著者

杉田 勇

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.88-104, 1995-10-01 (Released:2018-02-01)

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In 1990 The Japan Medical Association translated the Englisch concept "informed consent" as "explain and consent" into Japanes and made a report on informed consent. In the report it is said that informed consent will make an opportunity to reconstruct a new human relationship between physicians and patients in our country. But how is informed consent possible ? The aim of this paper is to consider informed consent from three aspects, i.1. legal, ethical and philosophycal theory and to establish the theoretical foundation for informed consent. The consideration of the paper is as follows. 1. Concept of informed consent. 2. Informed consent. for whom ? 3. Can we introduce informed consent directly into our country ? 4. Acceptance and modification of the informed consent concept. 5. Never treat a person simply as a means, but always as a goal. 6. The meaning of informed consent. -From consent to agreement.- 7. Conclusion. -Metaphysical meaning of informed consent.-

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.13, pp.105-114, 1995-10-01 (Released:2018-02-01)

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When we consider the ethical and social responsibility of nursing, we should note the concept of nursing advocacy, which is often used as a key word in nursing ethics in U. S. Nursing advocacy holds the view that nurses are responsible for advocacy of patients rights and interests. We can find out different model theories on nursing advocacy in many literature on bioetics and nursing ethics. For example, there is the legal rights model of G. J. Annas, the values-based model of Kohnke, the respect forpersons model by C. P. Murphy and the social advocacy model of Freeman. However, we do not have yet have a conclusive theory on it. We can draw some points on nurses' roles in informed consent between physicians and patients by using the concept of nursing advocacy, For example, nurses can give more explanations to patients to make up for a lack of medical informations by doctors. Moreover, they can help patients to understand information better by asking doctors in place of the patients, In this way, nurses can help patients to make decisions according to their own values. Nurses should do their best to keep best interests of patients, However, to enable nursing advocacy, nurses' rights as patients' advocates should be respected by physicians and other health care personnel.

著者

奈倉 道隆 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.13, pp.115-122, 1995-10-01 (Released:2018-02-01)

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In Japan, informed consent (IC) is not carried out satisfactorily in order to improve the situation, medical social work (MSW) is essential. While the need for MSW is increasing, it is yet recognized in the medial world of japan in four of the reasons for this fact are as follow (1) Medical doctors take the initiative in the field of medicine and patients become more passive. As a result publish do not try to ask for MSW support. (2) In Japan, medicine only means diagnosis, treatment or nursing of diseases. Solution psychological or social problems of a patient are not considered medical matters, even though they may be related to disease or treatment. (3) Right now, medicine is not administered through team work, and MSW, activities which received patient asking and coordination of medical activities do not operate smoothly yet. (4) In Japan people tend to think that maintaining a good relationship is much more important than realizing their own will or desire. These four factors hinder IC. Now it is necessary to solve these problems. The solution of this problem would also bring the proper situation to make progress IC and establish MSW concretely, which would contribute to IC.

著者

土屋 健三郎

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.12, pp.75-89, 1994-10-01 (Released:2018-02-01)

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The President's Address which I gave at the first entrance ceremony of the University of Occupational Environmental Health held in 1978 was entitled "The Mission of the University." The first article stated: "This university should educate students to become doctors who philosophize for themselves throughout their lives." The verb "philosophize" means to reflect seriously on great matters such as life and death,mind and body, etc. A philosophizing doctor integrates science and humanism with his or her person. In modern industrialized society, technology-oriented scientists and physicians tend to view nature as a set of external objects free for artificial intervention. This tendency presents many hazardous problems of bioethics. Modern Western rationalism is responsible for much of excessive dominance of science and technology. In contrast Oriental thinking views human life as being harmoniously incorporated in nature. In order to survive, the world must find a way to unify Oriental humanism with Western humanism. Although modern scientific technology has elevated the standard of living, it has also caused the destruction of nature. Here another controversial problem emerges; that is, whether or not satisfying human desires takes precedence over the sanctity of life and nature. This problem requires us to establish new environmental ethics. If we merely stand on either the biological view of life or the person-centered view of life, we understand life in utilitarian terms and do not realize the intrinsic meaning of life. To establish both the new bioethics and environmental ethics, we should regard the standpoint which sees life as a matter of quality and the nature-centered view as important. If human beings do something because they have the technique to do it, it may lead them to a self-destructive end. I believe that human beings should have a modest attitude toward life and nature.

