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.11, pp.26-35, 1993-10-01 (Released:2018-02-01)

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In the United States, the number of organ transplant cases has been rapidly increasing over the past fifteen years. Consequently, there has been a shortage of organs available for transplant operations so various measures have been sought to promote organ donations. For instance, many states have adopted a system where the reverse side of the driver's license functions as a donor card. The license holder along with two witnesses sign the consent making it possible for the license holder to donate his or her organs. Despite such schemes, however,the supply of organs has not met demands. As a result, there were instances where money changed hands to secure organs. Considered unethical, organ sales where eventually banned by law. In The United States, it is considered a moral and worthy act to voluntarily donate one's organs for science. A noticeable contrast to this can be found in Europe where organ donations are done on a contract basis. This reflects cultural-anthropological differences between the U. S. and Europe. In the case of Japan, people have great apprehensions about taking organs from the dead. This is due partly to a cultural background based on Confucianism; and partly to the on-going debate on defining what exactly constitutes "brain death". In addition, the act of giving in Japan has always had the element of mutual exchange; unilateral gift-giving without any form of reciprocation is unthinkable-which makes securing organs for transplant operations much more difficult. Japanese doctors, therefore, are required to call upon the people to donate organs as a gesture of good will. With these differing concepts of gift-giving in mind, taking the example of organ donations, I would like to discuss from a philosophical stand point what it means "to provide"or "to give" to someone. I also intend to expand my discussion to include western notions of "a gift" as a concept compatible with the idea of "charity" and "solidarity". Comparing these with the Buddhist concept of "dana", I would like to discuss "compassion", "bodhisativa-yana" (the way in which to attain enlightment), "dana-paramita" (discipline in training how to impart sacred doctorines to others), "atoma-paritoyaga" (the throwing away of the ego), "the field of good fortune", "repaying kindness" and "veneration". (Incidently, the English word donate stems from the Sanskrit dana.) By comparing these concepts, I would like to discuss methods of giving, the attitudes of those who accept and furthermore, the "things" that are givable and acceptable. By doing so, I hope that I shall be able to clarify the differences between the west and Japan regarding the notion of organ donations.

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.11, pp.48-60, 1993-10-01 (Released:2018-02-01)

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Many people now pay attention to the concepts of IC and autonomy of patients in health care. Nurses also begin to notice that it is necessary to change the traditional way of decision making in nursing care. Especially many American nurses believe that ethical decision making for nursing care must be led by patients' autonomy, because patient autonomy is the most important principle in bioethics. It is also related to human dignity. The concrete way of ethical decision making in nursing care is presented by the book; <Bioethical Decision Making for Nurses> by Thompson, J. E. and H. O.. They present the 10 steps to bioethical decisions. Step One : Review the situation Step Two : Gather additional information Step Three : Identify the ethical issues Step Four : Identify personal and professional values Step Five : Identify the values of key individuals Step Six : Identify the value conflicts, if any Step Seven : Determine who should decide Step Eight : Identify the range of actions and anticipated outcomes Step Nine : Decide on a course of action and carry it out Step Ten : Evaluate the results In this paper I explain this model theory concretely through some Japanese clinical cases. I believe that we can make an ideal method of carrying out bioethical nursing care by reviewing today's problem of decision-making in nursing care.

著者

信楽 峻麿

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.68-82, 1993-10-01 (Released:2018-02-01)

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It seems that there are two pairs of standpoints from which people observe the issues of life today. The first one is to grasp life as a matter of either quantity or quality. The second one is to consider the issues of life based on either the human-centered view or the nature-centered view. One of the views which grasps life as a matter of quantity is the biological view of life. It recognizes the value in the length and strength of life. Today's medical technique which puts supreme value on the prolongation of human life can be placed in this category. On the other hand, one of the views which see life as a matter of quality is the person-centered view of life. It recognizes the value and the dignity of life in its degree of maturity. This view, seeks the way in which human beings enrich and mature their lives. Traditional religions and ethics basically take this position. Today, these two standpoints come into keen confrontation with each other, as modern medical techniques make rapid progress. For example, today's medical technique makes it possible to control life itself. However, here a new and controversial problem comes out; that is, whether or not the prolongation of life takes precedence over the dignity of human life. In other words, this confrontation requires us to establish a new bioethics. As to the human-centered and the nature-centered views, the former basically sees a distinctive difference between the life of other creatures and that of human beings. In obedience to human desire, it aims at conquering and ruling nature. Today's scientific technology can be placed in this category. On the other hand, the nature-centered view sees the equality of all lives, for all lives equally possess sanctity. Furthermore, this view recognizes the mutual dependence of all lives, including animals and plants. The Buddhist view of life can be placed in this category. 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

