著者

村松 聡

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.16, pp.123-131, 1998-10-01 (Released:2018-02-01)

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Liberalism and self-determination are based on a typical modern age idea of person: From Locke and Kant to the contemporary English-American Bioethic studies, the self-consciousness stands at the center of this idea. According to this idea of person, as is known, the embryo and disabled newborn are excluded from persons. On one hand we must keep this idea, which supports the thought of self-determination, the credo of the liberal society. On the other hand, however, we need to revise the idea of person. Focusing on the issues of the disabled embryo and newborn, I criticize this idea of person and suggest a revised idea instead. To be noticed is the phenomenon emphasized by sociology and psychology that the self shows up not alone but through interaction with others. This phenomenon suggets that the self-consciousness includes by nature the consciousness of others. To argue this is the point of this study. Should the self-consciousness include recognition of others, it is to be shown that a man would be a person, only if he is recognized. Then the matter of the idea of person is not that of the definiton of person. The problem is whether we can deny the recognition of others. From this point I also try to restrict self-determination: Abortion is not to be justified by the self-determination of the persons concerned: of parents, in particular of mothers.

著者

フェッター ヘルムート

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.132-148, 1998-10-01 (Released:2018-02-01)

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1. Historische Vorbemerkung: a) ANSTOSS ZUR BEGRUNDUNG DER PSYCHOANALYSE: Unerklarbarkeit hysterischer Symptome. b) LUDWIG BINSWANGERS DASEINALYSE: Der Mensch als Person (phanomenologische Anthropologie) and seine Verflochtenheit mit der Welt (die Bedeutung von Husserl and Heidegger). c) ZUR CHER SCHULE DER DASEINSANALYSE VON MEDARD BOSS: Die Ubernahme von Heideggers Konzept des Daseinse 2. Die Hauptentdeckung Freuds-der Begriff des Unbewussten: a) HISTORISCHE VORBEMERKUNG: Die "petites perceptions" von Leibniz and ihre Auswirkungen in der Folgezeit. b) FREUDS AUSGANGSPUNKT: Bewusstseinspsychologie. c) FREUDS KONZEPT: Metapsychologie, die "hinter" das Bewusste zuruckgeht; die Parallele zur "Metaphysik" Hinweis auf Lacan. 3. Daseinsanalytische Stellungnahme zum Unbewussten: a) ANSPRUCH DES PRAKTIKERS FREUD: Die vermisste psychologische Grundlage der Psychiatrie; Interpretation seelischer Vorgange nicht als physiologische oder chemische Prozesse, sondern als Sinnzusammenhange. Deshalb die Bedeutung, die der Austausch von Worten zwischen Arzt and Patient hat, ebenso die Bedeutung der zwischenmenschlichen Beziehung in der psychoanalytischen Behandlung. b) NAIVITAT DES THEORETIKERS FREUD: Verborgener Cartesianismus (Dualisms von Korper and Seele) and Naturalisms (naturwissenschaftliche Erldarungsmodelle). c) DASEINSANALYTISCHE KRITIK: Der konkrete Mensch in seinem In-der-Welt-sein, als sprechendes Wesen, mit seiner Lebensgeschichte and in der Beziehung zum Mitmenschen kommt im Konzept der Metapsychologie gar nicht vor. 4. Wird die phanomenologische Kritik der Daseinsanalyse (insbesondere der von Boss) dem Konzept des Unbewussten vollig gerecht? a) FREUDS INTENTION: Mit dem Unbewussten will Freud auch das missing linkezwischen Mensch and ubriger Natur (den nichtmenschlichen Lebewesen) gefunden haben. b) ANFRAGE AN DIE DASEINSANALYSE: Sie entwickelt zwar einerseits ein dem Mensch als Wesen der Freiheit adaquates Konzept, 1 asst aber ausser Acht, dass der Mensch auch ein Naturwesen ist (auch wenn menschliche Natur mit tierischer nicht einfach gleichgesetzt werden darf). Das zeigt sich in den Rhythmen seines Lebens, im Schlafen and Wachen, den Perioden der Nahrungsaufnahme, in der Bedeutung der kosmischen Rhythmen, uberhaupt im Bereich dessen, was Tellenbach "Endon" nennt (ausgehend vom Versuch, die "endogenen Depressionen" zu verstehen). c) AUSBLICK: Das transkulturelle Gesprach von Hubert Tellenbach-Dialog uber "Natur" mit Bin Kimura.

