著者

牧野 尚哉

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.135-136, 1997-09-20 (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.14, pp.156-158, 1996-10-01 (Released:2018-02-01)

著者

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.14, pp.159-162, 1996-10-01 (Released:2018-02-01)

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Studies during the long history in Nursing have fostered specialized knowledge and techniques through various health care models. In the early days we can find the primordial forms of nursing in ancient diaita (greek word for health related Iifestile) aimed at arranging human life in response to nature. Forms of health care from the middle ages to early modern era in Europe had been meant to be the diaita as health practice which was rooted in an individually oriented thought based on "six nonnatural practice-sexeres non naturales. However, as the diaita in the middle age model gradually declined, this theory based on the power of natural healing lost its influence to studies of nursing and as the result it gave the way to the modern medicai models based upon theories of biologicai mechanism. Due to the methodological change to biological medical model in health care, diaita seemed as if it had disappeared from the historical scene. However,at the turning century we gained Nightingale who recovered originally intended meanings of nursing care. Nightingale found the fundamentals of health care in relation to the healing power of nature for human beings and thus it becomes imperative for caring people to prepare environments in responding to the needs of those who are cared for.This means that the fundamentals of health care should be based on the basic trust in natural healing power inherent in human beings. However, from the early twentieth century, the biological model of medicine became overwhelmingly influential and thus studies of nursing have been dealt with in relation to the scientific model of problem and solution. As the result it has been exposed to the situation of manipulative and mechanical principles in science. I would like to investigate the fundamentals of health care by studying ancient diaita and then to inquire into various problems derived from scientific models of health care severed from practical insights of humaneness. I would also like to clarify the future tasks of health care.

著者

川口 孝泰

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.14, pp.163-168, 1996-10-01 (Released:2018-02-01)

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With the rapid improvement of science and technology in recent years, Japanese hospitals are increasingly employing high-technology equipment.This gives rise to such issues as the necessity of obtaining informed consent and the quality of life in the hospital environment and is taking place against a background of increasing self-assertiveness on the part of health-care clients.There is a necessity for increased self-management and medical understanding on the part of health clients. Self-care is an important factor in effective care as well as an aid to the effectiveness of nurses. However, given the sociocultural context within which health care is delivered in Japan, issues such as "informed consent" and "quality of life" encounter obstacles as soon as they are raised. In this sociocultural context, the very fact of being "committed" to a hospital engenders a sense of fatalism and pessimistic expectations on the part of the patient. Moreover, patients in this cultural context are willing to surrender responsibility for their lives to medical staff members, while doctors and nurses have reciprocal expectations. In this symposium we argue that is necessary to focus on these problems from the perspectives of both the therapeutic and health care communities.

著者

桝形 公也

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.14, pp.169-173, 1996-10-01 (Released:2018-02-01)

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The rationing of health care resources is identified as "the most important ethical issue" facing health care today. Economists divide the allocation into two levels, namely macro-allocation and micro-allocation. The former is the problem of apportioning of money among social needs, for example, for health care, education and military affairs. The latter is the allocation of health care resources at the level of the hospital. Advances in medical technology are the main factor contributing to the enlargement of medical needs and according to it the cost of health care has rapidly increased and there is no natural limit, as Daniel Callahan says, to the development of medical needs and technology, but the resources are limited. The problems concerning which principles we can apply to allocate limited health care resources present difficult questions concerning social justice.This issue may threaten the integrity of health care professionals and sacrificie care needs. This problem should be solved on the basis of a double integrity system, namely that of patients and the health care system, and for that reason the role of nursing professionals is very large.

著者

奈倉 道隆

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.14, pp.174-176, 1996-10-01 (Released:2018-02-01)

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.14, pp.177-179, 1996-10-01 (Released:2018-02-01)

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.14, pp.180-181, 1996-10-01 (Released:2018-02-01)

著者

遠藤 正樹 阿萬 由起子 大倉 民江

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.14, pp.57-68, 1996-10-01 (Released:2018-02-01)

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Medical social workers have to meet a wide range of needs of patients and their families as citizens and persons involved in the total daily medical care. Especially in transplantation treatment the existence of social workers is indispensable for helping patients with their own decisions for their own benefit from psychological and social viewpoints. In actual team medical care, it is important to promote the medical staff 's further understanding of patients with regard to the advocacy and respect of their own thinking from the standpoint of a third party. The role and importance of social workers in transplantation treatment is discussed, torough a case the authors were involved in, by examining the process of self-decisions by a patient and his family. The actual case here was a patient who, as a citizen, desired a heart transplant after many years of fighting against diastolic cardiomyopathy and succeeded in receiving it in the United States. The importance of medical social workers has not been fully recognized in Japan. As a result there is still a persistent shortsighted view that their role is no more than to exhort and persuade patients in response to their complaints. This paper discusses and tries to define the differences in roles and specialties between transplant coordinators and social workers as the key persons in transplantation treatment on the basis of the actual case and a field report on the actual heart transplant in the United States.