武内 敦郎

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.83-91, 1993-10-01 (Released:2018-02-01)

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From ancient times, medical care was only symptomatic therapy. The postmortem dissection of the human body had been inhibited as an immoral action for a long period. Even Hippocrates, who opposed the scientific method on the observation and the treatment of the patients, made some errors in his medical hypothesis because of lack of knowledge about the anatomy and physiology of the human body. Since the Renaissance, the advancement of medicine was remarkable according to the discoveries and progress of natural sciences. As an example, the postmortem dissection of the human body was allowed and revealed the structure and functional mechanism of human beings. It brought a lot of knowledge concerning the cause of the diseases. Subsequently radical therapy and preventive procedure for many diseases were established during recent two centuries. According to the recent remarkable progress of chemistry and physics, diagnostic tools became more accurate and easy to use. Even the heart can be transplanted from a case of brain death, into a patient whose heart is severely ill, if the social conditions allow. However, these striking advances of medical procedures sometimes lead the patients to a mentally confused condition, such as the rejective mental reaction against the pure scientific and too unemotional behavior of medical staff. In order to prevent these unfavorable mental reactions of patients, all medical and associated staff should realize the importance of the mental care of patients.

著者

青木 茂

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.92-103, 1993-10-01 (Released:2018-02-01)

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The report deals with a theoretical connection between nursing ethics in the clinical setting and the bioethical ground underlying them. Special attention is given to the concept of "informed consent", which is often discussed in relation to bioethics. Clinical medicine today is now shifting its emphasis, previously placed on medical cure, to nursing care. One of the reasons for this change, in my opinion, is that advanced techniques in medical treatments having now reached a stage where many incurable diseases have actually proved curable, only truly incurable ones, such as chronic diseases of the aged, remain with us and they certainly require much more nursing care than medical cure. It is, therefore, undeniable that the importance of nursing care in clinical practice is now greater than ever. Achieving a higher level and quality of nursing service for patients is inseparable from both developing nursing skills and improving nursing ethics. In order to realize the latter purpose, nursing care ought to be designed to meet the needs of patients. Patients, on the other hand, decide themselves what they need: to help them have the power of "self-determination", they are entitled to obtain any information necessary for them to decide what they really need. The traditional idea of "patient-centered nursing", consequently, should be changed to the concept of "informed consent". So as to make this concept work efficiently in the clinic, relationships between patients and medical staff are expected to improve. This report is an attempt to elucidate these problems which arise at the crossroad of nursing ethics and bioethics under the following five sections: (1) Beginning of bioethics, (2) The concept of "informed consent", (3) A criticism of paternalism, (4) On the idea of "quality of life", (5) Establishing a back-up system in nursing.

著者

池邊 義教

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.104-113, 1993-10-01 (Released:2018-02-01)

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I. Care as the core of healing [figure] 1. The philosophical foundation of care - human integrity of soul and body - 2. The essence of care -sympathy and compassion- II. Medicine for life and death 1. Care and cure - Care looking on the human body as a vessel of sickness - Cure looking on the human body as a substance of disease 2. The unification of primary care and terminal care - every care situation is potentially terminal care - - every care situation is actually primary care - III. The visual point of bioethics 1. Responsibility to others - on response to the sick - inhumanity of reproductive medicine and transplantation medicine - 2. Healing as human activity - absence of death-ethics - - how to live depends on how to die - - difference of the medical death and the departure from this life - IV. Healing for the Sick 1. Care on the self-supporting ability - vis medicatrix naturae, vis moriendi naturae - 2. Care as art - care to support and to comfort the sick - - indispensability of caring documents based on life review therapy - I (the sick) am unable to carry the burden without your support. The doctor cures sometimes, relieves often, but comforts always.

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.11, pp.114-117, 1993-10-01 (Released:2018-02-01)

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Three main ethical issues were introduced and discussed. They were: 1. "Unethicalities" latent in medical practice and nursing-Things not generally permitted in society are from time to time permitted in the world of medical practice and nursing. Things which are vilified or proscribed as unethical acts in the rest of society are permitted in the name of " care and cure", and if one were to list them they would appear as follows. (1) Secrets of others cannot help but be learned. Facts which the patient and his/her family would like to keep secret must be clearly written down, preserved in records, and reported upon. (2) The bodies of others are touched and observed. (3) Necessity compels injuries to the skin, veins, and organs of others. (4) The cells/tissues and body fluids of others must be collected and examined. (5) Substances and energies which humans normally do neither ingest nor are exposed to must be imparted to the bodies of others for the purpose of diagnosis and treatment (6) Foreign objects such as suture materials and medico-chemicals are left within the human body. (7) Experimental acts must be performed not only on animals but also occasionally on humans. 2. Minimum ethical requirements in nursing and care 3. Ethical dilemmas in nursing and care with special reference to the future of the nurse-client relationship, nurse-nurse relationship and nurse-physician relationship.