著者

棚橋 實

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.149-150, 1998-10-01 (Released:2018-02-01)

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Studies on liberalism in medicine, as theoretical foundations for patients' self-decision-making, have not been fully explored. This is because liberalism itself consists of historical and ambiguious areas where less attention has been directed to its intent and debates. Renewing the definition of liberalism is among the most important duties that we must now (achieve?) pursue. "Withholding of life sustaining-treatment" as a role of the physician has been actively debated in the United States, but in Japan we have not discussed in detail about the role of the physician over the relationship with patients and families. The meaning of "futile" as a concept for terminally ill patients encounters many difficulties such as informed consent and patients' self-control. But the emphasis on finding a common ground between patients and physicians wishes remains unanswered in Japan. Concerning rejection of blood transfusions by Jehovah's Witnesses, the situation about patients' self-decision making in Japan has been at stake, since the religious and precautious problems have surrounded the concerns. But in February 1998 the Tokyo High-Court of Justice held that blood transfusions without consent are illegal and implied that we are going to get the mutual understanding of real self-decisionmaking. Recognizing the increased interest in liberalism, recent developments in health care policy have drawn sharp distinctions between medical treatmen for patients who are competent to make decisions and those who are not. While traditional liberalism favors competent patients, medical liberalism includes areas to which incompetent patients, such as embryos and patients in vegetative states belong, In these cases, liberalism itself can not be principally realized. A discussion about liberalism in medicine raises questions not easily answerd without consideration of one's own values and the values of society.

著者

倉持 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.16, pp.151-157, 1998-10-01 (Released:2018-02-01)

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For what purpose should a person, while living or in death, be used? This is the crucial issue of a human's 'Wesen'. Namely, a human being's 'Wesen' requires that one be treated, during life itself and even in death, as an entity with its own reghts. Therefore, if through one's own right of self-decision, we try to justify the use of one's body for the act of organtransplantation, the nature of the patient's, for example that of brain dead, intentions as well as clear legal standards must be formally defined. In cases in which certain endeavours do not violate a person's 'Wesen', when expression of the volition of represontative in the form of consent with sufficiently precise information is acquired, then the possibility of representative with legal authority can be considered. However, when the violation of 'Wesen' is involved, it is requisite that the said person must state, through a formal written declaration, that his or her body can be used as a means for a certain purpose. Furthermore, the creation of a third party's right to decide on the use of the said patient's body is also essential. Therefore, in this case, a consenting representative inevitably won't be effectuated.

著者

佐野 誠

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.158-165, 1998-10-01 (Released:2018-02-01)

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The issues of "informed consent" and "the patient's right to self-determination" have been discussed in the philosophical, ethical, and legal areas in medicine. In particular, the refusal of blood transfusions by Jehovah's Witnesses is regarded as a typical case of the discussions on the validity and limitation of the patient's right to self-determination. It is well-known that Jehovah's Witnesses refuse allogeneic blood transfusions on the basis of Biblical statements, such as "you must never eat flesh with its life still in it, that is the blood" (Genesis 9:4) or "you are to abstain… from blood" (Acts 15:29). What is the standard medical practice where a patient absolutely refuses blood transfusions? Is there the limitation of the patient's right to self-determination? How far is it possible to approve the choice of medical treatments by patients? In this paper, such problems are discussed from the following three standpoints. 1. The concrete contents of the refusal of blood transfusions by Jehovah's Witnesses. 2. The contents of the guidelines of ethics committees in the university hospitals of Japan. 3. The controversial points of these contents (1. and 2.) and the Japanese legal system. My conclusion is as follows : 1) If a Jehovah's Witness patient has his own judgement, whether he is an adult or a minor, and is not in a state of emergency, his will to refuse blood transfusions must be respected. 2) If he is an unconscious adult in an emergency and has an advance directive, his will must be respected. 3) If he is an unconscious minor in an emergency and medical doctors have no alternative choice, it will not be against the law that they give blood transfusions to him, because there has been no judicial precedent for such a case in Japan as yet.