著者

山下 博

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.12, pp.90-98, 1994-10-01 (Released:2018-02-01)

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The basic standards for education in universities or colleges were revised on March 7th, 1991.The purpose of the revision is to simplify the basic standards and to show the fundamental principles of education in universities and colleges. After the Second World War, the Japanese Ministry of Education introduced a new education system for the purpose of establishing a more humanistic system. For the past 50 years, this system has been in effect also in higher education. The principle of this system is ideal and works very well in primary and secondary school education. However, in higher education, the time allotted for major subjects has been decreased from four years to two years resulting in a lower quality of professional education in Japan. Now, the Japanese Ministry of Education has started to feel anxiety regarding the future of Japanese higher education and has decided to improve this system. this revision will be the second one since the Meiji restoration. By this revision, Japanese universities and colleges will be able to draw up their own curricula. In return, they are asked to establish a self-evaluation system, which is necessary for accreditation. In many medical schools in Japan, the faculty for general education is being abolished and medical subjects are taught even in the first year. On the other hand, since medical ethics is very important today,medical doctors must be trained in this field. In this unsettled situation, lecturers of general education subjects must also be fully dedicated to the purpose of their medical colleges and strive to improve their teaching methods accordingly. I explained the situation of general education in medical schools in Japan and the principle of our medical college.

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.12, pp.99-105, 1994-10-01 (Released:2018-02-01)

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Since the 19th century, the more that medicine has advanced, the more the distance between medicine and other specialties such as philosophy, ethics, and law has increased. When science and technology are subspecialized, the number of subspecialists with narrow views is very likely to increase. Medicine is not an exception. To narrow this distance between medicine and philosophy, ethics and law, many attempts and trials are in progress almost throughout the world, especially in advanced countries. Probably the most interesting among them is in the United States of America (USA). In the USA, with regard to clinical ethics and medicolegal problems, the development of a new srecialty or of a new job, independent both from patients and physicians, is in progress, and the number of new specialists has been increasing since the 1980s. One new specialty of this kind is called "ethics consultation", and its specialists are called "ethics consultants" or "clinical ethicists". An attempt toward in progress has been made in Hirosaki, Aomori Prefecture in Northern Japan, since 1991. An association named "Seminar Medicine and Community" was founded. The numbers was 300 in October, 1993. Of them, 174(58.0%) and 89(29.7%) consisted of physicians and comedical staff, respectively. The remaining 37(12.3%) are specialists in philosophy, ethics, law and so on. Meeting are held once every three months, for discussions on selected controversial topics and traditional basic problems relating to health care and medicine from interdisciplinary viewpoints. In addition we publish a journal (Journal of Health Care, Medicine and Community) every six months. Papers are published in Japanese with English abstracts. Papers either from inside or outside Japan by any author who does not belong to our association will be accepted if judged by the editorial board to be "distinguished"

著者

岡田 雅勝

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.12, pp.106-110, 1994-10-01 (Released:2018-02-01)

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In medical education,as in general education,it may be asked whether those subjects included in natural sciences, humanities,foreign languages and sports are really necessary. The essential task of philosophy is to think deeply about the most fundamental problems of our world and life, and to critically judge them. It is, therefore necessary to teach philosophy as part of medical education. However,in recent years, the presentation of philosophy to students has become far from simple. Younger generations are less inclined to think seriously and deeply about life and merely wish to spend their youth pleasantly. When considering such tendencies,teachers of philosophy, such as ourselves, must seriously reflect on what we do and how we can change our own attitudes about the role of philosophy in education. The points of my speech are as follows. 1) The aim in teaching philosophy is to cultivate, to nourish and to develop the intellect of students through lectures on philosophy. We should therefore lecture not only on Western Philosophy but also our own Japanese traditional spiritual culture. 2) Contemporary topics such as bioethics and medical technology should also be covered in philosophy. Knowledge of these topics will deepen student's understanding of what a human being is and will eventually help create the image of an ideal doctor. 3) We must attempt to provide students with the critical faculties to consider and judge, and live their own lives.