著者

桜井 弘木

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.10, pp.112-121, 1992-10-23 (Released:2018-02-01)

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This paper is developed from the symposium, "The New Image of Pharmacists in Medical Practice" held at the last study meeting of this association. Experience is a human behavior in the interaction between man and world (man is a part of the world), so that it has in all cases the interactive structure of knowledge (self-conscious and objective) and act, and also the nature of motion between the mover (agent) and the moved (patient). The meaning of this motion includes growing and changing. Invention is a creative modification of the world (man) by discovery of the nature of the world (man). At all times, medical practice is an experimental and inventive treatment of man by medical practitioners (agents-physicians, pharmacists, nurses, and so on) for man as patient. The experimental knowledge and act are case by case always imperfect, and the inventive (creative) treatment of man for man carries in itself responsibility, that is to say ethics. The medical practitioners must each and all be specialists who recognize correctly such essences of medical practice. Their teamwork in medical practice will be realized only by mutual understanding of these essences, and in addition, in the future, teamwork will become increasingly necessary. So, from now on, pharmacists must be required especially to be more active, more self-conscious, and more responsible for their own share of medical practice.

著者

太田 富雄

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.10, pp.122-131, 1992-10-23 (Released:2018-02-01)

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At the beginning, I would like to express my opposition to the Ad Hoc Committee on Brain Death and Organ Transplantaion in Japan. Although I have treated many brain dead patients as a neurosurgeon, my conclusion seems not to be derived from scientific knowledge, but from an unexplainable but perhaps natural reaction to Japanese culture. I know very well as a scientist that brain dead patients are all but dead as a human beings. However, they are usually not dying alone, but have their deeply sorrowful family members around them. Their psychological states can never be relieved or be replaced by "humanism" in such moments. Rather, I would like to let them die in dignity, withholding further active treatments, acting instead as the representative of God or as a priest at the farewell ceremony between the dying patient and the family members and close friends. I would also like to avoid organ transplantations. The reason is that I think there is a severe shortage of donors in Japan, unlike in the United States or the European countries. The health care system in our country is so complete that every patient who wants and has a reasonable indication of the need for transplantation has the right to be so treated. It would be chaos in Japan, much more severe than in any other country, if patients realized that transplantation works very well and they were in competition for donors.

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.10, pp.132-134, 1992-10-23 (Released:2018-02-01)

著者

佐藤 純一

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.10, pp.136-142, 1992-10-23 (Released:2018-02-01)

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"Doing Better and Feeling Worse." This phrase is the title of a book which criticized modern American medicine in the nineteen-seventies, and it means that the better the medical personnel do, the worse the patients feel. Now in Japan, many people, not only patients and laymen but also medical personnel, may be discontented with modern medicine in the same way. This paper was prepared for discussion in the symposium titled "Concerning the Humanism of a Medical Environment in Transition". It emphasizes the importance of the socio-cultural viewpoint in inquiring into medicine, for medicine is a socio-cultural system and ideology. Using the key concept "medical pluralism", this pape tries to describe the diversity of patients' (laymen's) concepts of disease, the variety of their illness-behaviors, and the relativity of patients (laymen) and medical systems.

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.10, pp.143-150, 1992-10-23 (Released:2018-02-01)

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The technical improvements in medication in the late twentieth century have caused a great change in the relationship between medical specialists and patients. Medical specialists tend to treat a patient as a pure object of technology; they tend to take into account only information as to the patient's physical conditions, which is derived from high-tech medical tests. But it must be noted that many diseases such as adult diseases cannot be cured by technological means only. In those cases, medical specialists have to care not only for the patient's body, but also for the patient's psychological conditions, social relations, and so on. In the field of "ultramodern medication", medical specialists intervene directly in the life and death of the human being by using the technologies of reproductive-medicine and those of transplantation-medicine. Such interventions are ethical, I think, only on the conditions that 1) patients are well informed about those treatments and they themselves want them voluntarily, and 2) there is a social agreement on utilizing those treatments.

