著者

小阪 康治

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.16, pp.24-34, 1998-10-01 (Released:2018-02-01)

---

Informed consent is the concept that has already been established in the Helsinki Declaration and Lisbon Declaration, and its necessity is now widely understood in Japan. There is a difference, however, between the principles of the declaretions and the actual medical situation. This is often true in various cases of medical ethics. It is the present situation in Japan that the ethical standards are connected with ambiguous descriptions such as "case-by-case" and emotional standards such as a doctor's sympathy for a patient and his or her death. In this report, the author tries to establish the ethical standards for informed concent so as to combine the principles of the declarations with the respective cases. It is stated that informed consent is to maintain the collaboration between the patients and medical staff by studying the Law of Moses. It is also stated that the maintenance of the medical standard including informed consent be considered from the viewpoint of ethics. In this report, the author analyze the ethical thoughts in the judicial precedents whose issues of law is in violation of informed concent. This maintenace of the medical standard itself is just the ethical standards combined with the principles of declaration, the actual medical situation and judical process.

著者

岡本 珠代

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.16, pp.35-45, 1998-10-01 (Released:2018-02-01)

---

Casuistry derives its tradition from the medieval Catholic practice of moral discussion dealing with difficult cases (=cases in Latin, hence casuistry) which can allegedly offer ways to resolve moral dilemmas without recourse to any ethical theories or overarching ethical principles. Contemporary bioethicists such as Albert Jonsen claim that the casuistic approach pays attention to a particular case with its circumstances, analyses it, compares it with other cases and decides its moral status as to whether it is a paradigm case or subsumed under a different category. A casuist makes a stark distinction between a case-based approach and a theory-dependent approach in ethics. The principle-based theorists such as Tom Beauchamps (despite their recent affinity with coherentism) are derogatorily called principlists whose main job is to strictly and deductively apply ethical principles in their "applied ethics". The casuistic bottom-up approach is shared by communitarian ethicists whose commitment is limited only to the close relationship in the local community. One of the casuistic rules employed to decide the morality of an action is called the doctrine of double effect. It justifies an action when it is performed from a good intention, such as to stop the suffering of a terminal-stage patient, even though the actual consequence is her death which was foreseen but not willed. This doctrine is subject to an abuse, and because it could camouflage an intention to bring about a negative effect, it has to be rejected. We can learn from casuists the value of an approach to analyse individual cases with reference to paradigms. A case analysis is an effective way of teaching ethics and of resolving moral dilemmas. But we also have to employ common values applicable to everyone in a global community to guide our actions, such as respect for persons, general welfare and the democratic decision-making procedure.

著者

藤野 昭宏

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.16, pp.65-77, 1998-10-01 (Released:2018-02-01)

---

In the field of occupational medicine and health services, occupational physicians often face ethical dilemmas or conflicts concerning their independence and the privacy of employees' health information. It is stated that, by law in Japan, employers must assume full responsibility for the safety and health of their employees at work. However, the independence of occupational physicians is not clearly regulated by the law. Therefore, an executive director has an obligation to administer the health data of workers and he may require an occupational physician to disclose the medical information of employees. The actual ethical dilemmas of occupational physicians are as follows: 1) company loyalty vs. medical ethics (e.g. disclosure vs. confidentiality of medical information), 2) workers right to know or to work vs. company managerial policy (e.g. do employers inform workers the health effects of chemicals in the workplace accurately, assessment of fitness for work, return to work, restructure of work system), 3) environmental ethics vs. bioethics (e.g. occupational physicians must have the responsibility for not only employees but also the community as well as the company). In order to dissolve these dilemmas, occupational physicians need to have three ethical opposing standpoints, namely, bioethics, environmental ethics and utilitarianism. This is the ethical peculiarity of occupational professionals in comparison with clinical doctors and it is not easy to exercise ethical judgment for employees and the company as specialists of occupational medicine. Therefore, the establishment of ethical codes or guidelines for occupational physicians are required in Japan as well as the UK.

