since they are unable to communicate their intention through their physical expression. Nurses should then try to find what care is needed and administer the necessary care.

著者

奈良 勲

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.162-166, 2000-12-15 (Released:2018-02-01)

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How to handle patients' bodies has been one of the key issues in medicine. It is the same in physical therapy which is one of the special fields in rehabilitation medicine. In most cases, the patients who need physical therapy have some sort of disorders or disabilities and sometimes they have to live under those conditions throughout their life. The bodies are not just physical media but they also include the mind. Then, when we handle patients' bodies, we are handling their minds at the same time. Therefore, our philosophical view of humans determines the level of handling patients' bodies.

著者

甲斐 克則

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.167-173, 2000-12-15 (Released:2018-02-01)

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The developments of modern medical technology raise problems on the legal status of patient's body in the various medical fields. Firstly, in the medical treatment. Who has the authority to select the means of intervention in the patient's body? Secondly, in the humanexperimentation or crinical trial/research. To what extent can doctors use the subject's body? Thirdly, in euthanasia, death with dignity and organtransplantation. Also in these cases, patient's body occupies an inportant position. And lastly, in the life-beginning or reproduction field. Here especially women's body and enbryo's or fetus's body or life become an issue. The common subject in these cases are whether we can regard the patient's body as a part of personality, and who has the authority to dispose of his body. In this paper I'm to consider on this subject from the viwpoint of medical law.

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.18, pp.174-181, 2000-12-15 (Released:2018-02-01)

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This discussion is focused on the patient's body in routine, popular, or standard medicine, such as hypertension, hyperlipidemia, diabetes mellitus, or atherosclerosis. Medicine related to extraordinary treatment such as organ transplantation, research, and denial from the patient to be treated based upon his/her age and so on, are beyond the limits of this discussion. Since ancient times, medicine has been a method to relieve a patient's pain and suffering. Modern medicine has made new discoveries in many diseases and their pathological mechanisms, as well as many new discoveries in the physiological aspects of the human body. It has recently shed new light on cells, molecules, and genes. We are however left with many unknown diseases. Medical methodology treats a patient as an object, objectively and scientifically. However, it should be a priority to treat a patient as a person, and to respect his/her patient's rights and human dignity. The doctor should explain the diagnosis, pathophysiology, risk factors and the hygiene, treatments, alternate therapies, prognosis, etc., to the patient. My answer to this question, what do I think about the patient's body?, is that the patient's body belongs to the patient, for the time being. The human body, however, is a nature in itself. In the studies of the human body as a nature, there are still many far beyond human intelligence. Although a patient is ill with some disease, he/she has his/her own lifestyle as a human being. We, physicians and patients, should not forget the natural aspect of the patient's body or his/her own lifestyle.

著者

松島 哲久

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.182-188, 2000-12-15 (Released:2018-02-01)

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In this paper, I first argue from the viewpoint of philosophy that the patient's body cannot be sufficiently comprehended by the logic of the biological mechanism. In order to make this point clear, I criticize the philosophical stand of the biological mechanism. Firstly, the position of the biological mechanism views a patient's body as an object of the world, so it cannot comprehend the reality lived by the body of patient. The patient's body, the biological mechanism reveals, is an anonymous body, not the proper living body of the patient. The biological mechanism lacks the perspective of individuality. Secondly, the understanding of disease of the biological mechanism is that of being-already-objectified, so it always remains in the past aspect of time. It lacks historicity and timeness and thus ignores the life history of the patient. Following the critical argument of the biological mechanism in modern medicine I propose a new comprehension of illness. It considers the patient's body as the milieu of the auto-expression of the patient's existential suffering. The comprehension of the patient's body should be that from the viewpoint of the unity of mind and body. Moreover, taking into consideration the relationship between medical staff and the patient, the patient's body should be understood as the body-aspair (interbodility). The patient's body reflects the body of medical staff, and reciprocally the latter reflects the former. They both form the intersubjectivity and then make themselves open into the world. So we should also understand the patient's body in the socio-cultural context. Thirdly, I propose the understanding of the body as sign/metaphor. It represents the semantics of illness. I insist upon the necessity of the hermeneutics of illness to understand the meaning the patient's body auto-expresses. The metaphor of the body bears both the meaning of discrimination and the religious-symbolic meaning. So the medical staff should transcend the discriminative meaning of the patient's body to its sacred meaning. Lastly, I argue the importance of the stand of ethics. The medical staff should constantly come face to face with the patient. We need to realize the patient's rights in accordance with the patient's actual body.