著者

ベッカー カール

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.15, pp.137-143, 1997-09-20 (Released:2018-02-01)

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This presentation considers three aspects by which an understanding of Japanese patient psychology can improve medical practice in Japan. (1) Recent advances in holistic and psychosomatic medicine illustrate that patients' psychology can influence medical outcomes. While it has long been common knowledge that bodily conditions influence mental moods, the burgeoning new field of psychoneuroimmunology is demonstrating that mental attitudes and emotions influence illness and health. The commonest stress-related ailments in Japan, from ulcers and high blood pressure to eczema and stiff shoulders, can be significantly alleviated by psychosomatic medical techniques such as relaxation and biofeedback. (2) The psychology of Japanese patients differs in many respects from that of Americans. For example, Japanese rarely strive to participate actively in their own healing processes, express individual decisions in writing, write living wills or advance directives, or consider themselves equal in status to their physicians. Given such deep-rooted cultural differences, even their best attempts to imitate Western medical practices encounter many difficultes. This section considers more suitable ways of counseling Japanese chronic and terminal patients based on their cultural expectations. (3) Similarly, the spread of bioethics has been closely linked to Western conceptions like full disclosure of information, second opinions, third-party review boards, and the legitimacy of whistle-blowing. The social hierarchies of Japanese hospitals render such practices counterproductive if not impossible. In the care of Japanese patients, mutual understanding based on discussion and family participation in decision-making produce far higher trust and satisfaction than information disclosure. This suggests that Japanese develop their own ideals and conceptions of bioethics based on their own cultual goals and assumptions.

著者

バロン パトリック

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.15, pp.144-148, 1997-09-20 (Released:2018-02-01)

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This paper attempts to look at some of the changes that have taken place in the Japanese health care environment during the last 30 years from the point of view of the patient. In the U.S. the period after the Second World War was marked by increasing litigation concerning the outcome of health care, and this in turn created demand for second opinions and expert opinions in law cases. Hand-in-hand with this development came the concept of informed consent, i.e. that the patients had the right to know everything about their own condition and the type of treatment that they were receiving. By extension, this came to mean that in any clinical trial the patients not only had the right to know but had to know their condition and the type of treatment they were receiving. While the number of persons in metropolitan areas in Japan who wish to be fully informed about their condition has increased, questionnaires have confirmed that in rural areas there is an unchanging large amount (@40%) of patients who do not want to be told directly by their physicin. This raises the question of "right to know" actually "a duty to be forced to know" ? Furthermore, in the field of medical publications, which are essential for most persons in academic medicine who want to develop a career, it has become increasingly common to enforce the demands of the US litigation / health care environment on all those wishing to publish papers in international journals, the overwhelming majority of which are published in the United States. Reference is made to a recent study by the Council of Biology Editors concerning the questionnaire they distributed to their members. The results of the questionnaire favored the idea that it would not be correct for one country to impose its cultural values on all papers submitted to a journal submitted in that country. This paper also suggests that, in order to allow comparison of traditional oriental medicine such as acupuncture and western medicine such as drug treatment, and given the different cultural situation of various countries in Asia, they should develop their own ethical and compassionate approaches to the scientific elucidation of treatment effects without necessarily copying in every detail the present approaches used in North America.

著者

冨倉 光雄

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.15, pp.149-156, 1997-09-20 (Released:2018-02-01)

著者

内野 滋雄

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.15, pp.157-166, 1997-09-20 (Released:2018-02-01)

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The history of dissection in Japan began in 1754 when Toyo Yamawaki dissected first in Kyoto. Later, many human bodies were dissected in various parts of the country during the Edo era, but all the cadavers were those that had been executed or died in a prison. The people at that time had a dark image that the dissection was performed on sinners. In the second year of Meiji, a thirty-four year old woman named Miki donated her body. She wished to be dissected after her death with her own will. Hers was the first body donation in Japan. Until World War II, cadavers devoted to the medical education were mostly from criminals, as in the Edo era. As, however, the human rights movement spreading throughout the country, it became difficult to obtain and dissect such cadavers and they became extremely short supply. After 1955, groups promoting body donation were formed in order to make up for the shortage of cadavers all over the country. Initially the groups were formed only to supplement the number of cadavers. But after 1975, donors became to think that it is their great contribution to the medical education and they can participate themselves in educating ethical and humanistic medical doctors even after they die.