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.12, pp.111-117, 1994-10-01 (Released:2018-02-01)

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The distinction between general education classes and specialized classes has been discarded in the amendment of regulations for university curriculum (July 1,1991). As a result, universities can now draw up their own curricula. However, the amendment also stipulates that universities "must give specialized education to the students as well as to take appropriate measures to enhance broad knowledge and comprehensive ability to make decisions and to enrich the humanity of the students." Philosophy classes, as a part of the curriculum, should also be given at medical schools in line with the ministry's policy on curriculum compilation. Generally speaking, students take philosophy classes merely as one of the liberal arts classes (history of philosophy, introduction to philosophy etc.). The goal of the classes is to show students the various issues concerning philosophy. But it is also, if not more,important for medical students to acquire "broad knowledge" as is stipulated above: That is to say, to be familiar with the philosophical ways of thinking and to appreciate the world of philosophy, in itself, so that students develop the ability to see problems and to solve them on their own. Science, medical science included, has developed remarkably and has benefited people in many aspects. On the other hand,however, it has also over-defined and over-simplified the human existence to a point where science how endangers the very existence of human beings. We have become suspicious of the optimistic view that one day science and technology will solve all the contradictions of modern civilization. It is philosophy, based on liberal ideas, spirit and above all, human love that would enable people to evaluate modern civilization for what it is and to question the raison d'etre of human existence. I would like to discuss the role of philosophy taught in medical schools as an important part of general knowledge, and also to illustrate what the students might face in taking such classes.

著者

平山 正実

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.12, pp.118-124, 1994-10-01 (Released:2018-02-01)

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The paper discusses the image of an ideal physician, and also mentions how such physicians may be nurtured. Ideal physicians are expected not only to listen carefully to what patients and their family members have to tell them but to give them hope, to pray for them and to face them with integrity. Further, they need to have deep insight about themselves, know their own limitations well, and at the same time should be able to maintain reason and conscience in their approach to patients. The above has to do with ones' attitude as physicians, or a character question visa-vis their becoming ideal physicians. Naturally, any good physician must be one who is knowledgeable and equipped with good technical skills in the field concerned. In rearing ideal physicians, the following points need to be taken into account: 1) Physicians are expected to treasure even 'negative events' they have had in their own personal history such as their own experience of becoming sick, similar cases, including the deaths, of family members, the days of disappointment / frustration and to remember them as they face patients; 2) During their freshman and sophomore years at medical college, they should be exposed to opportunities of directly meeting the sick and the disabled; 3) It is recommended that they take part in rope playing featuring moot ethics committee, medical courts, and others.

著者

平野 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.12, pp.125-131, 1994-10-01 (Released:2018-02-01)

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Law school and medical school in the USA are what we call professional schools where graduate students work. These two professional schools have similarities in both their educational systems and problems. Generally speaking, undergraduate students in the USA study general education courses in colleges or universities and then select a major which is specialized but not professional. General education in the USA is rather different from "ippan kyoiku" in Japan. Students in Japan study "ippan kyoiku" without reference to their own Majous, less of them,so students have no motivation to accomplish it. they are not very interested in "ippan kyoiku", including philosophy. Philosophy education is now in crisis. We are facing the reformation of college education. Medical schools are not free from the changes. I propose that this Symposium should suggest a new model of the education of philosophy in the new curriculum of Medical schools in Japan. That suggestion should have some effects on the reformation going on.