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.16, pp.90-100, 1998-10-01 (Released:2018-02-01)

---

After a short description on liberalism in health care from the viewpoint of both patients and physicians, based on more than 45 years of clinical practice, the situation of liberalism in health care of today's Japan was introduced. Although Japan has achieved the longest average lifeexpectancy in the 1990s, liberalism in health care of Japan is now in a situation of decline, and maintenance of the humanitarian patientphysician relationship and/or clientprovider relationship has been threatened greatly because financial, social and bureaucratic powers are now so strong in the health care of Japan. The situation of the health care system in Japan may be called socio-nationalistic with a concrete basis of capitalism of American model; in other words "competitive socio-communism"!

著者

伊東 隆雄

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.16, pp.112-122, 1998-10-01 (Released:2018-02-01)

---

Psychotic patients are different from demented people because they possess the ability for competence in principle. Therefore, medical treatment must be performed based on the concept of informed consent. But in reality, there can be discrepancies between their overt-will and covert-will, because they have pathological thought processes due to double orientation and ambivalence. So we must speculate on their true wishes, and act appropriately. If they express their true wishes covertly, performing medical treatment on them involuntarily is not paternalistic intervention. I consider this behavior one which is based on self-determination. In this situation, we must carry out treatment for somatic complications, and the range of the treatment we can do should be within the area of low invasive therapy, for example, medication or injection. We may not arrive at a consensus for surgical operations and more invasive therapies. I report on two schizophrenic cases in this paper, one with breast cancer and the other with diabetes. We could not carry out a surgical operation for the first case, but I am now using injection of insulin for the second case. In the field of clinical medicine, there is a tendency for informed consent to be considered part of the therapeutic contract. In this context, overt expression of agreement is necessary in order to set up the contract. Psychotic patients express their wishes for treatment unclearly or covertly, so they do not have the opportunity to receive treatment even though they want to. Expanding the bounds of informed consent for psychotic patients would place them at a disadvantage and deprive them of medical treatment. I worry about the emergence of a new form of discrimination against psychotic patients.

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.16, pp.123-131, 1998-10-01 (Released:2018-02-01)

---

Liberalism and self-determination are based on a typical modern age idea of person: From Locke and Kant to the contemporary English-American Bioethic studies, the self-consciousness stands at the center of this idea. According to this idea of person, as is known, the embryo and disabled newborn are excluded from persons. On one hand we must keep this idea, which supports the thought of self-determination, the credo of the liberal society. On the other hand, however, we need to revise the idea of person. Focusing on the issues of the disabled embryo and newborn, I criticize this idea of person and suggest a revised idea instead. To be noticed is the phenomenon emphasized by sociology and psychology that the self shows up not alone but through interaction with others. This phenomenon suggets that the self-consciousness includes by nature the consciousness of others. To argue this is the point of this study. Should the self-consciousness include recognition of others, it is to be shown that a man would be a person, only if he is recognized. Then the matter of the idea of person is not that of the definiton of person. The problem is whether we can deny the recognition of others. From this point I also try to restrict self-determination: Abortion is not to be justified by the self-determination of the persons concerned: of parents, in particular of mothers.

著者

フェッター ヘルムート

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.16, pp.132-148, 1998-10-01 (Released:2018-02-01)

