著者

土屋 貴志

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.106-111, 2009-10-01 (Released:2018-02-01)

著者

川村 和美

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.27, pp.117-122, 2009-10-01 (Released:2018-02-01)

著者

杉岡 良彦

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.27, pp.13-22, 2009-10-01 (Released:2018-02-01)

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What is integrative medicine? Integrative medicine refers to the integration of modern western medicine, traditional medicine, and complementary and alternative medicine. The definition of integrative medicine states that it takes into account the whole person (body, mind, and spirit). However, the meaning of the concepts of "integration" and "spirit" is not very clear. This paper aims to clarify these concepts and introduce dimensional anthropology. Dimensional anthropology was advocated by V.E. Frankl. He regards the human being as "a somaticmental (or psychic)-spiritual oneness and wholeness." In addition, he emphasizes that only the spiritual core warrants and constitutes oneness and wholeness. He called this view of the person dimensional anthropology. Human beings are free and responsible. Frankl refutes scientific determinism or scientism because these positions neglect freedom and responsibility of human beings. Determinism or scientism is one form of nihilism. An awareness of the spiritual dimension helps us identify the "existential vacuum." It indicates the condition wherein people suffer from a sense of meaninglessness and emptiness. Logotherapy helps a person to discover the meaning of life and, as a result, the existential vacuum can be overcome. Naikan therapy may also treat the existential vacuum. The introduction of dimensional anthropology to integrative medicine enables us to arrange the types of medicine not according to their principles or methods, but according to the dimension of the person who is using these medicines. Moreover, without dimensional anthropology, integrative medicine may help nihilism prevail in medicine, for the scope of integrative medicine is so broad and it will deal with not only cure but also prevention and health promotion with western, traditional, and complementary and alternative methods. I believe that the introduction of dimensional anthropology is indispensable for integrative medicine, and we must continue to establish a better view of the person in medicine.

著者

小出 泰士

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.27, pp.33-40, 2009-10-01 (Released:2018-02-01)

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As technology advances, a wider range of applications is being found for human body parts. For ethical reasons, it is urgent that we protect human beings from being harmed by these new technologies. However, in today's liberal society, based on respect for autonomy, one may be permitted to dispose freely of one's own body if one does no harm to others, or make use of human beings who are not autonomous in order to treat other patients. It is: (1) one's own body, (2) parts and products of a human body, (3) an embryo, fetus and dead body, that are protected by human dignity, not by respect for autonomy. In order to protect human beings from being harmed by the new technologies, we need a word equivalent to 'human dignity.' Thus by examining the effectiveness of the principle of human dignity in society, we will clarify the real intention of the French ideas on bioethics, which consider human dignity a fundamental spirit.

著者

屋良 朝彦

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.27, pp.41-51, 2009-10-01 (Released:2018-02-01)

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Serious accidents can be caused by inadvertent action. In particular, there are various unexpected but hazardous risks connected with medical treatment. In fact, some medical treatments have resulted in grave consequences. One typical example of this is the HIV crisis that occurred in the Japanese blood supply system. The government, doctors, nurses, other healthcare professionals and especially patients and their families were confronted with difficult decision-making against uncertain risks. The question is how to deal with unexpected and uncertain risks. The "precautionary principle" was introduced to cope with such difficulties. However, the precautionary principle is considered to be imprecise and vague when we try to apply it to real-life cases. Decision-making models are required. Healthcare professionals must work in collaboration with other healthcare professionals in multidisciplinary care teams. They must discuss cases with each other and make cooperative decisions. In the past, the doctor has often been assumed to be the most appropriate person to make the decisions. This is not so widely accepted today. Therefore we need a new model for collaborative decision-making. The aim of this article is to provide multidisciplinary care teams with a practical model for collaborative decision-making against uncertain and unexpected risks. The focus is on the process of decision-making. A paradigm case -HIV case- is presented to show how to apply the model to real-life cases. The question of the case is what kind of decision-making is possible for doctors, nurses, other healthcare professionals and hemophiliacs and their families to avoid HIV infection when the cause of the AIDS is unknown.

