著者

浅見 昇吾

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.17, pp.55-65, 1999-10-01 (Released:2018-02-01)

---

The birth of Dolly, a cloned lamb, shocked the whole world and triggered a worldwide dispute over the issue of cloning. Although there are many different approaches toward this matter, ethical ones are mainly considered here. Starting with rethinking why the news of Dolly was so shocking, I will make it clear that two kinds of cloning exist. Religious dimension will be argued after this by studying "Declaration in Defense of Cloning and the Integrity of Scientific Research, " which was signed by world-famous scholars. Marketing-related problems with human cloning also will be mentioned as a subject for our discussion. Following these considerations, the view of Dieter Zimmer in Germany, which is biological or biologistic, will be dissected into approvable and refutable parts. Then finally, the approach proposed by Jiirgen Habermas will be discussed, which brought ethical self-understanding into focus. It becomes obvious through examining these different approaches that both religious and marketing approaches are not so original with regard to the controversy over human cloning and have a tendency of being overwhelmed by 'normalization of new technologies, ' like previous procreative medical technologies. Although in Zimmer's biological approach there surely are some points worth considering, it as a whole is not theoretically strong enough. It is Habermas's ethical self-understanding or, so to speak, moral self-consciousness that is very unique as an ethical dimension on human cloning. There remain, however, several doubtful points; they therefore must be elucidated in order to reach a deeper understanding of human cloning on the philosophical and ethical level.

著者

重野 豊隆

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.17, pp.66-76, 1999-10-01 (Released:2018-02-01)

---

The present paper discusses "a tendency to regard the human body as an object", in which many young students in Japan adhere to implicitly. Furthermore, medical staff also adhere to the same tendency as the students. It is the purpose of this paper to propose both restraints on the tendency. Firstly, this paper shows a implication in one's naive experience in death with dignity. Patients' aspect of the body shows two views of patients' ideas on the human body : my body as private property and the state of affairs of my body as a diseased person. Secondly, this paper criticizes medical staff for their theory that it is possible for them to interpret the patients' condition according to statistics. This theory shows that the medical staff view the body as an object of operation for them. Finally, we confirm the difficult point of the tendencey, which is that this tendency suppresses the individuality, condition and expression of the body.

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.17, pp.77-84, 1999-10-01 (Released:2018-02-01)

---

The purpose of this study is to describe health professionals' involvement in patient-centered medical practice and to suggest solutions to various problems. In today's advanced medical society, the health profession is facing issues in patient-centered medical practice. However, in cases of the progressive cancer, the physician usually tells the patients' family first about the patients' diagnosis and prognosis prior to informing the patient. This is a problem because in these cases it is truly an infringement on the rights of the patient to know his or her condition. All of the patients have to be respected as individuals. The problem is often assumed that the idea of informed consent came from America and therefore there is a cultural difference between Japan and the West. In Japan, fundamental human rights are guaranteed under the Constitution. In reality, there has traditionally been a lack of individualism and a deficiency in concern about human right among the health profession. In recent years, as things are changing so rapidly, patients are growing in recognition of their rights and the general public has a fairly wide knowledge of medicine. There is increasing dissatisfaction within medical care that ignores informed consent. Who does the patient's life belong to? The patient needs to know about his or her health information first and then to decide if whom how to inform family members of his or her medical condition. I believe that we must respect the autonomy of every individual. That respect includes health professionals protecting the patient's right of self-determination.

著者

池谷 健 本田 勝紀 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.17, pp.106-117, 1999-10-01 (Released:2018-02-01)

---

A 62 year old man died of SAH at an Okinawan hospital in Dec. 1996, and his kidneys were transplanted after his death by consent of one daughter. Afterwards other members of his family, i. e. his wife, his son and his three other daughters, went to court over the inappropriate therapy and donation. We were asked to check a copy of his clinical chart tendered by the hospital, the letter of complaint of his family members, and the questionnaire to the hospital and answers from the director of the hospital. We pointed out 3 major issues : (1) Did he receive reasonable treatment? Was his brain death diagnosed correctly?, (2) Was the informed-consent of his family members for his organ transplantation stated clearly?, and (3) Did the co-ordinators give adequate information and make valid agreement? Did they confirm the donor's will? Did they confirm consensus of the family for donation? We cannot find out rational answers to the questions above. The patient was a mentally handicapped person, and the doctors abandoned his treatment soon after his arrival to the hospital. Once the opinion of his organ donation was made by one daughter 3 days after his admission, the doctors ignored any wish against donation by other family members. We believe that the happiness of the donor family is one of the most essential factor for organ transplantation to plant its roots in Japan. In this case, the family got no happiness but serious confusion. This case could be an extraordinary case, but because we have only a few means to check up the adequacy of organ donation in this country, this might not be an exceptional case. The difficulty to access medical data by the family must be dissolved immediately.

