著者

尾久 裕紀

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.64-71, 1997-09-20 (Released:2018-02-01)

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Ethical principales of medicine for physicians provide that a physician must have empathy with and respect for the "dignity of man". For example, the complete works of Hippocrates contain the following passage, "A physician must be impartial in his personal relations". This means that a physician needs to get along with the other persons even when there is a conflict of desires with them. Does a physician always deal with patients impartially in actual clinical practice? It is out of the question, if there is evidently a lack of fairness. But there are cases in which a physician lacks true fairness depending on the nuance of his words, although he appears to be fair formally. In this case there are several causes. In the presentation this time, we examine lack of fairness due to a physician feeling "disagreeable" toward a patient. Feeling "disagreeable" toward a patient may be devided into those cases when the physician himself is aware of it and those where he is not aware of it. For a physician to feel "disagreeable" toward a patient may be unavoidable since the patient-physician relation is a personal relation. In any case, this feeling is one of the causes for a physician to lack fairness to patients. For example, when a physician discloses medical information to a patint to whom he feels "disagreeable", the true meaning sometimes is not understood, or a distorted version is relayed to the patient intentionally or non-intentionally, even if the substance of disclosure is enough formally (or legally). Even when the same information is told in the same words, the way of relaying it and nuance can be changed by the "disagreeable feeling" toward the patient, and the inforlmation is understood quite differently by the patient. In this presentation, we study what situation also cause a physician to find a patient to be a "disagreeable person", whether it is against the ethics of medicine for a physician to feel "disagreeable" toward a patient and how a physician should deal with a patient impartially even when he thinks that patient to be a "disagreeable person".

著者

岡本 天晴 櫻庭 和典

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.72-84, 1997-09-20 (Released:2018-02-01)

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The massive earthquake that hit the Hanshin region in January 1995 caused 6425 deaths and over 40,000 casualties. Major public utilities were cut off, so medical practitioners found medical activities extremely difficult. Rescue operations by the self-defence forces failed to function properly. This disaster has called attention to the importance of Triage regarding medical services in such large-scale disasters. Triage comes from French, and was brought into English during the First World War, and was used in classifying the wounded. The definitions of Triage are 1. Classifying the injured by the seriousness of their external injuries or illness. 2. Deciding on the order of superiority for treatment. Let us consider the ethics of Triage from the following two aspects. a. The Means : In times of crises such as a war or a large-scale disaster,traditional medical ethics do not apply. Limited medical resources will mean that a capable Triage Officer should independently and speedily sort (i.e. triage) patients based on high-quality initial diagnosis, and decide on the order in which they will be treated. The ethics will be based upon the fact that Triage is the means for attaining the maximum happiness for the maximum number of people. The appropriatenss of the means will be subject to change depending upon the situation. Therefore Triage is a process modified repeatedly. b. Education : For an inexperienced doctor, it is an ethically difficult mission to classify numerous patients in a way that is different from daily practice. There are also doctors who emphasize that practice drills for medical services in times of large-scale disasters is aiding and abetting war, and that classifying numerous patients is inhumane. Doctors know little about Trige, and the general public is uninterested, so once a disaster strikes there is major chaos. It is therefore desirable to train capable Triage leaders and at the same time have the man on the street undergo training to be ready for large-scale disasters, and have an understanding of Triage. By doing this, disaster survivors will be aware that there are many patients around them whose treatment requires priority, and they will be able to engage themselves in volunteer activities or await their turn for treatment whih understanding. In this manner, it is possible to acknowledge the high ethics of Triage in neighbourly love, or regional unity, which is needed in times of large-scale disasters.

著者

花岡 真佐子 池川 清子

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.85-94, 1997-09-20 (Released:2018-02-01)

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Nursing techniques, unlike those developed in other field, arise and evolve out of interactive situations. The individually generated action performed in isolation, which, on a production line is appropriate, can be entirely inappropriate and ineffective where the question is one of care. In such a situation, therefore, the observer (the nurse) cannot handle the obsenrvee (the patient) in a mechanical fashion, as if the latter were not a sentient being but merely an object. It follows that the nurse's perceptive capabilities and judgment play a decisive role in the appropriateness and effectiveness of the techniques she or he employs. The nurse's perceptive modes must thus be examined. Living necessitates humans to maintain a constant relationship with the surrounding environment. The recognition and interpretion of and reaction to sensofy stimul are inherent features of this relationship. It is perception that establishes mutual relations between human being and his world, hence perception is crucial to nursing acts. The links existing between the various perceptive modes and the surrounding environment, together with the incorporation of such information into students'clinical training, form the subject of this paper.