著者

仙波 由加里

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.69-78, 2009-10-01 (Released:2018-02-01)

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The Donor Conception Review Committee of the Science Council of Japan concluded in March 2008, that surrogacy both with and without compensation should be prohibited in principle in Japan, albeit with possible exceptions for research purposes. However, it is unlikely that problems related to payments to surrogates can be eliminated simply by prohibiting commercial donor conception. If surrogacy for research purposes is permitted on a merely exceptional basis in Japan, issues regarding payments will undoubtedly remain. In this paper, I first give an overview of the current status of surrogacy in Japan and other countries and then go on to describe the details of a specific surrogacy case in California and the content of the 2008 Declaration of Istanbul on Organ Trafficking and Transplant Tourism. Finally, I discuss issues relating to the payment of reasonable expenses and reimbursement for surrogacy. Based on this discussion, I find that in the absence of a clear definition of "reasonable expenses," there is little difference between payments for commercial surrogacy, as in the U.S., and those for non-commercial surrogacy, as in the U.K. The Declaration of Istanbul explicitly discriminates between comprehensive reimbursements of the actual costs of live organ donation, as opposed to payments for an organ. It might be useful to apply a similar distinction to surrogacy by discriminating between the cost of surrogacy and the actual sale of women's or infants' bodies. In conclusion, we need to clearly specify the nature of "reasonable expenses" in order to prevent money-related disputes regarding surrogacy.

著者

大北 全俊

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.26, pp.63-71, 2008-10-22 (Released:2018-02-01)

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In this article, I discuss F. Nightingale's thoughts on what to do for the sick by examining her "Notes on Nursing." F. Nightingale begins her thoughts from the definitions of disease, and her consideration of the sick person is based on these definitions. The first definition is "all disease is a reparative process by Nature," the second that "diseases are conditions." The first shows that the relationship between the sick and people in charge of care for them is equal and complementary, since imposed on both of them is the same duty to obey Nature in healing the sick. The second shows that all in a society have an interest in the conditions causing disease. In conclusion, it is clear that that F. Nightingale's consideration of the sick person is "a look not isolating a sick person."

著者

村上 満子

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.26, pp.73-78, 2008-10-22 (Released:2018-02-01)

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We selected case A as the subject of our research: this schizophrenic individual had been hospitalized for about 12 years in a private psychiatric hospital. In order to determine factors crucial to his discharge, we used the method of vocabulary analysis to examine his medical and nursing records over 1,450 days. In this case, we focused in particular on eleven words concerning recovery and discharge. Our findings suggest the following: (1) the need for adequate assessment of his improvement, (2) the need for empowerment enabling improvement of his interpersonal relationships, and (3) the importance of resolving large gaps in intention regarding discharge between the patient and health professionals.

著者

阿保 順子 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.26, pp.79-81, 2008-10-22 (Released:2018-02-01)

著者

原 敬

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.26, pp.82-86, 2008-10-22 (Released:2018-02-01)

著者

稲葉 一人

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.26, pp.87-90, 2008-10-22 (Released:2018-02-01)

著者

長岡 成夫

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.26, pp.91-95, 2008-10-22 (Released:2018-02-01)

著者

近藤 まゆみ

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.26, pp.96-100, 2008-10-22 (Released:2018-02-01)

著者

水野 俊誠

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.25, pp.11-19, 2007-10-18 (Released:2018-02-01)

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It is believer that the concepts of mental illness, mental disease, and mental disorders, which represent the theoretical basis of psychiatry and psychiatric medicine, are more likely to bring about problems in use than the concepts of physical illness, physical disease, and physical disorders. In this paper, I will consider two such problems : (1)the concepts of mental illness, mental disease, and mental disorders often bring about more conflicts among experts regarding the diagnosis than that of physical illness, physical disease, and physical disorders ; and (2)there are more conflicts over whether some mental illness, mental disease, and mental disorders are illnesses or disease in a relevant sense as compared to physical illnesses, physical illnesses, physical disease, and physical disorders. Szasz, Boorse, and Fulford have all responded to the question of why these problems have com about. In this paper, I will critically examine their responses and then propose my own response to this question in the following manner. First, the concepts of mental illness, mental disease, and mental disorders bring about more conflicts among experts than that of physical illness, physical disease, and physical disorders because there is no consensus on whether the painters' condition damage their natural primary goods. According to Rawls, primary goods are "things that every rational man is presumed to want." Some primary goods such as health, vigor, intelligence, and imagination are natural goods ; although their possession is influenced by the basic structure of society, they are not directly under its control. Second, there is much debate about whether particular mental disorders, such as personality disorders, are illness or disease in a relevant sense as compared to physical disorders. This is because the evidence for biological deviations corresponding to mental disorders is often more lacking than that for physical disorders.