著者

丸山 マサ美

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.17, pp.118-122, 1999-10-01 (Released:2018-02-01)

---

This study analyses private papers written by women who underwent sterilization. First, a comparison is made with the model of E. Suchman who pointed out "illness behavior" and "stages of illness". In the present study, frequency of words in women who underwent sterilization treatment were analyzed by using WORD-SEP (frequency of word program). This is the Zipf's law. Zipf interpreted this fact as the one to express the fundamental basis of human behavior for "least effort". This progrum analysed the structure of the word frequencies in computer programming languages and manuals of computer by the same method as Zipf. We would turn from the argument of fining the other human activities regarding the various human behaviors whether they show a similar pattern as was found by Zipf or do they show a different pattern. We could approach the study of the structure of human needs of women who underwent sterilization. In light of the result, these words such as "watashi","onna", "jibun" and "ko" contained the arguments towords the problems. This paper will focus on these issues and further hypothesis of these issues.

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.17, pp.123-132, 1999-10-01 (Released:2018-02-01)

---

With regard to the social welfare of disabled persons, I will consider the relationship between feelings of pity for them and discrimination against them. In Japan, most people today who have not been in close contact with disabled persons feel pity for them. Is this feeling of pity an expression of discrimination against them? In this paper, I will describe and analyze the nature of this feeling and make the following points: 1) A feeling is experienced passively, so we cannot modify it at the same time that we are feeling it. Therfore, feelings of pity for disabled persons are not in themselves equivalent to discrimination against them. It is possible to interpret them as such, but this interpretation only presents discrimination as a problem without a solution. 2) Referring to Arbert Memmi's definition of discrimination in context of racism, I will consider the way in which discrimination is the result of a relationship between individuals and society. Discrimination shuld be understood at the social level, namely in its relationship to social structure and social organization. Only then can we find measures to resolve it. 3) Pity for persons with disabilities is no more than a groundless conviction held by non-disabled persons, and is a reflection of the lack of communication between these two groups. 4) We should start from the fact that people, both with and without disabilities live in the same world at the same time, and thus learn to naturally accept heterogeneuty and variety in people.

著者

中里 巧

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.17, pp.133-143, 1999-10-01 (Released:2018-02-01)

---

The fieldwork in medical philosophy aims at the innovation of the whereabouts of the meaning occurrence and the reasoning process. The fieldworker searches for the structure of the daily life of oneself who has lived for a long time. He reflects on the meaning system of his daily life, and searches for a contact point with some different meaning system. The fieldwork in medical philosophy is inward. It is to search the base layer of the research object and the researcher. It is to clear identities which are the standard of the value judgment. The researcher must avoid by the existing organization, the part and the name from what he thinks about with the medical spot and the member. It is a problem like a principle whether what it is, and depends on the meaning system. Research reports can often be warped by the readers' meaning structure. It is a political problem. If the researcher controls his work in accordance with the existing definition with the medical treatment, nursing, doctor, nurse etc., it will mean the death of thinking .

著者

本田 勝紀

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.17, pp.144-155, 1999-10-01 (Released:2018-02-01)