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.15, pp.107-118, 1997-09-20 (Released:2018-02-01)

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From an experience of more than twenty years in undergaduate and postgraduate education of medical ethics and bioethics, the author discussed the following four problems. 1. Eduation of bioethics should be started as early as possible by parents and kindergarten teachers, and should be followed by primary and secondary school teachers prior to medical education. 2. During the past twenty years, almost every Japanese including medical students became very familiar with medicoethical and bioethical issues arising from new medical technology. However, education on citizens' everyday ethics and pupil / students' ethics are more important than medical ethics relating to modern topics such as euthanasia, in vitro fertilization, organ / tissue transplantation and so on. 3. When, by whom, where, in which stage of the curriculum, in which style, on what kind of topics, medical ethics education should be done, are all very difficult questions to answer, However, the author have reached the following answers. (1) The effect of lecture style education on medical ethics in a large lecture hall, especially in the preclinical course is very limited. (2) Small group discussion on everyday clinical practice is more important than a systematic lecture. (3) Everyday ethical and humanitarian behaviors of all practitioners to the patients and their families are more important than lectures by famous professors. 4. Why Japanese physicians show less concern about medicoethical and bioethical issues was discussed. Some of the reasons are : (1) It results largely from a cultural difference between Euro-American countries and Japan. (2) Japan is too legalistic country in which most behavior of the people is regulated by laws, most of them enacted in the 19th century, rather than by medical ethics and bioethics. (3) Medical practice in Japan is typical Managed Care controlled by government and National Health Insurance Laws. For most physicians it is rather rare to find an opportunity of ethical decision-making. (4) The Physician-Health Insurance Law relationship and patient-government relationship are very often more important as well as more powerful than the patient-physician relationship in Japan. (5) Medical education in Japan both in pre- and postgraduate courses is a typical School Medicine or University Medicine which places too much attention on medical science and modern high-technology, respecting less the humanity, human dignity and interests of the community.

著者

渋谷 健

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.119-134, 1997-09-20 (Released:2018-02-01)

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It has been said there is a mutual understanding between doctors and patients, established through confidence in the doctor-patient relationship. As a result there are usually few medical conflicts on treatment and policies, despite the fact there is no actual formal informed consent. Recently however the position of the patient requires more consideration than previously when providing medical care. No doubt a portion of this increased sensitivity stems from the Nuremberg Principle of 1947 and "The Declaration of Helsinki" adopted in 1964. These credos require physicians to seek peace and give the highest priority to the well-being and happiness of human beings, and certainly their patients. I intend to bring forward in my philosophy of medical ethics issues of QOL (Quality of Life), Medical Ethics, Human Rights and Equality, and renewal. I will discuss the necessity of informed consent and the need to harmonize at a global level many of these issues. Reference will be made to historical considerations in the establishment and preservation of the Japanese view of ethics and philosophy, a comparison of Japanese and Western viewpoints, the purpose of the "Declaration of Helsinki", and these issues as they impact in new drug development during clinical trials.

著者

牧野 尚哉

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.135-136, 1997-09-20 (Released:2018-02-01)

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.14, pp.156-158, 1996-10-01 (Released:2018-02-01)

著者

池川 清子

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.14, pp.159-162, 1996-10-01 (Released:2018-02-01)

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Studies during the long history in Nursing have fostered specialized knowledge and techniques through various health care models. In the early days we can find the primordial forms of nursing in ancient diaita (greek word for health related Iifestile) aimed at arranging human life in response to nature. Forms of health care from the middle ages to early modern era in Europe had been meant to be the diaita as health practice which was rooted in an individually oriented thought based on "six nonnatural practice-sexeres non naturales. However, as the diaita in the middle age model gradually declined, this theory based on the power of natural healing lost its influence to studies of nursing and as the result it gave the way to the modern medicai models based upon theories of biologicai mechanism. Due to the methodological change to biological medical model in health care, diaita seemed as if it had disappeared from the historical scene. However,at the turning century we gained Nightingale who recovered originally intended meanings of nursing care. Nightingale found the fundamentals of health care in relation to the healing power of nature for human beings and thus it becomes imperative for caring people to prepare environments in responding to the needs of those who are cared for.This means that the fundamentals of health care should be based on the basic trust in natural healing power inherent in human beings. However, from the early twentieth century, the biological model of medicine became overwhelmingly influential and thus studies of nursing have been dealt with in relation to the scientific model of problem and solution. As the result it has been exposed to the situation of manipulative and mechanical principles in science. I would like to investigate the fundamentals of health care by studying ancient diaita and then to inquire into various problems derived from scientific models of health care severed from practical insights of humaneness. I would also like to clarify the future tasks of health care.