著者

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.15, pp.167-169, 1997-09-20 (Released:2018-02-01)

著者

澤田 愛子

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.15, pp.170-172, 1997-09-20 (Released:2018-02-01)

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.16, pp.12-23, 1998-10-01 (Released:2018-02-01)

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It is not the purpose of this paper to give a new model or definition of health concept and to legitimate it, but to reflect critically on the way to use or investigate this tempting and puzzling concept. Recently health has ballooned to be very pseudohypertrophic. It is a synonym for happiness in respect of totality and ideality. After Kant, these concepts should not be used "constitutively", but may be used only "regulatively". Health measurement is an example of misuse. Another misuse is positive health, in which QOL is frequently stressed. Originally QOL has been used in the social sciences, the social policy processes, or in clinical practices for individual patients. Positive health, in addition, tends to apply QOL to healthy persons. This abuse is due to pseudohypertrophy of health concept; health as flourishing human life or self-fulfilment. In respect of health concept, from medical philosophy to medical ethics, from the clinical to the preventive dimension, the dual transition of our concern is proposed.

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.15, pp.26-32, 1997-09-20 (Released:2018-02-01)

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This study analyses private papers written by women who underwent sterilization treatment. First a comparison is made with the model of E.Suchman who pointed out "illness behavior" and "stages of illness". How big is the pain of infertility as a result of the enormous stigma attached to the inability of giving birth to one's own child? The sense of desperation is followed by hope-and then desperation again and again. Why are children of any value? Because of a particular passionate desire of caring for and nurturing children? The medical procedures they underwent and the many "failures" they experienced are described. But they say, "If we lived in a world in which infertility is not seen as a 'disease' that can be 'cured', these technological accidents and experimental procedures could be avoided." That is, pressure from society can turn a fertility problem into a curse which provokes feelings of guilt, above all the desperate belief that, 'I have to try one more time, one more procedure.' : What is "illness", and What is the object of "treatment" ? After all, this study is an analysis of the content of papers concerning cognitive factors of illness behavior.

著者

関 修

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.15, pp.33-47, 1997-09-20 (Released:2018-02-01)

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1. Medical Philosophy, Ethics and Problems of Homosexuality. The various concepts of sexuality were invented by psychopathology in the late 19th Century. In the DSM-III-R of 1987, homosexuality suddenly became normal from abnormal. However transgender remains an illness, as it was before. It is only a political problem. Another important problem is about AIDS. In Japan, there is discrimination between AIDS caused by medicine and AIDS caused by other factors. 2. Homosexuality as Thought : Situation of modern French Thought. In France, The "May Revolution" of 1968 caused the foundation of a new university : Paris 8th (Vancennes). One of its founders, Rene Scherer began his first lecture on sexuality in the faculty of Philosophy. His partner, Guy Hocquenghem, founded FHAR. Recently, Red and Black-Homosexuals in France after 1968 by F.Martel was published. However, Prof. Scherer has told me it is a defective book. 3. Thought of G. Hocquenghem : concerning homosexual desire. The originality of Hocquenghem's thought seems to lie in his idea of forming "a group of subjects" through the anus. The creation of relations among others by anality stands against ideas of couples. Being homosexual is not a means to attain self-identification, but a means to be out of self, to become a foreigner. It is also an escape to an infinite drifting from a stiff identity. 4. The Voice of M. Foucault : Homosexuality as a form of existence. Foucault's thought about homosexuality summarizes two points. First, to be homosexual is not correct ; to become homosexual is correct. He takes "gay" to create a new form of existence. Therefore, he does not think coming-out to be inevitable. Secondly, his problem is to begin to love among individuals. It means that "I" is more essential than sexuality. Here there seems to be fascination for passivity. 5. Conclusion : In Japan, they say "gay" is already out of fashion : now "queer" replaces it. However, such nomenclature is only a matter of fashion. To my regret, regular studies on gayness or queerness are not carried out in Japan. Now, it is necessary to study homosexuality as thought. That means to meet various thoughts not only to introduce and imitate them but to get involved in them : to have a mind of "hospitality". That is a critically needed task in Japan.