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.25, pp.121-127, 2007-10-18 (Released:2018-02-01)

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The purpose of this survey was to determine whether there are differences in the knowledge, opinions, and way of thinking about state-of-the-art health care and bioethics among students from different disciplines who attended bioethics-related classes in departments of medicine, Buddhist studies, social welfare, and dietetics. The survey was conducted with 303 students in 4 departments in 3 universities by a questionnaire completed by each person. Some differences were found among the disciplines in self-evaluation concerning knowledge of "bioethics" (p<0.01). On the other hand, there were no significant differences among the disciplines in opinions or ideas concerning bioethical topics such as "development of research" and "organ sale". Experience with study in the academic field or biology made a difference in students' self-evaluation concerning knowledge of bioethics, but did not affect answers to questions regarding opinions or ideas. This held true for a comparison between students (n=169) who took classes on bioethics and those who did not. It appeared that while self-evaluation regarding knowledge of bioethics was enhanced by study experience, opinions and ideas on bioethics were significantly correlated with study experience.

著者

圓増 文

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.26, pp.1-10, 2008-10-22 (Released:2018-02-01)

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In this paper, I attempt to address what we should do as parties in a healthcare professional-patient relationship in order to secure trusting relationship. The word "trust" is frequently used to express an ideal healthcare professional-patient relationship, e.g. "we can't provide good treatment without securing a trusting relationship with a patient" or "we have to do this and that in order to secure a trusting relationship". However, what can be done to secure a trusting relationship with someone? Further, what does a "trusting relationship" mean? Since there is much ambiguity regarding what a trusting relationship means, we will encounter problems even if we accept "trusting relationship" as an ideal healthcare professional-patient relationship. Thus, in the first section, I will try to identify what the "trust-relationship" means when it is used to refer to an ideal relationship. In the second section, I will clarify what we can do to secure an ideal trusting relationship. Finally, I will explore what we should do to secure an ideal healthcare professional-patient relationship.

著者

田村 京子

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.26, pp.11-20, 2008-10-22 (Released:2018-02-01)

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All individuals would like to receive competent and safe medical care and treatment from caregivers whom they trust. However, some recent medical accidents that have been published have resulted in a loss of trust in medical caregivers. This paper examines the trust between a patient and his/her caregiver with reference to medical errors, considers from the following respects. 1. When a person suffers an unexpected adverse outcome of treatment, he/she expects his/her medical caregiver to have a faithful attitude toward him/her. In particular, he/she expects the caregiver to be completely honest and clearly explain the effects of the treatment given to him/her and whether his/her condition could deteriorate. I believe that medical caregivers are responsible for informing patients who have suffered adverse outcomes of treatment. This is based on the ethical principles of doing no harm and respecting the patient's right to know. 2. Medical errors may occur because a substantial number of medical treatments involve high risks. Moreover, errors may also result due to organizational factors. 3. In Japan, large hospitals, where medical errors may frequently occur, have begun to investigate and examine the causes of such errors to reduce their occurrence and to improve patient safety. However, it appears that little attention is being given to policies concerning the disclosure of such errors. 4. All healthcare organizations should establish a strong, proactive policy to support individuals who have suffered errors in treatment by completely and honestly disclosing such errors to patients. If healthcare organizations do not support individual patients, they are not being honest with them. Moreover, ethical support from organizations may protect individuals from the shame, guilt, fear, and loneliness that they may experience.