著者

川口 孝泰

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.14, pp.163-168, 1996-10-01 (Released:2018-02-01)

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With the rapid improvement of science and technology in recent years, Japanese hospitals are increasingly employing high-technology equipment.This gives rise to such issues as the necessity of obtaining informed consent and the quality of life in the hospital environment and is taking place against a background of increasing self-assertiveness on the part of health-care clients.There is a necessity for increased self-management and medical understanding on the part of health clients. Self-care is an important factor in effective care as well as an aid to the effectiveness of nurses. However, given the sociocultural context within which health care is delivered in Japan, issues such as "informed consent" and "quality of life" encounter obstacles as soon as they are raised. In this sociocultural context, the very fact of being "committed" to a hospital engenders a sense of fatalism and pessimistic expectations on the part of the patient. Moreover, patients in this cultural context are willing to surrender responsibility for their lives to medical staff members, while doctors and nurses have reciprocal expectations. In this symposium we argue that is necessary to focus on these problems from the perspectives of both the therapeutic and health care communities.

著者

桝形 公也

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.14, pp.169-173, 1996-10-01 (Released:2018-02-01)

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The rationing of health care resources is identified as "the most important ethical issue" facing health care today. Economists divide the allocation into two levels, namely macro-allocation and micro-allocation. The former is the problem of apportioning of money among social needs, for example, for health care, education and military affairs. The latter is the allocation of health care resources at the level of the hospital. Advances in medical technology are the main factor contributing to the enlargement of medical needs and according to it the cost of health care has rapidly increased and there is no natural limit, as Daniel Callahan says, to the development of medical needs and technology, but the resources are limited. The problems concerning which principles we can apply to allocate limited health care resources present difficult questions concerning social justice.This issue may threaten the integrity of health care professionals and sacrificie care needs. This problem should be solved on the basis of a double integrity system, namely that of patients and the health care system, and for that reason the role of nursing professionals is very large.

著者

奈倉 道隆

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.14, pp.174-176, 1996-10-01 (Released:2018-02-01)

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.14, pp.177-179, 1996-10-01 (Released:2018-02-01)

著者

品川 信良

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.14, pp.180-181, 1996-10-01 (Released:2018-02-01)

著者

遠藤 正樹 阿萬 由起子 大倉 民江

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.14, pp.57-68, 1996-10-01 (Released:2018-02-01)

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Medical social workers have to meet a wide range of needs of patients and their families as citizens and persons involved in the total daily medical care. Especially in transplantation treatment the existence of social workers is indispensable for helping patients with their own decisions for their own benefit from psychological and social viewpoints. In actual team medical care, it is important to promote the medical staff 's further understanding of patients with regard to the advocacy and respect of their own thinking from the standpoint of a third party. The role and importance of social workers in transplantation treatment is discussed, torough a case the authors were involved in, by examining the process of self-decisions by a patient and his family. The actual case here was a patient who, as a citizen, desired a heart transplant after many years of fighting against diastolic cardiomyopathy and succeeded in receiving it in the United States. The importance of medical social workers has not been fully recognized in Japan. As a result there is still a persistent shortsighted view that their role is no more than to exhort and persuade patients in response to their complaints. This paper discusses and tries to define the differences in roles and specialties between transplant coordinators and social workers as the key persons in transplantation treatment on the basis of the actual case and a field report on the actual heart transplant in the United States.

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.14, pp.69-80, 1996-10-01 (Released:2018-02-01)

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In Japan the law obliges employers to carry out an annual Health Check-up Examination for their employees. This may be effective for early detection and prevention, but could be an excessive intervention in rights and liberty of individuals, because the result of screeing is used not only for medical services, but for personnel management. Indeed no ethical problem has occured in the case of occupational diseases; nowadays the main target of workplace prevention is, however, non-occupational, chronic diseases, which are to a great extent relative to each individual private life or genes. Informed Consent is generally neglected, or rather ignored. And the priority of various alleged 'compehensive, total' health evaluations to the traditional, which has had to do with physical states of employees, is overestimated. Both in principles and in methods these should be reexamined. The socalled healthiest state is the self-realization. In this sense, health is a synonym for happiness, which is merely ideal. Not the constitutive, but the regulative use is appropriate for an ideal concept. The extent of self-enrichment or -fulfillment of each employee should not be evaluated in the workplace. The dogma of 'positive mental health', commands employees to strive for a higher, maturer mental activity. This is a mirror of shameful, discriminatory stigmatization against the mentally ill.