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.15, pp.48-63, 1997-09-20 (Released:2018-02-01)

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From America and Europe, there is a great abundance of reports of large-scale randomized clinical trials on various medical problems. They have brought important findings to medical practice. Such knowledge is available in all over the world, including Japan. However, in Japan, we have little experience of randomized multicenter clinical trials, and only a very small number of patients have participated in these studies during the initial period. There are still many diseases and many patients with intractable pathophysiological conditions, and many requests to relieve them or to improve their health, using high-level technology. Why do megatrials fail in Japan? While some have indicated that Japanese physicians have paid scant attention to or have had no experience of large-scaled, multicenter, double-blind, prospective, or randomized clinical trials. I would rather point out the following : we have the health insurance for all Japanese ; the coverage is for anyone, anytime, anywhere in the country, and for any type of conventional treatment ; so most Japanese individuals have little pressure to develop or to resolve medical problems. However, since the consultation time is only about three minutes, the physician does not have enough time to explain details on the clinical trial, therefore the condition of informed consent is poor in Japan. In addition, the peer review system has little tradition and there is no neutral powerful agent as the FDA. Consequently patients are not confident in physicians and the Japanese health care system in general.

著者

尾久 裕紀

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.15, pp.64-71, 1997-09-20 (Released:2018-02-01)

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Ethical principales of medicine for physicians provide that a physician must have empathy with and respect for the "dignity of man". For example, the complete works of Hippocrates contain the following passage, "A physician must be impartial in his personal relations". This means that a physician needs to get along with the other persons even when there is a conflict of desires with them. Does a physician always deal with patients impartially in actual clinical practice? It is out of the question, if there is evidently a lack of fairness. But there are cases in which a physician lacks true fairness depending on the nuance of his words, although he appears to be fair formally. In this case there are several causes. In the presentation this time, we examine lack of fairness due to a physician feeling "disagreeable" toward a patient. Feeling "disagreeable" toward a patient may be devided into those cases when the physician himself is aware of it and those where he is not aware of it. For a physician to feel "disagreeable" toward a patient may be unavoidable since the patient-physician relation is a personal relation. In any case, this feeling is one of the causes for a physician to lack fairness to patients. For example, when a physician discloses medical information to a patint to whom he feels "disagreeable", the true meaning sometimes is not understood, or a distorted version is relayed to the patient intentionally or non-intentionally, even if the substance of disclosure is enough formally (or legally). Even when the same information is told in the same words, the way of relaying it and nuance can be changed by the "disagreeable feeling" toward the patient, and the inforlmation is understood quite differently by the patient. In this presentation, we study what situation also cause a physician to find a patient to be a "disagreeable person", whether it is against the ethics of medicine for a physician to feel "disagreeable" toward a patient and how a physician should deal with a patient impartially even when he thinks that patient to be a "disagreeable person".

著者

岡本 天晴 櫻庭 和典

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.15, pp.72-84, 1997-09-20 (Released:2018-02-01)

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The massive earthquake that hit the Hanshin region in January 1995 caused 6425 deaths and over 40,000 casualties. Major public utilities were cut off, so medical practitioners found medical activities extremely difficult. Rescue operations by the self-defence forces failed to function properly. This disaster has called attention to the importance of Triage regarding medical services in such large-scale disasters. Triage comes from French, and was brought into English during the First World War, and was used in classifying the wounded. The definitions of Triage are 1. Classifying the injured by the seriousness of their external injuries or illness. 2. Deciding on the order of superiority for treatment. Let us consider the ethics of Triage from the following two aspects. a. The Means : In times of crises such as a war or a large-scale disaster,traditional medical ethics do not apply. Limited medical resources will mean that a capable Triage Officer should independently and speedily sort (i.e. triage) patients based on high-quality initial diagnosis, and decide on the order in which they will be treated. The ethics will be based upon the fact that Triage is the means for attaining the maximum happiness for the maximum number of people. The appropriatenss of the means will be subject to change depending upon the situation. Therefore Triage is a process modified repeatedly. b. Education : For an inexperienced doctor, it is an ethically difficult mission to classify numerous patients in a way that is different from daily practice. There are also doctors who emphasize that practice drills for medical services in times of large-scale disasters is aiding and abetting war, and that classifying numerous patients is inhumane. Doctors know little about Trige, and the general public is uninterested, so once a disaster strikes there is major chaos. It is therefore desirable to train capable Triage leaders and at the same time have the man on the street undergo training to be ready for large-scale disasters, and have an understanding of Triage. By doing this, disaster survivors will be aware that there are many patients around them whose treatment requires priority, and they will be able to engage themselves in volunteer activities or await their turn for treatment whih understanding. In this manner, it is possible to acknowledge the high ethics of Triage in neighbourly love, or regional unity, which is needed in times of large-scale disasters.