---

1. Historische Vorbemerkung: a) ANSTOSS ZUR BEGRUNDUNG DER PSYCHOANALYSE: Unerklarbarkeit hysterischer Symptome. b) LUDWIG BINSWANGERS DASEINALYSE: Der Mensch als Person (phanomenologische Anthropologie) and seine Verflochtenheit mit der Welt (die Bedeutung von Husserl and Heidegger). c) ZUR CHER SCHULE DER DASEINSANALYSE VON MEDARD BOSS: Die Ubernahme von Heideggers Konzept des Daseinse 2. Die Hauptentdeckung Freuds-der Begriff des Unbewussten: a) HISTORISCHE VORBEMERKUNG: Die "petites perceptions" von Leibniz and ihre Auswirkungen in der Folgezeit. b) FREUDS AUSGANGSPUNKT: Bewusstseinspsychologie. c) FREUDS KONZEPT: Metapsychologie, die "hinter" das Bewusste zuruckgeht; die Parallele zur "Metaphysik" Hinweis auf Lacan. 3. Daseinsanalytische Stellungnahme zum Unbewussten: a) ANSPRUCH DES PRAKTIKERS FREUD: Die vermisste psychologische Grundlage der Psychiatrie; Interpretation seelischer Vorgange nicht als physiologische oder chemische Prozesse, sondern als Sinnzusammenhange. Deshalb die Bedeutung, die der Austausch von Worten zwischen Arzt and Patient hat, ebenso die Bedeutung der zwischenmenschlichen Beziehung in der psychoanalytischen Behandlung. b) NAIVITAT DES THEORETIKERS FREUD: Verborgener Cartesianismus (Dualisms von Korper and Seele) and Naturalisms (naturwissenschaftliche Erldarungsmodelle). c) DASEINSANALYTISCHE KRITIK: Der konkrete Mensch in seinem In-der-Welt-sein, als sprechendes Wesen, mit seiner Lebensgeschichte and in der Beziehung zum Mitmenschen kommt im Konzept der Metapsychologie gar nicht vor. 4. Wird die phanomenologische Kritik der Daseinsanalyse (insbesondere der von Boss) dem Konzept des Unbewussten vollig gerecht? a) FREUDS INTENTION: Mit dem Unbewussten will Freud auch das missing linkezwischen Mensch and ubriger Natur (den nichtmenschlichen Lebewesen) gefunden haben. b) ANFRAGE AN DIE DASEINSANALYSE: Sie entwickelt zwar einerseits ein dem Mensch als Wesen der Freiheit adaquates Konzept, 1 asst aber ausser Acht, dass der Mensch auch ein Naturwesen ist (auch wenn menschliche Natur mit tierischer nicht einfach gleichgesetzt werden darf). Das zeigt sich in den Rhythmen seines Lebens, im Schlafen and Wachen, den Perioden der Nahrungsaufnahme, in der Bedeutung der kosmischen Rhythmen, uberhaupt im Bereich dessen, was Tellenbach "Endon" nennt (ausgehend vom Versuch, die "endogenen Depressionen" zu verstehen). c) AUSBLICK: Das transkulturelle Gesprach von Hubert Tellenbach-Dialog uber "Natur" mit Bin Kimura.

著者

棚橋 實

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.16, pp.149-150, 1998-10-01 (Released:2018-02-01)

---

Studies on liberalism in medicine, as theoretical foundations for patients' self-decision-making, have not been fully explored. This is because liberalism itself consists of historical and ambiguious areas where less attention has been directed to its intent and debates. Renewing the definition of liberalism is among the most important duties that we must now (achieve?) pursue. "Withholding of life sustaining-treatment" as a role of the physician has been actively debated in the United States, but in Japan we have not discussed in detail about the role of the physician over the relationship with patients and families. The meaning of "futile" as a concept for terminally ill patients encounters many difficulties such as informed consent and patients' self-control. But the emphasis on finding a common ground between patients and physicians wishes remains unanswered in Japan. Concerning rejection of blood transfusions by Jehovah's Witnesses, the situation about patients' self-decision making in Japan has been at stake, since the religious and precautious problems have surrounded the concerns. But in February 1998 the Tokyo High-Court of Justice held that blood transfusions without consent are illegal and implied that we are going to get the mutual understanding of real self-decisionmaking. Recognizing the increased interest in liberalism, recent developments in health care policy have drawn sharp distinctions between medical treatmen for patients who are competent to make decisions and those who are not. While traditional liberalism favors competent patients, medical liberalism includes areas to which incompetent patients, such as embryos and patients in vegetative states belong, In these cases, liberalism itself can not be principally realized. A discussion about liberalism in medicine raises questions not easily answerd without consideration of one's own values and the values of society.

