著者

浜町 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.23, pp.11-21, 2005-10-26 (Released:2018-02-01)

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According to Faden and Beauchamp, informed consent is a process of communication between a patient and a physician that results in the patient's authorization to undergo a specific medical intervention. The Japanese Medical Association, however, defines informed consent as "explanation by physicians and agreement by patients". Using the JMA definition, informed consent has been practiced by many physicians and patients in Japan. Not all patients, however, are satisfied with this method of decision making. The purpose of this paper is to discuss how this communication should be undertaken among stakeholders concerned with medical decision making. In the first part of this paper, two methods of communication are analyzed, one based on the JMA interpretation and the other based on Faden and Beauchamp. In the former, communication consists of a physician's explanation and the patient's consent. In the latter, communication is undertaken through the physician's recommendations and presentation of reasons why the patient should take the physician's advice, the physician's understanding of the patient's concerns and interests, the physician's explanations, and the patient's consent. In the second part of the paper, these two methods of communication are compared with actual cases of informed consent in health care. The paper then demonstrates that the two methods of communication are insufficient in the case of opposing opinions among stakeholders or when stakeholders have no understanding of each others' interests. The paper concludes that it is necessary for communication in health care to take place in two steps. The first involves uncovering the stakeholders' interests. The second involves determining the best solution based on those interests. It is a so-called consensus building process that incorporates these two important communication steps.

著者

勝山 貴美子

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.23, pp.23-33, 2005-10-26 (Released:2018-02-01)

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In December 2001, the Ministry of Health, Labor and Welfare issued a policy document titled "A Grand Design for the Promotion of Use of Information Technology in Health". The document describes a number of scenarios to be realized over a period of five years involving the provision and use of health services by means of information technology. Goals include the deployment of an electronic health record system to 60% of all hospitals with more than 400 beds.In order to promote such efforts, policies are needed to ensure the security of information and the protection of privacy. A law protecting personal information was passed in 2003 and came into effect in 2005. This paper discusses this law and examines its meaning, its significance, and its potential problems. The increased gathering and use of information in medical care environments does not always lead to more patient-centered care. Satisfaction with the gathering and protection of this information is important to patient outcome and may affect the ability of the physician and other medical staff to elicit patients' concerns, consider patients' psychosocial needs, and involve patients in treatment decision making, all of these being communication techniques that fall under the umbrella of "patient-centered" care.

著者

朝倉 輝一

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.23, pp.43-53, 2005-10-26 (Released:2018-02-01)

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Nurses often face ethical dilemmas involving issues of conscience and responsibility. Etymologically, "conscience" (συνειδησιs, conscientia) involves getting to know meaning of one's own act together with the internalized other. In order for a person to protect his or her identity when exposed to danger, conscience is "the internal surveillance organization" which judges orders according to his or her subjective restraint-norm" in relation to a specific act and features "a cognitive element and an influence-element". Not only does it mean the internal moral sense for distinguishing right from wrong freedom of an inside, but also it is inevitably accompanied by an external act in some form, such as an act or an omission. It is possible, however, that one's appeal to conscience makes a wrong decision because of incorrect information, groundless belief etc. But nurses should be allowed to refuse to carry out particular treatment or procedures based on personal appeal to conscience. Therefore the nurse appealing to conscience must undertake a step-by-step process of justification in order to fulfill a duty of care by carefully considering the patient's safety and welfare, based on acceptance of consequence and exact information. Administrators must discern whether the nurse appealing to conscience makes judgment based on appropriate knowledge and correct information and whether the proposed result is safe and acceptable. If so, administrators have a duty to support that result.Although the appeal to conscience is a fundamental right and can reveal someone's dishonesty (the whistle-blowing), it is not positively accepted in Japan. The dignity of each person's identity cannot be protected only by nurse's appeal to conscience. Consequently nursing practice committees or other ethics committees should discuss this and similar issues which include refusal based on a nurse's appeal to conscience.