著者

前野 竜太郎

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.18, pp.35-42, 2000-12-15 (Released:2018-02-01)

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We usually emphasize the objectivity of physiotherapy because of its reliability and validity. When we usually do physiotherapy, we can find out various physiotherapeutical problems in accordance with objective evaluation of the patient. We can then set up a rehabilitation goal, and sometimes we might prescribe scientific exercise for a patient. However, is that all we need? In particular, how about the great number of chronic cases? If we persist in our scientific method, we couldn't discover the whole patient. I suggest we need to use not only a rational medical rehabilitation approach but also an existential medical rehabilitation approach for chronic patients. Existential medicine means holistic medicine. Even if we can't expect improvement in the disability of all chronic patients, we must understand what their problem is as a whole patient, and be concerned about their suffering. If so, they may communicate real narratives. This promotes healing for them. It may also build confidence between patient and physiotherapist. This would be a different kind of rahabilitation based upon caring. The point I want to make is that a existential medical rehabilitation has seen a great number of chronic patients change from a suffering existence to a healing existence.

著者

岡本 珠代

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.43-54, 2000-12-15 (Released:2018-02-01)

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I had to have colorectal cancer surgery in April 1999, in a local general hospital in the western part of Japan. A seemingly formal process of informed consent took place in terms of the physician's disclosure and my signing of the consent form. But the physician would never make any disclosure without the presence of my husband, even though I had asked him in advance to tell me everything directly. On the consent form, there was a list of risks and complications of the proposed procedure, but there was no mention of possible alternatives. The consent form was rather archaic in that its preface stated that they demanded of a patient a full understanding of what is to be disclosed and prohibited any protestation against the hospital's medical policies in case of an insurmountable accident (which, in fact, can only be determined by a third party). My physician-oncologist forced me to sign a consent form for an angiography and an arterial injection of an anti-cancer agent in spite of my refusal three times. Also, there was deception in the process of intravenous administration of chemotherapy. I ended up refusing the prescribed regimen because of its serious side effects. The legal doctrine and the ethical, democratic idea of informed consent are two different things. The former may easily be implemented even in Japan, as physician discretion and patient incompetence can justify non-disclosure. Legally, there is no requirement for ascertaining a patient's understanding of what is disclosed, whereas the ethical requirement demands that consent is meaningless if disclosure is inadequate and not understood by the patient. Indeed, only effective dialogue between honest and caring health-care professionals and the patient can effectuate a healing process and prevention of serious medical harm.

著者

大塚 耕太郎 酒井 明夫 浅利 宏英

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.18, pp.55-65, 2000-12-15 (Released:2018-02-01)

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Two cases of schizophrenia (A : paranoid type, B : residual type according to the ICD-10 criteria) were studied, both of which were referred from a psychiatric hospital to the surgical and psychiatric departments of a University Hospital for the treatment of physical complications. Both patients were diagnosed with cancer and surgical treatment was recommended. Although case A underwent surgery along with the full informed consent requirement, case B was treated through proxy consent by her family due to impaired capacity. The difference in competence between these patients seemed to be related to their negative symptoms, for example apaty, abulia, withdrawal, and slowed thought of case B was more severe. In addition, this case study revealed that "reduction of restriction produced by phenomenological disturbances in subjective time in chronic disease" and "coordination of medico-cultural differences between psychiatry and other medical specialties" are necessary to improve the QOL of schizophrenic patients with physical complications. It is suggested that consultation-liaison psychiatry in a broad sense, including sufficient aspects of bioethics and philosophy of medicine, would be useful for the treatment of physical complications of psychiatric patients.

著者

西河内 靖泰

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.66-77, 2000-12-15 (Released:2018-02-01)

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In 1999, the multiple organ transplantation from a heart-beating-donor was reported from Kochi Red Cross Hospital. This was the first case in Japan after the "Organ Gift Act (1997) ". The patient was transported by ambulance to the hospital on Feb. 22, 1999. The Japanese mass media should have been prudent enough not to violate the donor's privacy, such as exact age, address, family, and occupation. But they set their feet on the quiet donor's home town, and took photos and movies. Afterwards, the MHW (Ministry of Health and Welfare) and JOTNW (Japan Organ Transplant Network) forbade the direct access of the media reporters to the hospital and family members, and limited not only the streams of the non-medical information of the patient but also the medical information needed to check the correctness of the transplantation. The immediate disclosure of the medical information is essential to protect the recepients rights. Without this information, patients and families can't check the official announcements of the hospital. Their medical report might be changed by the hosptital to make it consistent with other data or reports. If so, they can know neither the accuracy of the donor's diagnosis nor the accuracy of information used to make the informed consent of the family. The Japanese mass media must make the rational guidelines to distinguish the essential medical information, needed to assess the adequacy of the choice, from non-essential information. I stress the peculiar situation of the case. This transplantation was the first heart-beating donation case in Japan except the very doubtful heart transplantation case by Wada in 1968. I think first that the donor's family must have a very strong will for the correct donation and transplantation. It is their honorable obligation to disclose enough medical data to make the medical staff protect the donor's patient rights.