---

Some cases of "brain death"-heart transplantetion in Japan have been performed in 1999 after a long- period of time following the Wada scandal of 1967. The problems of whether "brain death" is the termination of human life or not have not been solved medically, socially or ethically, even though the new organ transplantation law, including the description-a brain-dead body, was enforced during a brief discussion in 1997. The main reason was that the authorized Takeuchi criteria of the Ministry and Welfare in 1985, and 1997 together, stated that brain death is not a concept on death, but a clinical concept on statistical study on brain-death cases of our country. So, the "brain-dead" person in transplantation is the weaker patient compared with the recipient patient. In 1996, Professor Abe was arrested for the accidental homocide of a hemophilia patient injected with non-heated blood. The patient later died of AIDS after the injections. Professor Abe routinely carried out these types of injections till the middle of 1985 through a subordinate doctor of Teikyo University. I think that Professor Abe is the weakest person compared with the AIDS patient, who was supported by patients groups, lawyers, public prosecuters and the mass media. Being a specialist on blood medicine, he could know the risk of blood from the USA possibly comtaminated with AIDS, reading the some new English articles 10 years ago, but he never discontinued the use of the blood therapy. The reason was that at that time, there was no consensus on the non-heated blood for hemophilia as the origin of "AIDS", medically (no strong arguments on the blood were done for the origin of the AIDS in the blood group meeting, and so strong debate was done on the strict relation between the serological findings and fatal signs of AIDS patient in the infection group meeting), socially, and legally. And secondly blood therapy was the only routine method to treat the bleeding of hemophilia. Thirdly this legal and fanatic investigation against Prof. Abe was performed 10 years after the injection based on long years of medical data. He is the victim of irrationalism and fascism in the medical society including both doctors and patients of our country, because in Europe and American countries where the more strict discussions on the relation between the blood use and AIDS signs have been continued these 10 years medically, socially and legally, no arrest of the clinical doctors has been found in the investigation till now.

著者

谷田 憲俊

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.16, pp.166-174, 1998-10-01 (Released:2018-02-01)

---

Death with dignity and euthanasia have been discussed in conjunction with misery in the dying process. Lack of understanding of terminal care may be contributed to on-going confusion in discussions of this issue. For example, pro-life groups often make the criticism that self-determination involving withholding or withdrawing life-sustaining treatment from terminal patients undermines the value of human life. This criticism is not valid. Life-sustaining treatments in the terminal stage are performed without medical evidence of effectiveness, and are hence called extraordinary treatments. Since there is no definite treatment option in the terminal stage, any method can be chosen from available teratments. Even if a patient chooses withholding or withdrawing life-sustaining treatment, no other person can object to the decision because nobody is morally obliged to receive uncertain extraordinary treatment for mere prolongation of the dying process. Here, self determination does not devalue human life. Rather, life and self-determination can be compatible when a terminal patient is cared for with evidence-based medicine.

著者

酒井 明夫

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.16, pp.175-182, 1998-10-01 (Released:2018-02-01)

---

Psychiatric practice in modern Japan has a history of about 100 years. In the early stages, legal regulations placed more emphasis on the protection of society in general rather than the protection of the patients with mental disease. However, in the Mental Health and Welfare Law as currently enforced, it is stressed that the human rights of each patient must be esteemed as much as possible and the core of the policy is on the liberalization of the therapeutic environment. Hence the history of legislation for psychiatric practice in Japan may be interpreted as a process with liberalistic tendencies gradually influencing this legislation. On the other hand, when we look at the physician-patient relationship in psychiatric practice in severe cases, in particular, in the cases of schizophrenia, volition and individual thinking are often disabled in both content and application. In these cases, where mental disorders reach such a stage that human judgment is impaired, informed consent cannot be obtained, and medical treatment by the "autonomy model" is practically impossible to perform. In this case, we might say that from the beginning psychiatric practice has gone beyond the frame of liberalism. The patients are often confined in a certain morbid thinking and cognitive system, and they can speak only from inside a certain framework, and the disease is based on "lack of freedom in thinking". The purpose of psychiatric practice is to help the patients be free from such morbid world and to help them speak freely and openly. In this sense, the treatment for the patients may be defined as an attempt to acquire liberalism. Therefore, perhaps as in other countries, psychiatric practice in Japan may be defined as a process toward the restoration or establishment of liberalism both in the historical sense and in each individual physician-patient relationship.