著者

山中 恵利子

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.23, pp.55-63, 2005-10-26 (Released:2018-02-01)

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The purpose of this paper is to examine the construction of a world of subjective meaning for Mr. A, who experienced depression in middle age. As a methodological tool, I use the theory of relevance advanced by Alfred Schutz. This paper first examines how Schutz' theory explains how, in social constructivist terms, "subjective reality turns into objective reality," and clarifies the temporal status of internal time consciousness. The paper then examines Schutz' construct of different sets of interests, or relevances: topical, interpretive, and motivational.In conversations between Mr. A and the author over four years, Mr. A's "narrative" changed. According to the theory of relevance, major changes of subject are seen in the evolution of Mr. A's statements from "I cannot go to work," "I am labeled as someone who cannot succeed in work," and "I feel tense at work" to such statements as "I want to break free from this vicious circle." By examining such statements the theory of relevance is able to clarify the meaning in epoche how Mr. A perceives the problems that he faces and how he attempts to deal with them. The author shows how Schutz' concept of relevance, as an intersubjective category, is able to reduce the distance between the actor and the observer. Using the concept of relevance, the author shows that an interviewer or hearer will come to an interpretive understanding of a speaker producing meaning compositions, by way of contrapuntal analysis, while, as if an accompanist, the hearer stands close to the speaker.

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.23, pp.65-75, 2005-10-26 (Released:2018-02-01)

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Generally speaking, it is existential pain, that is, spiritual pain, that distresses terminal patients to the very end. But spiritual pain isn't a concern only to terminal patients. It's fundamentally a concern that all people, as mortal beings, must address. This paper examines the search for spiritual relief. A key concept in this search is the "turning of outlook on life and death". This means that a thorough realization of the certainty of death becomes an unconditional affirmation of life. The reality of death invalidates any "meaning" or "value" that we place on our lives. At first glance, this invalidation seems to result in a negative situation. But a thorough realization of the certainty of death evidences "something beyond human power" that refuses to be given "meaning" or "value" by human beings. This "something beyond human power" is "life itself", or the "being itself" that we tend to miss in daily life. In the sense stated above a thorough realization of the certainty of death is something special. Recent thinking is that terminal patients can reconfirm the meaning or value of their lives through "narrative" . This paper, however, proposes that spiritual pain is a important clue to "something that can't be described" and therefore eliminates the need to ascribe "meaning" or "value". This paper proposes that there is no answer to the question "What is the meaning of life (or death)?" and that spiritual pain cannot be relieved by seeking the answer to this question. Paradoxically, spiritual relief can be found by living with the uncertainty of death and the mystery of life, not by removing these through "narrative".

著者

安藤 泰至

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.23, pp.77-86, 2005-10-26 (Released:2018-02-01)

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The purpose of this paper is to give a new perspective to human illness. A good deal of discussion has been held on the difference between "illness" and "disease", especially from the viewpoints of medical anthropology and medicine for total health. However, no perspective yet adequately describes and appreciates "illness" as a complete experience forming part of human life. One problem with developing such a perspective is the concept of "illness" itself. It is well known that we sometimes achieve mental or spiritual growth through our experience of illness. But we usually say we "grow through our struggle with illness", instead of saying we "grow through our illness". When we use the first expression, illness is considered something to be overcome. But illness has another aspect, which Gabriel Marcel called "mystere", in contrast to "probleme". "Probleme" is that which we can analyze, answer to, and take measures to deal with from outside. In contrast, we can only "live" mystere by ourselves, and in mystere, questing itself is at the same time a kind of answer to it. So, as we can learn from Buddhism, we must view illness as an essential human life-experience having a secret treasure. A second problem concerns the limitation of the frameworks of medical professions that use the term "illness". From the perspective set out above, these frameworks are too narrow to fully describe and appreciate our experiences of illness. In other words, these frameworks tend to reduce the "mystere" of illness to the "probleme" of it. We must therefore focus carefully on the narratives of patients who live their own mystere of illness and endeavor to understand them from the viewpoint of "wisdom of illness", which means going beyond the framework offered by medical professionalism.

