著者

大橋 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.29, pp.4-14, 2011-09-30 (Released:2018-02-01)

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Advances in the field of genetics have enabled the diagnosis of many genetic diseases, which has led to the benefits of prevention, early detection and treatment in some of them. Nevertheless many are neither preventable nor curable yet, even though we can diagnose them. Moreover, discrimination against patients with genetic diseases and their blood relatives exists. Therefore, a person tested who was diagnose with a genetic disease is sometimes determined to keep the test result from not only his/her employer and insurance company, but also his/her relatives (spouse and blood relatives). However, for blood relatives who are at the same genetic risk, knowing the result may be desirable from the viewpoint of prevention, detection, and treatment in the early stage, when the disease is preventable or curable. In this situation, two conflicting rights, namely, the right to privacy of the tested person and the right of blood relatives to know may be asserted. Although health care providers are responsible for the confidentiality of patient information, they may plan to inform blood relatives of their genetic risk for the sake of the above-mentioned benefits. This paper deals with the subject of how the conflict of interest between the tested person and his/her relatives should be regulated, and what actions health care providers should take. Blood relatives and the tested person share some common genetic information. I think that the genetic information of the tested person can be considered as that of blood relatives themselves under specified strict conditions because of their partial genetic identity. Then access to the genetic information of the tested person can be legally protected as the exercising of the self information control right of blood relatives.

著者

福田 八寿絵

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.29, pp.35-43, 2011-09-30 (Released:2018-02-01)

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The great majority of people rely on media reports for health and medical knowledge. However, medical news reports sometimes present extremely biased views. For example, an alliance of pharmaceutical companies sometimes targets the news media to create fear about disease or bring attention to new treatment. Recently, web-based audits designed to improve the quality of medical news reports have been set up in Australia and Canada, under the name "Media Doctor" and a similar system known as a Health News Review has been started in the U.S. In this paper, firstly we will examine the background to the setting up of the evaluation projects on medical news reports. Secondly we will also attempt to clarify the nature of the current Media Doctor review. Thirdly, we will examine the regulation on direct to consumer advertising of prescription drugs in Canada, Australia, and the United States. Finally, the role of online-based evaluation systems will be considered. They provide objective analysis of health news and the results produce feedback for journalists, General Practitioners and Health Consumers. The projects are intended to contribute to the education of journalists and to bring about better collaboration between the medical profession and journalists, in order to improve the quality of health news.

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.29, pp.44-52, 2011-09-30 (Released:2018-02-01)

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Due to ever-pervasive gene studies and researches and the wide use of biobanks, the introduction of general consent is an urgent issue for promoting medical researches. However, in light of the conditions of IC, general consent is seen as an unorthodox or problematic consent form. This paper discusses the standards and forms that are required in order to respect the self-determination and protect the personal information of a subject(patient), and thereby presents a plausible argument for "a two-part consent process". Furthermore, this paper shows, using the Havasupai Case that some serious problems can be caused by communication gaps. To give general consent a definite form, it is not sufficient to take the consent's formal conditions into consideration; it is necessary to consider the role of medical coordinators. The stress is upon the need to create a common understanding and perception of the framework of medical studies shared by a subject(patient) and medical staff.

著者

吉武 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.29, pp.63-72, 2011-09-30 (Released:2018-02-01)

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In consensus building process in medicine, it is crucial for its participants to understand why each of the stakeholders has his/her opinion. The aim of this paper is to develop the notion of "reason of opinion" and to propose the idea of "history of reason" to understand what a satisfactory consensus is in conflict resolution in medicine. The notion and the idea contain four factors, that is, 1) when one started to form the reason of an opinion, 2) how one formed the reason, 3) what the relationship between the present opinion and its reason is, and 4) what kind of result is supposed to come out after the decision. Knowing the stakeholder's history of reason makes it possible 1) for stakeholders to understand more deeply the patient's needs and to find the better solution for the situation, 2) for the patient to become aware of his/her own sense of value and to confirm what he/she expects after the decision, 3) for all the stakeholders to decrease the risk of misunderstanding and to share their expectations, 4) and for them to find the way to the final solution. This new approach, which includes the notions of the history of reason and the expectation in stakeholders, leads to the way to integrate both the evidence based medicine and the narrative based medicine.