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.16, pp.183-185, 1998-10-01 (Released:2018-02-01)

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.16, pp.186-187, 1998-10-01 (Released:2018-02-01)

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.16, pp.188-190, 1998-10-01 (Released:2018-02-01)

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.17, pp.1-10, 1999-10-01 (Released:2018-02-01)

---

Heute ist der Tod zu einem Problem in der Gesellschaft und der Wissenschaft geworden. Aber das ist schon ein Problem, wie man sich sachgemass zum Todesproblem wenden kann. Weichen wir immer noch der ernsten Konfrontation mit dem Problem aus? Die Methode der modernen Wissenschaft und die Seinsweise des Menschen in der gegenwartigen Welt konnen diesem Problem nicht entsprechen, denn sie intendieren Todesausweichung, Todesvendrangung und Todes-vergessenheit. Die Tendenz zur Todesvergessenheit ist ein philosophisches Problem von heute. Wir konnen sie im Wunsch des Volks, "nach dem angenehmen Leben angenehm zu sterben", in der Metaphysik und der Religion der Unsterblichkeit der Seele oder im Bestreben der modernen Medizin, die ihre Aufgabe nur darin findet, Leben zu erhalten und zu verlangern. Viktor von Weizsacker (1886-1957) versteht Leben nicht als nur Leben, sondern als Leben und Sterben, also als das, was Tod als sein Strukturmoment enthalt. Er unternahm, das Subjekt in Biologie und Medizin einzufuhren. Wir konnen nicht verstehen, wie das Lebende als Subjekt entstehen, bestehen und vergehen kann, denn wir selber als Lebewesen befinden mitsamt alien Lebewesen uns in einer Abhangigkeit, deren Grund wir nicht erkennen konnen. Wir miissen dann das Lebende und dessen Grund unterscheiden, ebenso wie das Sterben als die Immanenz und den Tod als die Transzendenz. Diese biologische Differenz und die Koharenz dazwischen machen unsere ursprungliche Erfahrung des Todes. Der Tod im reli-giosen Begriff und der Tod im medizinischen Begriff sind zu unter-scheiden, aber sie sollen sich bei der Praxis in der Klinik vereinigen.

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.17, pp.11-22, 1999-10-01 (Released:2018-02-01)

---

Health education that hides away senility and death is blind. Death education that talks only of death itself and the future life after death is empty. A critical synthesis of these two schools of education will be explored. In the lifestyle modification movement of modern health education, in which nurses set forth the notion of transcendent health, diseases and death are regarded as a failure or penalty for not maintaining a healthful lifestyle. This is false. Death education should be introduced into health education. The question is, in what way ? Death education as such lacks unity, in purpose, principle and method. Here we ask for a form of death education that could be harmonized with health education for everybody. Religious death education is not suitable for public health. Some look upon death education as a preparation to pass away in peace, that is good death. To set up, to evaluate and grade "Quality of Death (QOD)" -this is a parody of QOL -is problematic. Some regard death education as needed in order to live well. This is an existential narrative. Is meditation on death, however, a necessary condition of good life ? After all negative death education, in contrast to positive death education, is recommended : Education which shows the limitations of medical services and human self-control.

著者

小阪 康治

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.16, pp.24-34, 1998-10-01 (Released:2018-02-01)

---

Informed consent is the concept that has already been established in the Helsinki Declaration and Lisbon Declaration, and its necessity is now widely understood in Japan. There is a difference, however, between the principles of the declaretions and the actual medical situation. This is often true in various cases of medical ethics. It is the present situation in Japan that the ethical standards are connected with ambiguous descriptions such as "case-by-case" and emotional standards such as a doctor's sympathy for a patient and his or her death. In this report, the author tries to establish the ethical standards for informed concent so as to combine the principles of the declarations with the respective cases. It is stated that informed consent is to maintain the collaboration between the patients and medical staff by studying the Law of Moses. It is also stated that the maintenance of the medical standard including informed consent be considered from the viewpoint of ethics. In this report, the author analyze the ethical thoughts in the judicial precedents whose issues of law is in violation of informed concent. This maintenace of the medical standard itself is just the ethical standards combined with the principles of declaration, the actual medical situation and judical process.