著者

ロス ジュディス・ウィルソン 松岡 悦子

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.10, pp.151-165, 1992-10-23 (Released:2018-02-01)

著者

エンゲルハート H.トリストラム 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.10, pp.166-186, 1992-10-23 (Released:2018-02-01)

著者

三輪 亮寿

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.9, pp.126-140, 1991-07-31 (Released:2018-02-01)

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Legal cases in the field of pharmaceutical affairs were analyzed and discussed on legal as well as ethical grounds to understand the identity and the raison-d'etre of the "pharmaceutical sciences provided by the college of pharmacy or the pharmaceutical faculty of the university", which should be called the "pharmaceutical sciences" proper. The results of this study indicated that 1) All of the legal topics arose from the "Separation between the law and the actual conditions", 2) The society and the law demanded "something" on the "pharmaceutical sciences" proper, and 3) This "something" differentiated the "pharmaceutical sciences" proper from the ordinary pharmaceutical sciences provided by the other colleges or faculties of the university. This "something" is not manifested in any tangible form or visible acts, but its essence can be defined as the deep and true recognition of "the dignity of human life". This concept can be called ethical, and it identifies the nature of the "pharmaceutical sciences" proper. The nature of pharmaceutical products can also be said to be ethical because of its close interrelationship with human life and health. Therefore, the nature of "pharmaceutical sciences" proper wholly dealing with pharmaceutical products should be "ethical". The raison-d' etre of the "pharmaceutical sciences" proper should be to create, produce and control pharmaceutical products using its own knowledge and skills based on sincere ethical considerations which can only be provided by the college of pharmacy or the pharmaceutical faculty of the university, and this is not comparable to the functions of other colleges or faculties.

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.9, pp.141-144, 1991-07-31 (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.9, pp.145-147, 1991-07-31 (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.10, pp.12-24, 1992-10-23 (Released:2018-02-01)

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In the discussion on informed consent, we find some doctors may think they should not give patients some information, even if the patients think it indispensable. And vice versa. This results from moral gaps. Therefore, informed consent needs to bridge moral gaps. L. Kohlberg points out gaps among developmental stages as well as among ideas about values. He suggests bridging the former by making the latter comprehensible to all concerned. However, doesn't the person on the higher moral stage think the lower inmoral? No, according to Kohlberg, because the higher moral stage includes the lower stages as reintegrated components. But K. Wilber criticizes Kohlberg saying that the higher moral stage doesn't include the lower, unlike the higher cognitive stage. Which is right? In order to answer this question, I investigated the relation among stages and sent out questionnaires. Theoretically speaking, the higher moral stage doesn't include the lower stages, because unlike cognitive stages, moral stages don't have only cognitive structures, but also content formed by the structures, namely, the meaning of roles as human relations. The higher moral stage includes the lower cognitive structures, but no lower social meanings. Thus the morally higher person won't discuss things on the lower stage. Therefore, to bridge these moral gaps is possible only by raising the lower people up to the higher stages. And the higher stage 5 is easy to reach for adults, because they have already reached the cognitive stage necessary to reach moral stage 5. Furthermore this stage itself enables moral development by promoting role-playing, another antecedent of moral development. And my questionnaires also show that stage 5 can bridge moral gaps. Thus the discussion for informed consent must be based on moral stage 5. Concretely speaking, hospitals should offer not only doctors but also patients as many chances to participate in their everyday decisions as possible.

著者

森 忠重

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.10, pp.25-45, 1992-10-23 (Released:2018-02-01)

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The role of personalized treatment has always posed problems in considerations of Japanese medical history. Japanese medical treatments in medieval times were inextricably related to Buddhistic and ethnologic factors, just as European medical treatments were to Christian factors. To be more exact, Japanese medicine was almost totally influenced by Buddhism. The problems, however, exist in determining why medical treatments became Buddhistic or ethnologic, and how they became personalized. Wherever ideological paradigms were corrupted, naturalistic medical treatment would supplant the then existing personalized treatments. In this thesis, such replacement processes are traced back and considered in terms of the exorcisms and maledictions performed in esoteric Buddhism, relief measures taken for leprous patients, clinical examinations of the death of human beings, and in sensitivity to death in literary and religious terms.

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.10, pp.46-56, 1992-10-23 (Released:2018-02-01)

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The aim of this paper is to look for the ways the medicine of today might take root in the fundamentals of life, that is, in terms of environmental ethics. Highly technological medicine should be grounded in such fundamentals if it wants to be medicine for human beings. But in order to reach this goal we must consider the ambiguity that is intrinsic in bioethics. On the one hand, the historical current of ethics, according to R. F. Nash, is irreversibly expanding, taking the relevance of ethics out of itself and beyond its egocentric viewpoint. Bioethics should be also placed in this stream, so as to admit the rights of nonhuman beings. On the other hand, applications of high medical technologies cause us to restrict the boundaries of our humanity, and this brings about various difficult problems for bioethics. We should attempt to get over these difficulties by proposing a new medical system based on a self-organizing system. It must be open to all other social systems and would make possible the fundamental communication between the self and the other. To realize this system, I think, it is necessary to establish a new ontology that requires us to transcend anthropocentric ethics and to discover the continuity between nature and humanity.