著者

前田 義郎

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.23, pp.87-96, 2005-10-26 (Released:2018-02-01)

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As a result of recent developments in reproductive and regenerative medicine, the moral status of the zygote and the embryo is becoming increasingly important. This paper considers them from the perspective of "potential persons" and investigates issues arising from this perspective. In particular I critically examine Tooley's personhood theory. First, I examine the "interest principle" as a core of Tooley's theory. (1) On the normative character of "interest", Tooley insists interest is necessary for an entity to have a right to life, but I insist interest is a necessary and sufficient condition for invoking others' moral consideration toward the interest-holder. (2) On the interest of potential persons, I prove the possibility of acknowledging it. (3) On the "particular interests principle", I argue conscious interest isn't the only possible interest for persons. Thus I show the "interest principle" isn't sufficient for determining personhood. I then propose another principle for determining personhood: an "ends in itself" argument based on "moral ability". Those who destroy an entity regard it as merely a means, and then being an end in itself is decisive for a person. Next, I discuss being "end in itself" based on moral ability and conclude we can regard potential persons as potential holders of that ability. Finally, I consider the concept of "potentiality". Tooley argues that the destruction of potential persons is morally equivalent to contraception. I clarify the assumptions underlying this argument by examining his "three potentialities" argument and "moral symmetry principle". He considers potentiality in terms of causality (the cause-effect relationship). When considering living entities, however, I propose we consider potentiality in terms of teleology (the parts-whole relationship, and the process aiming at goals). This paper aims to establish a framework for protecting potential persons as potential moral agents. It concludes that this is fully possible.

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.22, pp.119-121, 2004-10-18 (Released:2018-02-01)

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.22, pp.123-126, 2004-10-18 (Released:2018-02-01)

著者

テン・ハーフ ヘンク・A・M・J 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.22, pp.127-136, 2004-10-18 (Released:2018-02-01)

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In the last three decades, euthanasia has been a topic of continuous debate in the Netherlands and elsewhere. I is obvious that euthanasia has medical, moral and legal aspects, but it also has cultural, social and political dimensions. In the Netherlands, after three decades of debate and practical experience, euthanasia is since April 2002 regulated as a legitimized medical intervention under particular conditions. However, the legal regulation of euthanasia does not mean that the practice has lost its controversial and contentious character. In this presentation I will focus on four issues. First, the legalization of euthanasia in the Netherlands, identifying the characteristics of the new law. Second, rules and regulations in European countries will be compared, especially the laws in Belgium and the Netherlands. It is also clear that the medical practice of euthanasia varies significantly among European countries, contrary to the implicit assumption that physicians in the Netherlands practiced openly what was hidden in other countries. Third, the issue of legalization, and the various moral and pragmatic arguments pro and con legalizing euthanasia, will be analyzed. Finally, different approaches to death and dying seem to emerge from the euthanasia debate. Three approaches are distinguished: controlled death, preventive death, and palliated death. The increasing focus on the patients' quality of life is an opportunity for the emerging approach of 'palliated death', going beyond the images of 'controlled death' and 'preventive death'.

著者

根村 直美

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.22, pp.141-145, 2004-10-18 (Released:2018-02-01)

著者

斎藤 清二

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.22, pp.147-153, 2004-10-18 (Released:2018-02-01)

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.22, pp.155-160, 2004-10-18 (Released:2018-02-01)

著者

倉持 武 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.22, pp.161-162, 2004-10-18 (Released:2018-02-01)

著者

堀田 義太郎

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.22, pp.37-46, 2004-10-18 (Released:2018-02-01)