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.12, pp.132-136, 1994-10-01 (Released:2018-02-01)

著者

勢川 瑠美子

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.11, pp.118-122, 1993-10-01 (Released:2018-02-01)

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今日に至るまでの看護は、時代の変化に伴い、社会が求めるニーズ並びに働く看護婦たちのニーズ等から多岐にわたり、その役割は拡大されてきました。平成3年に「看護の日」及び看護週間が認められ看護の本質や意味を国民的レベルで考えることが提唱され、看護の問題を国民一人一人の課題として考えようとするところに至ったことは、看護者の望むところではありますが、医療の中の検査、処置、薬剤や機器の高度化は看護婦の診療介助業務をますます増加し、患者のケアに十分な時間をとることが難しくなってきています。このような中で家族や患者の期待する看護ケアを提供するためには、共に働く医療チーム(特に医師)の協力は不可欠であります。これらに関わる現状と問題を具体的に挙げる中から「医療と看護」を再考していく機会にしたいと考えています。

著者

永田 勝太郎

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.11, pp.123-132, 1993-10-01 (Released:2018-02-01)

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The need of terminal care has been pointed out for a long time, but its practice has not come to be common in clinical work. This is mainly because of the lack of philosophy and methodology of terminal care. To practice terminal care it is indispensable to have a philosophy and methodology of comprehensive medicine based on whole person medicine (Balint, M.), which pursues the possibility of humanistic medical care. In the context of whole-person medicine, the bio-psycho-socio-existential medical model is the basic viewpoint to understand a patient. Furthermore, to perform comprehensive medicine, mutual respect between the current occidental medicine and the traditional oriental medicine with an interface with psychosomatic medicine is essential. Especially to care for a cancer pain patient, this viewpoint is indispensable. The core of psychosomatic medicine is Balint's medical interview, in which a patient is accepted, supported, and assured by a medical professional. In this interview, the medical professional works as a medicine (Balint, M.), that is to say, it is "therapeutic self (Watkins, J. G.). Logotherapy (Frankl, E. V.) is one method of the psychotherapy the main approach of which is to seek after a patient's meaning of life. "Life review interview" (Butler, R.) is one of the concrete methods of logotherapy. Through logotherapy, some cancer patients could gain awareness of their own meaning of life, then overcame cancer, and created their own new life. That is to say, they could live with cancer. The common attitude of such patients is "gentleness and toughness", through the experience of cancer. A nurse always takes care of a patient who is a human being with some disease. In the practice of nursing, a nurse meets many patients and observes many lives, which are living and dying. Nursing is one of the most humanistic occupations.

著者

杜 治政 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.11, pp.133-146, 1993-10-01 (Released:2018-02-01)

著者

欒 栄生 王 暁艶 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.11, pp.147-148, 1993-10-01 (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.12, pp.1-14, 1994-10-01 (Released:2018-02-01)

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How can we judge medical treatment ethically? We could do so from common ethics, if such ethics existed. But they do not. Therefore we must know first of all how medical treatment can be judged from various ethical viewpoints. In this report, the main ethical viewpoints concerning sex selection in reproduction are investigated. In addition, what kind of ethics are necessary for agreement on the subject are studied. What are the main ethical views? First, these must mediate between incompatible views of value supporting conventional ethical views. The main ethical views are based on fundamental values, or they are formalistic and have no material values. Secondly these views must also be have social reality. Namely these must be produced by our society and be supported by it too. Such views include the theory of natural rights, utilitarianism and personalism. These three views take different attitudes toward motives for sex selection in impregnation selecting acts and their effects. The reason why they cannot reach the same conclusion is that these views insist on different values from each other, though such values are fundamental. Therefore in order to reach the same conclusion we must agree about fundamental values, i. e. in order to obtain common ethics we must form the same view of value. But it is one of the most difficult tasks. Because one's value consciousness depends on one's own community, in order to form it we must integrate various communities of various people. Can we integrate them merely by communications about ethics?

著者

松川 俊夫

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.12, pp.15-27, 1994-10-01 (Released:2018-02-01)

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Why can we use animals for scientific experiments? Why can kill innocent animals to improve our life? Are human beings 'more equal' than the other animals? Those are very serious questions. The case for / against animal researches has many implications, which invite us to philosophical and ethical thinking. This paper examine these items. (1) Utilitarian and Kantian view on the moral status of animals. (2) Environmental ethics and bioethics on animal researches. (3) Reconsidering our system of rights and duties concerning animals. It is clear that the concept of 'person' plays an important role in the case for / against animal right. We must try to specify the reason why animals are not persons. One sort of 'speciesism' is proposed. This paper concludes as follows: to solve the difficult problems about experimented research animals, we must face the question of the ontology of life. Applied ethics always lead to metaphysics.