著者

守屋 治代

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.28, pp.73-82, 2010-09-24 (Released:2018-02-01)

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In this paper, I aim to clarify three views of the body from three characteristic nursing theories on the holistic paradigm. They are C. Roy's adaptation nursing model, which depends on behavioral science, P. Benner's nursing theory, which depends on phenomenology and J. Watson's nursing theory, which depends on transpersonal theory. 1. "A body as a behavioral system" by C. Roy: This type of body is treated as an object operated by another. The body of the nurse does not interchange with the patient's body directly so it will miss something in sharing with the patient. 2. "A lived body" by P. Benner: This type of body is lived with the other person. The body of the nurse is called by the patient's body and encounters it there. 3. "A transpersonal body" by J. Watson: This type of body is an energy field, and appears in multi-dimensions; body, mind and spirit. The body of the nurse resonances with the patient's deep energy field without words. We can find these "bodies" working together in practice scenarios. The nurses need to be careful to recognize their own view of the body.

著者

横尾 美智代 早島 理

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.28, pp.83-92, 2010-09-24 (Released:2018-02-01)

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The purpose of this research was to examine whether the bioethics of medical students changed after receiving medical science lectures. The same questionnaire survey was conducted in the 1st year, 4th year and 6th year for new medical students in 2002-2003, and their replies were analyzed. As a result, the same trends were seen in all 3 surveys as regards "progress in medicine," "progress in genetic research," and "the use of genetic diagnostic tools for intractable nervous diseases with no cure." On the other hand, as to the question "would you willingly donate a sample to genetic research if asked?" the number who gave a positive response increased with increasing years of study (P < 0.001). This suggests that although students' perception of their own problems did change, their perception of problems related to society as a whole stayed the same from the time of their admission as new students right up to sixth grader.

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.28, pp.93-97, 2010-09-24 (Released:2018-02-01)

著者

宮下 浩明 西村 ユミ

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.28, pp.98-99, 2010-09-24 (Released:2018-02-01)

著者

吉田 みつ子

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.28, pp.100-102, 2010-09-24 (Released:2018-02-01)

著者

五十子 敬子

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.28, pp.103-108, 2010-09-24 (Released:2018-02-01)

著者

板井 孝壱郎

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.28, pp.109-113, 2010-09-24 (Released:2018-02-01)

著者

岩崎 大

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.28, pp.10-18, 2010-09-24 (Released:2018-02-01)

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In the recent trend toward patient's rights, a patient-centered approach has replaced paternalism as a professional-patient relationship. Medical staff organize a care construction based on four moral principles, namely respect for autonomy, beneficence, non-malfeasance, and justice. In particular for terminal care, patients who face their own death exhibit philosophical and religious anxiety. In medical care, this feeling is called spiritual pain. It is an existential, holistic issue that occurs in medical care. Existential philosophers claim that death limits human life though fear and anxiety. But the act of facing death can help human's find subjective truth in their lives. Jaspers thought that to find subjective truth we need existential communication in which there is no restriction and restraint. Existential communication that has a human-human relationship can be a construct of spiritual care and an aid in leading life on an individual basis.

著者

加藤 穣

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.28, pp.29-37, 2010-09-24 (Released:2018-02-01)

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In several areas in the world, including New York State and the State of New Jersey, one can virtually be diagnosed dead based on cardiac death criteria even if brain death occurs. In New York and New Jersey, such exemption from brain death determination is often a consequence of the accommodation of religious and moral objection to neurological death criteria. This paper aims to shed some light on the implications and problems of conscientious objection to the determination of death based on brain death. In the first place, the paper describes the background that led to the enactment of such objections in New York and New Jersey, including the initiative by some religious group. Then, the efficacy of the frequentlymentioned parallelism between conscientious objection to brain death and military service is called into question. After distinguishing between the positive and negative effects of conscientious objection to brain death, the paper argues that conscientious objection to brain death differs from objection to conventional conscription understood as a strong obligation in that the "object" of the objection is not obligation but the default death definition or the alleged singularity of human death, considering that the New York guidelines, for example, prescribe no obligation for patients or their families. In so doing, the paper questions the understanding that the essence of accommodation of conscientious objection to brain death is sincerity in limiting the free choice or self-determination in death declaration. The possible ramifications of the above conscience clause are also discussed.