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In this paper, I examine one discussion of Disability Studies, 'the political economy of disability.' The political economy of disability focuses on the norm of modem society from which people with disabilities are excluded. The study of the political economy of disability shows that modem societies are based on the norm known as the 'work based' distribution system. The norm dictates that people earn the right to goods through working. But not all people are able to work or want to working. In these cases, modem societies face the 'distributive dilemma' (D.A. Stone). To resolve this dilemma, modem societies need to consider the second standard of distribution, which is a 'needs based' distribution system. In this system, an important role as the category of 'disability.' 'Disability' is a category used as one of the criteria that decides who deserves to receive goods based on the 'needs based' distribution system. This criterion relies on clinical and medical diagnosis. My point is that the insights of the political economy of disability are right, but the crucial problem remains. The problem lies in the standard and the measure itself that evaluates the condition and the position of the people in society. I consider the problem of standard which is defined by medical diagnosis. In conclusion, I will show that the political economy of disability is posing acute question on dominant norm in modern society.

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.22, pp.47-57, 2004-10-18 (Released:2018-02-01)

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Im erstaunlichen Ausmass des Fortschritts der neuen medizinischen Technik in den vergangenen Jahrzehnten bekunden sich Moglichkeiten der Lebensgestaltung und -vernichtung, von denen man noch nichts ahnen konnte, als in der Zeit des nationalsozialistischen Regimes eine ungeheure Vernichtungsmassnahme realisiert wurde. Viktor von Weizsacker veroffentlichte noch wahrend des Nurnberger Arzteprozesses vielleicht als einziger akademischer Mediziner einen Aufsatz: "Euthanasie" und Menschenversuche(1947). Er ausserte sich dabei nicht zur Schuld oder Unschuld von Personen, fur ihn sass auf der Anklagebank auch der Geist der Medizin, der den Menschen nur als Objekt nimmt. Er konzentrierte sich daher auf die Frage: Wie war es moglich? Was fur eine Medizin war es denn, die so terrorisierbar und verfuhrbar war? Die Totung unheilbarer Geisteskranker und weiterer Gruppen von sogenanntem "lebensunwertem Leben" wurde erst im nationalsozialistischen Staat als legalisiert bezeichnet. Damit verschob man das Problem der Medizin auf die juristische und politische Ebene. Eben diesem widerspricht Weizsacker und er macht die Unterlassung zum Thema seines medizinischen Gutachtens. Aber es handelt sich nicht um das Verstandnis eines medizinfremden Vorgangs, sondern um eine Selbstentfremdung, um eine Degeneration der Medizin selbst. Er fragte also nach dem Anteil der modernen Mediziner uberhaupt und prufte arztliche Motive and Willensbildung. Der Einsicht Weizsackers nach waren drei Motive fur die nationalsozialistische Lebensvernichtung zu prufen: Unwert des Lebens, Mitleid und Opfer. Ich verstehe diese Auswahl im Zusammenhang mit den drei Fragen des Damons an Jesus Christus in der Wuste im Neuen Testament. Das Problem der Euthanasie ist dann das der Dreieinheit von Aberglaube, Mystik und Macht oder Wissenschaft, Religion und Politik, das von "Der Grossinquisitor" in Die Bruder Karamasoff Dostojewskis, das der menschlichen Freiheit. Bei den Vernichtungsmassnahmen des Nationalsozialismus spielte der Opfergedanke als eine Verschmelzung von Toten und Erlosung eine entscheidende Rolle. Aber weder der Unwert des Lebens noch das Mitleid, noch der Opfergedanke in der Art seiner Anwendung sind imstande, die sogenannte "Euthanasie" des NS-Regimes zu begrunden.