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.14, pp.69-80, 1996-10-01 (Released:2018-02-01)

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In Japan the law obliges employers to carry out an annual Health Check-up Examination for their employees. This may be effective for early detection and prevention, but could be an excessive intervention in rights and liberty of individuals, because the result of screeing is used not only for medical services, but for personnel management. Indeed no ethical problem has occured in the case of occupational diseases; nowadays the main target of workplace prevention is, however, non-occupational, chronic diseases, which are to a great extent relative to each individual private life or genes. Informed Consent is generally neglected, or rather ignored. And the priority of various alleged 'compehensive, total' health evaluations to the traditional, which has had to do with physical states of employees, is overestimated. Both in principles and in methods these should be reexamined. The socalled healthiest state is the self-realization. In this sense, health is a synonym for happiness, which is merely ideal. Not the constitutive, but the regulative use is appropriate for an ideal concept. The extent of self-enrichment or -fulfillment of each employee should not be evaluated in the workplace. The dogma of 'positive mental health', commands employees to strive for a higher, maturer mental activity. This is a mirror of shameful, discriminatory stigmatization against the mentally ill.

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.14, pp.107-120, 1996-10-01 (Released:2018-02-01)

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In Japan, medical and social consensus on why brain death is the termination of human life? has not been obtained since the first heart transplantation by Dr. Wada in 1968. Discussions were concentrated on the diagnosis of brain death of an alive drown donor and operational indication (with the technical problems) of the recipient patient.Historically patient rights have not been established in medicine in Japan, so we studied 8 kidney(1 pancreas) transplantation cases from brain-dead patients including Tsukuba case* based on newspaper informations for these 10 years. The basic diseases were:brain contusions 4,subarachnoidal bleeding 1,a bee-toxin shock 1.cerebrovascular disease (dementia) 1,and unknown 1. The finai explanations on the critical conditions were:will soon die 2,near brain death 3,brain death 2,and unknown 1. According to the most authorized Takeuchi report on Brain Death, the concept of brain death is just clinical,and the definition is irreversible dysfunction of total brain. Indeed, many reports on brain-dead patients demonstrate that they are not dead, because of body movement (spinal nerve action), secretions of pituitary hormones, alterations of brain Xray-findings, and delivery of brain-dead pregnant women. By analyzing of our cases, we summarize that (1)before brain death was djagnosed, almost all families were told that patients would soon die, and the main subject of treatment was converted to preparation for transplantation. (2)the most ethically important problem was found in Tsukuba case, which showed the discrimination of psychohandi-caped patient in consent and treatment policy-abandonment of resuscitation. Obtaining no chances of discussion with those doctors, we accused the operators and neurosurgeons as committing murder of the donors, but still now, no decision for or against criminal prosecution has been announced these 10 years

著者

シッパーゲス ハインリッヒ 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.14, pp.121-136, 1996-10-01 (Released:2018-02-01)

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"Medizin in Bewegung" ist die Gesammtbenennung einer anthropologisch orientierten Heilkunde, die in den 20er und 30er Jahren von den grossen Lehrern der Heidelberger Klinik in Gang gesetzt und in Unruhe gehalten wurde and der spanische Medizinhistoriker Lain Entralgo den "Durchbruch eines neuen Weges in der Geschichte der Medizin" kennzeich-nete und schon im Jahre 1950 "Heidelberger Schule" nannte. Dem Wortsinne nach bedeutet "etwas in Bewegung": dass etwas angelaufen war, in Fahrt gekommen ist, aber noch nicht ans Ende gelangen konnte, so dass wir uns noch in einem "Durch gangsstadium" befinden. Die Medizin steht ja - in Praxis wie Theorie - "in dauernder Bewegung". In Bewegung geriet die moderne Medizin nicht nur durch eine ganze Serie von atemberaubenden Techniken, sondern auch durch eine Reihe von kompensatorischen Bemuhungen um die psychische Seite and die soziale Schicht der Krankheit. Damit verbunden war ein neues arztliches Denken: Es ging jetzt weniger um die Erforschung der Ursache von Krankheiten als urn eine neue Beziehung zum Leben and zum Leiden des einzelnen Kranken. Drei Personlichkeiten werden uns in dieser "Heidelberger Schule" immer wieder begegnen: Ludolf von Krehl(1861-1937), sein Kollege Richard Siebeck(1883-1965) und deren Schuler Viktor von Weizsacker (18861957). Wir sind heute uberinformiert an einem enormen Verfugungs wissen, aber verkumert an Orientierungswissen "Seit dem Anbruch der Neuzeit sind die Volker reich an Wissen, Gedanken, Erkenntnis, aber arm an Weisheit", sagt Viktor von Weizsacker. Weisheiten aber vermitteln uns kaum noch die Wissenschaften. Weisheit haben wir aus anderen Quellen zu suchen: in den Bekenntnissen der grossen Philosophen, der Kunstler, der grossen Glaubenden aller Volker und aller Zeiten. Eingeordet in das dynamische Spannungsgefuge zwischen Verwurzelung und Entfaltung mochte ich hier drei charakteristische Momente der "Medizin in Bewegung" zu bedenken geben: 1. Die Heilkunde als eine Philosophie des gesunden und kranken Leibes; 2. Die Heilkunst als eine Wesenslehre der erkrankten Person, und 3. Die soziale Wirklichkeit des Patienten und damit eine Medizin der Mitmenschlichkeit.