著者

本田 勝紀

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.14, pp.107-120, 1996-10-01 (Released:2018-02-01)

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In Japan, medical and social consensus on why brain death is the termination of human life? has not been obtained since the first heart transplantation by Dr. Wada in 1968. Discussions were concentrated on the diagnosis of brain death of an alive drown donor and operational indication (with the technical problems) of the recipient patient.Historically patient rights have not been established in medicine in Japan, so we studied 8 kidney(1 pancreas) transplantation cases from brain-dead patients including Tsukuba case* based on newspaper informations for these 10 years. The basic diseases were:brain contusions 4,subarachnoidal bleeding 1,a bee-toxin shock 1.cerebrovascular disease (dementia) 1,and unknown 1. The finai explanations on the critical conditions were:will soon die 2,near brain death 3,brain death 2,and unknown 1. According to the most authorized Takeuchi report on Brain Death, the concept of brain death is just clinical,and the definition is irreversible dysfunction of total brain. Indeed, many reports on brain-dead patients demonstrate that they are not dead, because of body movement (spinal nerve action), secretions of pituitary hormones, alterations of brain Xray-findings, and delivery of brain-dead pregnant women. By analyzing of our cases, we summarize that (1)before brain death was djagnosed, almost all families were told that patients would soon die, and the main subject of treatment was converted to preparation for transplantation. (2)the most ethically important problem was found in Tsukuba case, which showed the discrimination of psychohandi-caped patient in consent and treatment policy-abandonment of resuscitation. Obtaining no chances of discussion with those doctors, we accused the operators and neurosurgeons as committing murder of the donors, but still now, no decision for or against criminal prosecution has been announced these 10 years

著者

シッパーゲス ハインリッヒ 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.14, pp.121-136, 1996-10-01 (Released:2018-02-01)

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"Medizin in Bewegung" ist die Gesammtbenennung einer anthropologisch orientierten Heilkunde, die in den 20er und 30er Jahren von den grossen Lehrern der Heidelberger Klinik in Gang gesetzt und in Unruhe gehalten wurde and der spanische Medizinhistoriker Lain Entralgo den "Durchbruch eines neuen Weges in der Geschichte der Medizin" kennzeich-nete und schon im Jahre 1950 "Heidelberger Schule" nannte. Dem Wortsinne nach bedeutet "etwas in Bewegung": dass etwas angelaufen war, in Fahrt gekommen ist, aber noch nicht ans Ende gelangen konnte, so dass wir uns noch in einem "Durch gangsstadium" befinden. Die Medizin steht ja - in Praxis wie Theorie - "in dauernder Bewegung". In Bewegung geriet die moderne Medizin nicht nur durch eine ganze Serie von atemberaubenden Techniken, sondern auch durch eine Reihe von kompensatorischen Bemuhungen um die psychische Seite and die soziale Schicht der Krankheit. Damit verbunden war ein neues arztliches Denken: Es ging jetzt weniger um die Erforschung der Ursache von Krankheiten als urn eine neue Beziehung zum Leben and zum Leiden des einzelnen Kranken. Drei Personlichkeiten werden uns in dieser "Heidelberger Schule" immer wieder begegnen: Ludolf von Krehl(1861-1937), sein Kollege Richard Siebeck(1883-1965) und deren Schuler Viktor von Weizsacker (18861957). Wir sind heute uberinformiert an einem enormen Verfugungs wissen, aber verkumert an Orientierungswissen "Seit dem Anbruch der Neuzeit sind die Volker reich an Wissen, Gedanken, Erkenntnis, aber arm an Weisheit", sagt Viktor von Weizsacker. Weisheiten aber vermitteln uns kaum noch die Wissenschaften. Weisheit haben wir aus anderen Quellen zu suchen: in den Bekenntnissen der grossen Philosophen, der Kunstler, der grossen Glaubenden aller Volker und aller Zeiten. Eingeordet in das dynamische Spannungsgefuge zwischen Verwurzelung und Entfaltung mochte ich hier drei charakteristische Momente der "Medizin in Bewegung" zu bedenken geben: 1. Die Heilkunde als eine Philosophie des gesunden und kranken Leibes; 2. Die Heilkunst als eine Wesenslehre der erkrankten Person, und 3. Die soziale Wirklichkeit des Patienten und damit eine Medizin der Mitmenschlichkeit.

著者

南 裕子

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.14, pp.137-140, 1996-10-01 (Released:2018-02-01)

著者

溝口 純二 大川 貴子

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.14, pp.141-146, 1996-10-01 (Released:2018-02-01)

著者

竹崎 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.14, pp.147-151, 1996-10-01 (Released:2018-02-01)