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.22, pp.59-68, 2004-10-18 (Released:2018-02-01)

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Amyotrophic Lateral Sclerosis (ALS) is a motor neuron disease which evokes complicated questions in the Japanese health care system. In order to address these questions, we must analyze a wide range of ethical, legal, and social issues, paying special affention to the ethics of withholding and withdrawing mechanical ventilation. In the first section of this paper I provide a brief review of the facts concerning Japanese patients with ALS: (1) the effect of the patient's own wishes on choices concerning mechanical ventilation; (2) the barriers to home care, especially the burden placed on the families taking care of patients on ventilation, e.g. removing sputum from patients' tracheas; (3) the barrier for institutional care, e.g. the limitation of health care resources; and (4) the limited range of choices at the end stage of a patient's life. The second section is an ethical analysis of the preceding issues: (1) the relation between autonomy and dignity, which have been dissociated in recent ethico-legal arguments regarding end of life issues; (2) Consideration of the justice of allocating resources which may empower patient's autonomy and dignity. In conclusion, Sen's ideas on capability will be used as the foundation of arguments for increasing the allocation of resources to care for patients with ALS, and to expand the range of choices patients can make as to living with or without mechanical ventilation.

著者

佐藤 労

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.22, pp.77-83, 2004-10-18 (Released:2018-02-01)

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The duty to be a good medical doctor is considered from a viewpoint of Kant's ethics. Consideration of this article is begun with the so-called "lie paper" of Kant. A consequentialism of utilitarianism in this paper is criticized as follows. Even if a goodness of means to lie is guaranteed by a goodness of an end to save a life of liar's friend, the connection between a means and an end is not necessary but rather contingency. A goodness of means is not always guaranteed. And an act which is performed out of duty is good by itself because the duty is affected with a sentiment. There are two kinds of duties, complete or incomplete. The former is legal duty, the latter virtuous. A virtuous act is recognized as an example that a man conducts morally, which is an expression of a moral law. This act is admirable and respectable because of an expression of a moral law. It compelles an observer to become good and to be a good doctor that a man observes those who conduct the virtuous act.

著者

浅見 昇吾

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.22, pp.85-92, 2004-10-18 (Released:2018-02-01)

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Diese Arbeit versucht, die Moglichkeiten von Ludwig Sieps Naturbegriff bzw. Kosmosethik zu prufen. Zuerst werden einige Besonderheiten der Konzeption Sieps deutlich gemacht, indem Sieps Theorie mit der Kritik von Anton Leist, Ursula Wolf und Dietmar von der Pfordten konfrontiert wird. Wir gehen sozusagen einem Streit um das Klonen des Menschen in der "Frankfurter Rundschau" nach. Dann wird eine neue Konzeption von Jurgen Habermas in Betracht gezogen. Habermas hat in seiner Schrift "Die Zukunft der menschlichen Natur-Auf dem Weg zu einer liberalen Eugenik?" zum ersten Mal grundsatzlich zu Problemen der Bioethik Stellung genommen und ubt heftige Kritik an Siep. Aus dem Vergleich zwischen einem Kosmosethiker und einem Diskursethiker ergibt sich, dass beide Theorien nicht vollkommen plausibel sind. Zuletzt wird ein neuer Ansatz zur medizinischen Ethik empfohlen.

著者

金谷 光子 尾曽 直美

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.22, pp.93-102, 2004-10-18 (Released:2018-02-01)

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Because there may be limitations in the scientific method of discovering and treating patients' "problems," the narrative approach has become increasingly important. These limitations have been pointed out by scholars from various fields. Hermeneutic view point has it that clinical knowledge is mostly based on the doctor's assumption and differs greatly from the world in which the patients live their lives. What should those in the nursing profession choose as a means of understanding patients? There is a Social Constructionist view that understanding is obtained through "language." When the sick patient tells about the world in which he/she lives in certain words, he/she has decided not to tell in other words. Then the patient's world appears before us as he/she tells. The patient organizes his/her world through telling as well. After over three years of interviewing with Ms. K, who was stuck with her mal-treating mother, we verified what telling brought to her, and how it was connected with understanding herself. Listening to Ms. K's narrative was linked to understanding her world in which she lived her life. It also brought a certain order to her confused history. As a result, her regrettable past came to have possibility for the future, altering her mentality so much as to make it possible for her to say "I have done my best" and "I have been living so well."