著者

南 裕子

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.14, pp.137-140, 1996-10-01 (Released:2018-02-01)

著者

溝口 純二 大川 貴子

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.14, pp.141-146, 1996-10-01 (Released:2018-02-01)

著者

竹崎 久美子

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.14, pp.147-151, 1996-10-01 (Released:2018-02-01)

著者

片田 範子

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.14, pp.152-155, 1996-10-01 (Released:2018-02-01)

著者

曽我 英彦

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.13, pp.174-177, 1995-10-01 (Released:2018-02-01)

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The notion of "informed consent" appeared recently as an ethico-medical term. But the concept is not new. Where people want to live peacefully with others consent has always been indispensable, and there could be no consent without information. Why is the term "informed consent" now the topic of discussion" ? This term suggests that modern medicine based natural science has lost humanism and regard recuperation. In spite of infestation of Paternalism, professional arrogance, pursuit of commercial benefit etc., not a few medical professionals live still in the illusion that the medicine were the representative system of humanism. There is another illusion that a patient could give consent as a free and independent individual. From the illusion comes the self-determination right of patient in his health care. If a individual were realy independent, is'nt "informed" consent self-contradictory? The informations given from doctors are often onesided and patients can be biased or even forced to give agreement. This kind of agreement can not be real and ethical consent. So long an individual were absolute independent there can be no consent but antagonism. Modern western philosophy established by Descartes stands on individualism or egoism. As an idea or a symbol of liberation of people from dictators, it had historical significance. But is any one realy absolutely independent and free? This question was already possible British empiricists. Hegle and Marx asserted that the free individual, thought to be a independent, self determining substance, cannot release himself from the contradiction of self-alienation. Husserl's Intersubjektiv and Watuji's Ningen (human relation in itself) suggest that a person can only be himself in a community of mutual dependence. This thought to one of the fundamental principles of Buddhism. The subject of the consent is not an individual, neither physician nor patient, but a community of physician-patient relation based on mutual trust and information. So the consent in this meaning or, in other word, accord is the principle of not only medical but universal ethics.

著者

岡本 天晴

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.13, pp.178-181, 1995-10-01 (Released:2018-02-01)

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"Informed-Consent" is a concept which has been developed and is functioning at the medical world in the United States. The concept is the patient-centered, valuing the rights of patients. On the other hand, the medical concept in Japan has still been based on so-called "Paternalism" which regards all the medical acts of doctors. People in general in this nation are indifferent mainly because of the lack of public awareness, and prevailing traditional attitude-undirected doctors and dependent and patients. Much discussion in Japan on the matter these days seems rather superficial, without solving the basic problems, there are differences of Japan-American culture, educational system, quality of medical treatment etc. On introducing and practicing "Informed-Consent" to Japan, as a Buddhist philosopher, the another feels the necessity to preserve "trust and empathy-relationship" between patients and doctors by gradual attitudinal change on both sides. My concern is result of the overly rapid introduction of the idea which may lead us to social problems seen in the States such as constant legal disputes overemphasizing the rights and duties of the medical treatment. The another therefore, calls the attention of medical practitioners to re-evaluate the Buddhistic concept of "Hohben (Sk.upaya)" which implies acts of "Deep Wisdom and Compassion" on the doctors' side to guide patients mentally and physically.

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.13, pp.182-187, 1995-10-01 (Released:2018-02-01)

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Recently in the field of health care in Japan, as in other countries, there is increasing number of people below that every person has a right to self-decision concerning health can, so that no medical intervention may be carried out without voluntary and informed consent. This argument is, of course, valid and persuasive, at last theoretical. However once we apply this principle to each and every case of health care, we immediately confront some difficulties. Because medical case has infinite variable, and in many cases we cannot forefully obtain free and informed consent. In the first half of this paper, we consider the theoretical and historical validity of the informed consent principle. In the second half, circumstances which make it difficult to take care of patients in accordance with the concept of informed consent will be pointed out.

著者

矢次 正利

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.14, pp.1-3, 1996-10-01 (Released:2018-02-01)