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.28, pp.49-57, 2010-09-24 (Released:2018-02-01)

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Clinical ethics is enterprises to elucidate what may or may not be done in concrete clinical settings. It differs from normative or prescriptive medical ethics, as one of sub-divisions of applied ethics, which tries to establish and underpin the supreme but abstract principles applicable to medical cases. Whereas normative medical ethics chiefly concerns principles, clinical ethics does this or that particular case, if real or fictitious. Case study is the lifeblood of clinical ethics. The simpler the case at hand is, the easier we can apply any given principle to the case. A good thick case, however, is not as simple as so-called principlists might hope. To enrich clinical ethics, and to avoid reducing clinical ethics to normative medical ethics which often deals with thin cases just as exemplification of mechanical application of authorized principles, we should inquire into the fundamental features of clinical ethics and the nature of thick cases. As long as we pay attention to the fact that describing and reading a case inevitably require imagination and interpretation, each clinical ethics case is identified with a literary text. Actually what has focused on how we can legitimate our interpretation on a text is hermeneutics. A philosopher referred to a tradition or a culture as a horizon which makes it possible to interpret and understand a cultural work. But we should recognize that what to be read in clinical ethics are individual texts embedded within certain peculiar contexts rather than monumental works in capital letters. Then this article argues that the disciplinary model of clinical ethics is not ethics in general but literature.

著者

宮坂 道夫

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.28, pp.58-65, 2010-09-24 (Released:2018-02-01)

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This paper analyzes how discourse ethics and narrative ethics contribute to resolve ethical questions in the context of clinical ethics. Jonsen et al. present a practical approach to ethics case analysis in medicine. Their approach has universal value, but at the same time has some defaults: culture-specific aspect to USA, lacking perspectives of time/process, prospective guide, and communicational aspects. Habermas' discourse ethics supplies some of the deficiencies, but will hardly handle cases in which (A) the patient is lacking competence to participate in the discourse, and, (B) the patient has the ability to participate in the discourse, but at an insufficient level to perform fully rational discussion. Narrative ethics, on the other hand will sophisticate clinical ethics by supplying norms such as "Take into account the process of formation of individual's values and that of norms in a group of people," and "Compare cases and stories." It will enable clinical ethics to handle the case of patients lacking the ability to make rational discussion. Although incompetent patients cannot be handled with that meta-ethical sophistication, the question can be reset as follows: "Can we determine the story of an incompetent agent via discourse in which the agent does not participate?" By resetting this way, narrative ethics may open new horizons to consider this sort of question in the light of normative argument.

著者

宮嶋 俊一

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.28, pp.66-72, 2010-09-24 (Released:2018-02-01)

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Although modern bioethics, as a scientific discipline, was originally seen as secular rather than religious, some aspects of bioethics have developed a religious propensity over the past few years. Yasunori Ando, a Japanese religious philosopher and Masaru Ikezawa, a Japanese religious scientist, in analyzing the relationship between bioethics and religion concluded that the two are actually closely connected. Within bioethics, there is one approach that aims to generate consensus about bioethical issues when inquiring into the fundamental nature or essence of matters. The latter sometimes overlaps with religious thinking and concepts. Even though religious rights should always be defended in the public arena, religious reasons or reasoning alone cannot guarantee the validity of any assertion. Thus the dialogical bioethical aspect has an important role to play here as the interface between the two approaches can lead to fresh, new development.

著者

串 信考

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.27, pp.89-93, 2009-10-01 (Released:2018-02-01)

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In Japan, 4 children were born by posthumous reproduction from 2001 to 2004 (1 in Shikoku, 1 in Tokyo, 1 in Osaka, and 1 in Nagano). In the case in Shikoku, the Supreme Court denied the legal child-parent relationship between the child whom the wife bore using her dead husband's frozen sperm and the deceased husband. Japan does not have a law that specifies posthumous reproduction, and the Supreme Court used this lack of existing legislation to deny the child-parent relationship. I am opposed to the judgment of the Supreme Court. Posthumous reproduction should be admitted under certain conditions. Firstly, before the man dies, he has to agree to posthumous reproduction. Secondly, the man has to freeze his sperm based on his own free will. The example of Shikoku fulfills the two conditions. About 60% of the general public approve of posthumous reproduction in Japan. However, there are many dissenting opinions among obstetricians such as the Japan Society of Obstetrics and Gynecology. Japanese society has strong views about the family, which may relate to its general approval of posthumous reproduction. It may become the pressure which has it forced that a woman bears a child. I am opposed to the pressure. However, if the pressure on a woman bearing a child is refused and she wishes to perform posthumous reproduction based on her own free will, I will respect her decision.

著者

虫明 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.27, pp.94-98, 2009-10-01 (Released:2018-02-01)

著者

今井 道夫 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.27, pp.99-101, 2009-10-01 (Released:2018-02-01)

著者

原島 秀吉

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.27, pp.102-105, 2009-10-01 (Released:2018-02-01)