著者

森下 直貴

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.12, pp.48-61, 1994-10-01 (Released:2018-02-01)

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Recently, there has been vigorous discussion throughout Japan on the question of 'brain death and organ transplantation'. However, considering the process which shows various differences of how to think among people, must be pointed out an essential lack of reflection on the concept of 'Consensus'. This lack is natural as far as all other discussions on public affairs are concerned. This paper aims at determining the sense of 'Consensus' (the best one is a from of inventing some compromise through negotiation), at criticizing 'pluralism' (or Liberalism) that is a certain background for that sense, and as this result, at inquiring conditions under which the 'Social 'Consensus' could be formed. These conditions are as follows: (1) the logic of arguments (2) a value-right system supporting arguments or discussions (3) institutions forming discussions Furthermore, the above mentioned view is applied to the Japanese discussion on 'brain death and organ transplantation', and several desirable proposals about it are made.

著者

盛永 審一郎

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.11, pp.1-13, 1993-10-01 (Released:2018-02-01)

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Hans Jonas proposes "Future-oriented" ethics in his writings : "Das Prinzipi Verantwortung" and "Technik, Medin und Ethik". It is "a commensurate ethic of foresight and responsibility " and in this ethical theory the concept of "responsibility" is central. According to these ethics the categorical imperative is as follows: "Act so that the effects of your action are compatible with the permanence of genuine human life"; that is, act so that mankind may exist. Now I analyze these writings and intend to make clear the principle of these ethics. Firstly, I analyze why such an imperative is enjoined, in relation to a problem of modern technology. He insists that the nature of human action has changed with modern technology, and that ethics should change with its changed nature, since ethics is concerned with action. Secondly, I analyze his grounds for such an imperative. Wishing to found its rational ground, he takes a plunge into ontology and struggles to draw the ontological proof of the command: that Man should exist. The naked ontic fact of mankind's existence is the basis of a valid claim to being and "ought to be." Then, proceeding to its subjective and psychological ground, he finds the archetype of all responsibility in the parents of the child, for the parents are receptive to the child's appeal, which finds its response in their mind. It is the feeling of responsibility. As a result of these analyses three things are clear: (1) the concept of responsibility is not the empty and formal one of every agent being responsible for his acts but the substantive one which makes him responsible for the particular object that has a claim on his acting; (2) the ontology of responsibility is not that of eternity but of time, for every agent can be responsible only for the changeable and perishable; and (3) the ethics which may be erected on the principle of responsibility must not remain bound to anthropocentrism.

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.11, pp.14-25, 1993-10-01 (Released:2018-02-01)

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In the follow reflection, I try to discuss about the essential being of life and to examine the philosophical-biological thoughts of Hans Jonas. According to Jonas, organic identity, which can be observed by the fact of metabolic regeneration, must be different from the physical identity of matter. He adopted the idea of freedom in order to clarify ontologically the phenomena of life. During the course of its life, an organism remains the same, while continually changing its material constituents. Therefore the identity of the form of a living thing is free from the physical identity of matter. Further, it is not the identity of a mere form, but of a self-constituting agent who realizes this living form of itself. We obtain this understanding of life from the experience of our body. The body is the only affair within the entire res extensa which reveals a sort of intimacy. The major problem of philosophical biology must be life, centered in the problematic existence of the living body. But the fundamental freedom of the organism, as realized in metabolic activity, is of a dialectical character, for, to realize itself and to continue itself, the living form needs material constituents and their constant refurbishment. It is a "needful freedom". The independence from the material universe indicates likewise a certain dependence on that universe. Life must die. Understood so, the unity or the bi-unity, as Jonas says, between subject and object, self and its world or freedom and necessity, remains a still unsolved problem. Neither mere partial monism nor dualism can hope to solve it. We need an new, integral monism, which must seek to absorb the radical polarity into a higher unity of existence. Viktor von Weizsacker asserted that the meaning of life is not its continuing to exist, but sacrifice. The fact of sexuality reveals this. Individuals and species die for others and live. The environment is nothing but the whole which lets living things live for and with others.