著者

花岡 真佐子 池川 清子

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.15, pp.85-94, 1997-09-20 (Released:2018-02-01)

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Nursing techniques, unlike those developed in other field, arise and evolve out of interactive situations. The individually generated action performed in isolation, which, on a production line is appropriate, can be entirely inappropriate and ineffective where the question is one of care. In such a situation, therefore, the observer (the nurse) cannot handle the obsenrvee (the patient) in a mechanical fashion, as if the latter were not a sentient being but merely an object. It follows that the nurse's perceptive capabilities and judgment play a decisive role in the appropriateness and effectiveness of the techniques she or he employs. The nurse's perceptive modes must thus be examined. Living necessitates humans to maintain a constant relationship with the surrounding environment. The recognition and interpretion of and reaction to sensofy stimul are inherent features of this relationship. It is perception that establishes mutual relations between human being and his world, hence perception is crucial to nursing acts. The links existing between the various perceptive modes and the surrounding environment, together with the incorporation of such information into students'clinical training, form the subject of this paper.

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.15, pp.107-118, 1997-09-20 (Released:2018-02-01)

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From an experience of more than twenty years in undergaduate and postgraduate education of medical ethics and bioethics, the author discussed the following four problems. 1. Eduation of bioethics should be started as early as possible by parents and kindergarten teachers, and should be followed by primary and secondary school teachers prior to medical education. 2. During the past twenty years, almost every Japanese including medical students became very familiar with medicoethical and bioethical issues arising from new medical technology. However, education on citizens' everyday ethics and pupil / students' ethics are more important than medical ethics relating to modern topics such as euthanasia, in vitro fertilization, organ / tissue transplantation and so on. 3. When, by whom, where, in which stage of the curriculum, in which style, on what kind of topics, medical ethics education should be done, are all very difficult questions to answer, However, the author have reached the following answers. (1) The effect of lecture style education on medical ethics in a large lecture hall, especially in the preclinical course is very limited. (2) Small group discussion on everyday clinical practice is more important than a systematic lecture. (3) Everyday ethical and humanitarian behaviors of all practitioners to the patients and their families are more important than lectures by famous professors. 4. Why Japanese physicians show less concern about medicoethical and bioethical issues was discussed. Some of the reasons are : (1) It results largely from a cultural difference between Euro-American countries and Japan. (2) Japan is too legalistic country in which most behavior of the people is regulated by laws, most of them enacted in the 19th century, rather than by medical ethics and bioethics. (3) Medical practice in Japan is typical Managed Care controlled by government and National Health Insurance Laws. For most physicians it is rather rare to find an opportunity of ethical decision-making. (4) The Physician-Health Insurance Law relationship and patient-government relationship are very often more important as well as more powerful than the patient-physician relationship in Japan. (5) Medical education in Japan both in pre- and postgraduate courses is a typical School Medicine or University Medicine which places too much attention on medical science and modern high-technology, respecting less the humanity, human dignity and interests of the community.

著者

渋谷 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.15, pp.119-134, 1997-09-20 (Released:2018-02-01)

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It has been said there is a mutual understanding between doctors and patients, established through confidence in the doctor-patient relationship. As a result there are usually few medical conflicts on treatment and policies, despite the fact there is no actual formal informed consent. Recently however the position of the patient requires more consideration than previously when providing medical care. No doubt a portion of this increased sensitivity stems from the Nuremberg Principle of 1947 and "The Declaration of Helsinki" adopted in 1964. These credos require physicians to seek peace and give the highest priority to the well-being and happiness of human beings, and certainly their patients. I intend to bring forward in my philosophy of medical ethics issues of QOL (Quality of Life), Medical Ethics, Human Rights and Equality, and renewal. I will discuss the necessity of informed consent and the need to harmonize at a global level many of these issues. Reference will be made to historical considerations in the establishment and preservation of the Japanese view of ethics and philosophy, a comparison of Japanese and Western viewpoints, the purpose of the "Declaration of Helsinki", and these issues as they impact in new drug development during clinical trials.