著者

倉持 武

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.16, pp.151-157, 1998-10-01 (Released:2018-02-01)

---

For what purpose should a person, while living or in death, be used? This is the crucial issue of a human's 'Wesen'. Namely, a human being's 'Wesen' requires that one be treated, during life itself and even in death, as an entity with its own reghts. Therefore, if through one's own right of self-decision, we try to justify the use of one's body for the act of organtransplantation, the nature of the patient's, for example that of brain dead, intentions as well as clear legal standards must be formally defined. In cases in which certain endeavours do not violate a person's 'Wesen', when expression of the volition of represontative in the form of consent with sufficiently precise information is acquired, then the possibility of representative with legal authority can be considered. However, when the violation of 'Wesen' is involved, it is requisite that the said person must state, through a formal written declaration, that his or her body can be used as a means for a certain purpose. Furthermore, the creation of a third party's right to decide on the use of the said patient's body is also essential. Therefore, in this case, a consenting representative inevitably won't be effectuated.

著者

佐野 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.16, pp.158-165, 1998-10-01 (Released:2018-02-01)

---

The issues of "informed consent" and "the patient's right to self-determination" have been discussed in the philosophical, ethical, and legal areas in medicine. In particular, the refusal of blood transfusions by Jehovah's Witnesses is regarded as a typical case of the discussions on the validity and limitation of the patient's right to self-determination. It is well-known that Jehovah's Witnesses refuse allogeneic blood transfusions on the basis of Biblical statements, such as "you must never eat flesh with its life still in it, that is the blood" (Genesis 9:4) or "you are to abstain… from blood" (Acts 15:29). What is the standard medical practice where a patient absolutely refuses blood transfusions? Is there the limitation of the patient's right to self-determination? How far is it possible to approve the choice of medical treatments by patients? In this paper, such problems are discussed from the following three standpoints. 1. The concrete contents of the refusal of blood transfusions by Jehovah's Witnesses. 2. The contents of the guidelines of ethics committees in the university hospitals of Japan. 3. The controversial points of these contents (1. and 2.) and the Japanese legal system. My conclusion is as follows : 1) If a Jehovah's Witness patient has his own judgement, whether he is an adult or a minor, and is not in a state of emergency, his will to refuse blood transfusions must be respected. 2) If he is an unconscious adult in an emergency and has an advance directive, his will must be respected. 3) If he is an unconscious minor in an emergency and medical doctors have no alternative choice, it will not be against the law that they give blood transfusions to him, because there has been no judicial precedent for such a case in Japan as yet.

著者

ベッカー カール

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.15, pp.137-143, 1997-09-20 (Released:2018-02-01)

---

This presentation considers three aspects by which an understanding of Japanese patient psychology can improve medical practice in Japan. (1) Recent advances in holistic and psychosomatic medicine illustrate that patients' psychology can influence medical outcomes. While it has long been common knowledge that bodily conditions influence mental moods, the burgeoning new field of psychoneuroimmunology is demonstrating that mental attitudes and emotions influence illness and health. The commonest stress-related ailments in Japan, from ulcers and high blood pressure to eczema and stiff shoulders, can be significantly alleviated by psychosomatic medical techniques such as relaxation and biofeedback. (2) The psychology of Japanese patients differs in many respects from that of Americans. For example, Japanese rarely strive to participate actively in their own healing processes, express individual decisions in writing, write living wills or advance directives, or consider themselves equal in status to their physicians. Given such deep-rooted cultural differences, even their best attempts to imitate Western medical practices encounter many difficultes. This section considers more suitable ways of counseling Japanese chronic and terminal patients based on their cultural expectations. (3) Similarly, the spread of bioethics has been closely linked to Western conceptions like full disclosure of information, second opinions, third-party review boards, and the legitimacy of whistle-blowing. The social hierarchies of Japanese hospitals render such practices counterproductive if not impossible. In the care of Japanese patients, mutual understanding based on discussion and family participation in decision-making produce far higher trust and satisfaction than information disclosure. This suggests that Japanese develop their own ideals and conceptions of bioethics based on their own cultual goals and assumptions.