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.16, pp.35-45, 1998-10-01 (Released:2018-02-01)

---

Casuistry derives its tradition from the medieval Catholic practice of moral discussion dealing with difficult cases (=cases in Latin, hence casuistry) which can allegedly offer ways to resolve moral dilemmas without recourse to any ethical theories or overarching ethical principles. Contemporary bioethicists such as Albert Jonsen claim that the casuistic approach pays attention to a particular case with its circumstances, analyses it, compares it with other cases and decides its moral status as to whether it is a paradigm case or subsumed under a different category. A casuist makes a stark distinction between a case-based approach and a theory-dependent approach in ethics. The principle-based theorists such as Tom Beauchamps (despite their recent affinity with coherentism) are derogatorily called principlists whose main job is to strictly and deductively apply ethical principles in their "applied ethics". The casuistic bottom-up approach is shared by communitarian ethicists whose commitment is limited only to the close relationship in the local community. One of the casuistic rules employed to decide the morality of an action is called the doctrine of double effect. It justifies an action when it is performed from a good intention, such as to stop the suffering of a terminal-stage patient, even though the actual consequence is her death which was foreseen but not willed. This doctrine is subject to an abuse, and because it could camouflage an intention to bring about a negative effect, it has to be rejected. We can learn from casuists the value of an approach to analyse individual cases with reference to paradigms. A case analysis is an effective way of teaching ethics and of resolving moral dilemmas. But we also have to employ common values applicable to everyone in a global community to guide our actions, such as respect for persons, general welfare and the democratic decision-making procedure.

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.16, pp.65-77, 1998-10-01 (Released:2018-02-01)

---

In the field of occupational medicine and health services, occupational physicians often face ethical dilemmas or conflicts concerning their independence and the privacy of employees' health information. It is stated that, by law in Japan, employers must assume full responsibility for the safety and health of their employees at work. However, the independence of occupational physicians is not clearly regulated by the law. Therefore, an executive director has an obligation to administer the health data of workers and he may require an occupational physician to disclose the medical information of employees. The actual ethical dilemmas of occupational physicians are as follows: 1) company loyalty vs. medical ethics (e.g. disclosure vs. confidentiality of medical information), 2) workers right to know or to work vs. company managerial policy (e.g. do employers inform workers the health effects of chemicals in the workplace accurately, assessment of fitness for work, return to work, restructure of work system), 3) environmental ethics vs. bioethics (e.g. occupational physicians must have the responsibility for not only employees but also the community as well as the company). In order to dissolve these dilemmas, occupational physicians need to have three ethical opposing standpoints, namely, bioethics, environmental ethics and utilitarianism. This is the ethical peculiarity of occupational professionals in comparison with clinical doctors and it is not easy to exercise ethical judgment for employees and the company as specialists of occupational medicine. Therefore, the establishment of ethical codes or guidelines for occupational physicians are required in Japan as well as the UK.

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.16, pp.90-100, 1998-10-01 (Released:2018-02-01)

---

After a short description on liberalism in health care from the viewpoint of both patients and physicians, based on more than 45 years of clinical practice, the situation of liberalism in health care of today's Japan was introduced. Although Japan has achieved the longest average lifeexpectancy in the 1990s, liberalism in health care of Japan is now in a situation of decline, and maintenance of the humanitarian patientphysician relationship and/or clientprovider relationship has been threatened greatly because financial, social and bureaucratic powers are now so strong in the health care of Japan. The situation of the health care system in Japan may be called socio-nationalistic with a concrete basis of capitalism of American model; in other words "competitive socio-communism"!

著者

伊東 隆雄

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.16, pp.112-122, 1998-10-01 (Released:2018-02-01)

---

Psychotic patients are different from demented people because they possess the ability for competence in principle. Therefore, medical treatment must be performed based on the concept of informed consent. But in reality, there can be discrepancies between their overt-will and covert-will, because they have pathological thought processes due to double orientation and ambivalence. So we must speculate on their true wishes, and act appropriately. If they express their true wishes covertly, performing medical treatment on them involuntarily is not paternalistic intervention. I consider this behavior one which is based on self-determination. In this situation, we must carry out treatment for somatic complications, and the range of the treatment we can do should be within the area of low invasive therapy, for example, medication or injection. We may not arrive at a consensus for surgical operations and more invasive therapies. I report on two schizophrenic cases in this paper, one with breast cancer and the other with diabetes. We could not carry out a surgical operation for the first case, but I am now using injection of insulin for the second case. In the field of clinical medicine, there is a tendency for informed consent to be considered part of the therapeutic contract. In this context, overt expression of agreement is necessary in order to set up the contract. Psychotic patients express their wishes for treatment unclearly or covertly, so they do not have the opportunity to receive treatment even though they want to. Expanding the bounds of informed consent for psychotic patients would place them at a disadvantage and deprive them of medical treatment. I worry about the emergence of a new form of discrimination against psychotic patients.