著者

後藤 雄太

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.26, pp.31-40, 2008-10-22 (Released:2018-02-01)

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This paper aims to criticize abortion and to present a vision of what our society and life should be. In Japan, abortion is technically illegal, but loopholes result in about as many as 300,000 approved pregnancy terminations a year. This paper insists that most abortions (including shady abortions) in Japan should not be approved (the paper does not dwell on abortion in cases of rape or when there is danger to the mother's life because space is limited). Broadly speaking, the main issues in the abortion debate are whether the fetus is a "person" or not, whether "rights" such as the reproductive rights of women and the fetal right to live should be recognized and whether a relationship between a pregnant woman and her fetus is formed. This paper argues against abortion from a relationalistic viewpoint; it criticizes the past relationalistic views and develops a new relationalistic view. Abortion is an act where adults unilaterally deny "the life of a child who is growing and affirming his/her own being", thereby destroying any relationship with the child. Moreover, it is an act of adults refusing a child's participation in society simply because the child was accidentally conceived by parents who did not want him/her, or simply because the child was diagnosed with a disability, etc. In brief, abortion ruins our conception of "society being a place that welcomes life hospitably". Welcoming life hospitably is to accept it unconditionally; just as it is. In order to actually solve the abortion problem, one must establish relationships where one can affirm one's own life, the opposite sex person's life, and the fetus' life, as well. This is much more important than abstractly arguing over rights, personhood, and such.

著者

鶴島 暁

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.26, pp.41-49, 2008-10-22 (Released:2018-02-01)

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In bioethics, especially in discussions of advanced technology such as genetic engineering, religious phrases like 'Playing God,' 'Creation,' and 'Image of God' are often used. In this paper, I deal with the phrase 'Playing God'. This phrase is often used as a slogan, 'You should not play God,' to oppose advanced technologies such as cloning and genetic manipulation. 'Playing God' is thus considered a human behavior that goes beyond boundaries ordained by God and involves knowing things that human beings should not know. 'You should not play God' is a sentence providing warning against this. Sometimes it is used as a basis for deriving specific conclusions. However, it is ambiguous. The implications of this phrase are unclear and depend on the interpretation of the user. As a consequence, people use the phrase frequently to mean different things without indicating exactly what 'Playing God' means, and sometimes come to different conclusions. Therefore, if the meaning of this sentence is not specified, it is of no use to consider its validity. Therefore, in this paper I analyze the phrase 'Playing God' and clarify its meaning, contents, and function in some contexts in which it is used. The following points are made. The sentence 'You should not play God' is just a warning to promote awareness of human fallibility, incompleteness, and finitude. There is some difficulty in using this phrase as a basis for reaching specific conclusions. If people wish to make this phrase function effectively, they must clarify the domain of God, offer rational and theological reasons for treating a domain as God's field, and clarify the Will of God or natural process presupposed behind the phrase 'Playing God.'

著者

永田 まなみ

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.26, pp.51-61, 2008-10-22 (Released:2018-02-01)

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Because the word 'care' is often used in nursing as a daily word and in polysemic fashion, usage of it needs to be organized, refined, and modified for inclusion of it as an academic term. In this paper, an attempt is made to clarify the meaning of the word 'care' by considering what specific meanings and roles those within the nursing discipline may assign this word, so that desirable nursing practice can be clearly explained. In reference to 'nursing care', nursing has been explained using everyday interpretations of the word 'care'. While discussing appropriate nursing, on the other hand, intangibles such as qualities required in those who do nursing care, etc. have been mentioned as crucial to making nursing care true nursing. For the past twenty years, there has been an unfortunate tendency to use the word 'human caring' as equivalent to nursing, and the word 'care' as a catch-all to conveniently indicate both the nature and the goodness of nursing, as a result of which the nature of nursing remains unclear. If in nursing the word 'care' is redefined in accordance with the continuing and evolving application of its previous usage in academic discipline, while avoiding discrepancies from practical wisdom, it would then be appropriate to define it as aid extended to advance the well-being and autonomy of each individual patient before us who lives wishing for health. Considering the current situation in which nurses care for multiple patients, it is not possible to discuss the entirety of desirable nursing if we rely solely on the word 'care'.