著者

バロン パトリック

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.15, pp.144-148, 1997-09-20 (Released:2018-02-01)

---

This paper attempts to look at some of the changes that have taken place in the Japanese health care environment during the last 30 years from the point of view of the patient. In the U.S. the period after the Second World War was marked by increasing litigation concerning the outcome of health care, and this in turn created demand for second opinions and expert opinions in law cases. Hand-in-hand with this development came the concept of informed consent, i.e. that the patients had the right to know everything about their own condition and the type of treatment that they were receiving. By extension, this came to mean that in any clinical trial the patients not only had the right to know but had to know their condition and the type of treatment they were receiving. While the number of persons in metropolitan areas in Japan who wish to be fully informed about their condition has increased, questionnaires have confirmed that in rural areas there is an unchanging large amount (@40%) of patients who do not want to be told directly by their physicin. This raises the question of "right to know" actually "a duty to be forced to know" ? Furthermore, in the field of medical publications, which are essential for most persons in academic medicine who want to develop a career, it has become increasingly common to enforce the demands of the US litigation / health care environment on all those wishing to publish papers in international journals, the overwhelming majority of which are published in the United States. Reference is made to a recent study by the Council of Biology Editors concerning the questionnaire they distributed to their members. The results of the questionnaire favored the idea that it would not be correct for one country to impose its cultural values on all papers submitted to a journal submitted in that country. This paper also suggests that, in order to allow comparison of traditional oriental medicine such as acupuncture and western medicine such as drug treatment, and given the different cultural situation of various countries in Asia, they should develop their own ethical and compassionate approaches to the scientific elucidation of treatment effects without necessarily copying in every detail the present approaches used in North America.

著者

冨倉 光雄

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.15, pp.149-156, 1997-09-20 (Released:2018-02-01)

著者

内野 滋雄

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.15, pp.157-166, 1997-09-20 (Released:2018-02-01)

---

The history of dissection in Japan began in 1754 when Toyo Yamawaki dissected first in Kyoto. Later, many human bodies were dissected in various parts of the country during the Edo era, but all the cadavers were those that had been executed or died in a prison. The people at that time had a dark image that the dissection was performed on sinners. In the second year of Meiji, a thirty-four year old woman named Miki donated her body. She wished to be dissected after her death with her own will. Hers was the first body donation in Japan. Until World War II, cadavers devoted to the medical education were mostly from criminals, as in the Edo era. As, however, the human rights movement spreading throughout the country, it became difficult to obtain and dissect such cadavers and they became extremely short supply. After 1955, groups promoting body donation were formed in order to make up for the shortage of cadavers all over the country. Initially the groups were formed only to supplement the number of cadavers. But after 1975, donors became to think that it is their great contribution to the medical education and they can participate themselves in educating ethical and humanistic medical doctors even after they die.

著者

五十嵐 靖彦

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.15, pp.167-169, 1997-09-20 (Released:2018-02-01)

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.15, pp.170-172, 1997-09-20 (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.16, pp.12-23, 1998-10-01 (Released:2018-02-01)

---

It is not the purpose of this paper to give a new model or definition of health concept and to legitimate it, but to reflect critically on the way to use or investigate this tempting and puzzling concept. Recently health has ballooned to be very pseudohypertrophic. It is a synonym for happiness in respect of totality and ideality. After Kant, these concepts should not be used "constitutively", but may be used only "regulatively". Health measurement is an example of misuse. Another misuse is positive health, in which QOL is frequently stressed. Originally QOL has been used in the social sciences, the social policy processes, or in clinical practices for individual patients. Positive health, in addition, tends to apply QOL to healthy persons. This abuse is due to pseudohypertrophy of health concept; health as flourishing human life or self-fulfilment. In respect of health concept, from medical philosophy to medical ethics, from the clinical to the preventive dimension, the dual transition of our concern is proposed.

著者

丸山 マサ美

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.15, pp.26-32, 1997-09-20 (Released:2018-02-01)

---

This study analyses private papers written by women who underwent sterilization treatment. First a comparison is made with the model of E.Suchman who pointed out "illness behavior" and "stages of illness". How big is the pain of infertility as a result of the enormous stigma attached to the inability of giving birth to one's own child? The sense of desperation is followed by hope-and then desperation again and again. Why are children of any value? Because of a particular passionate desire of caring for and nurturing children? The medical procedures they underwent and the many "failures" they experienced are described. But they say, "If we lived in a world in which infertility is not seen as a 'disease' that can be 'cured', these technological accidents and experimental procedures could be avoided." That is, pressure from society can turn a fertility problem into a curse which provokes feelings of guilt, above all the desperate belief that, 'I have to try one more time, one more procedure.' : What is "illness", and What is the object of "treatment" ? After all, this study is an analysis of the content of papers concerning cognitive factors of illness behavior.

著者

関 修

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.15, pp.33-47, 1997-09-20 (Released:2018-02-01)

---

1. Medical Philosophy, Ethics and Problems of Homosexuality. The various concepts of sexuality were invented by psychopathology in the late 19th Century. In the DSM-III-R of 1987, homosexuality suddenly became normal from abnormal. However transgender remains an illness, as it was before. It is only a political problem. Another important problem is about AIDS. In Japan, there is discrimination between AIDS caused by medicine and AIDS caused by other factors. 2. Homosexuality as Thought : Situation of modern French Thought. In France, The "May Revolution" of 1968 caused the foundation of a new university : Paris 8th (Vancennes). One of its founders, Rene Scherer began his first lecture on sexuality in the faculty of Philosophy. His partner, Guy Hocquenghem, founded FHAR. Recently, Red and Black-Homosexuals in France after 1968 by F.Martel was published. However, Prof. Scherer has told me it is a defective book. 3. Thought of G. Hocquenghem : concerning homosexual desire. The originality of Hocquenghem's thought seems to lie in his idea of forming "a group of subjects" through the anus. The creation of relations among others by anality stands against ideas of couples. Being homosexual is not a means to attain self-identification, but a means to be out of self, to become a foreigner. It is also an escape to an infinite drifting from a stiff identity. 4. The Voice of M. Foucault : Homosexuality as a form of existence. Foucault's thought about homosexuality summarizes two points. First, to be homosexual is not correct ; to become homosexual is correct. He takes "gay" to create a new form of existence. Therefore, he does not think coming-out to be inevitable. Secondly, his problem is to begin to love among individuals. It means that "I" is more essential than sexuality. Here there seems to be fascination for passivity. 5. Conclusion : In Japan, they say "gay" is already out of fashion : now "queer" replaces it. However, such nomenclature is only a matter of fashion. To my regret, regular studies on gayness or queerness are not carried out in Japan. Now, it is necessary to study homosexuality as thought. That means to meet various thoughts not only to introduce and imitate them but to get involved in them : to have a mind of "hospitality". That is a critically needed task in Japan.

著者

宮越 一穂

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.15, pp.48-63, 1997-09-20 (Released:2018-02-01)

---

From America and Europe, there is a great abundance of reports of large-scale randomized clinical trials on various medical problems. They have brought important findings to medical practice. Such knowledge is available in all over the world, including Japan. However, in Japan, we have little experience of randomized multicenter clinical trials, and only a very small number of patients have participated in these studies during the initial period. There are still many diseases and many patients with intractable pathophysiological conditions, and many requests to relieve them or to improve their health, using high-level technology. Why do megatrials fail in Japan? While some have indicated that Japanese physicians have paid scant attention to or have had no experience of large-scaled, multicenter, double-blind, prospective, or randomized clinical trials. I would rather point out the following : we have the health insurance for all Japanese ; the coverage is for anyone, anytime, anywhere in the country, and for any type of conventional treatment ; so most Japanese individuals have little pressure to develop or to resolve medical problems. However, since the consultation time is only about three minutes, the physician does not have enough time to explain details on the clinical trial, therefore the condition of informed consent is poor in Japan. In addition, the peer review system has little tradition and there is no neutral powerful agent as the FDA. Consequently patients are not confident in physicians and the Japanese health care system in general.