著者

片田 範子

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.14, pp.152-155, 1996-10-01 (Released:2018-02-01)

著者

曽我 英彦

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.13, pp.174-177, 1995-10-01 (Released:2018-02-01)

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The notion of "informed consent" appeared recently as an ethico-medical term. But the concept is not new. Where people want to live peacefully with others consent has always been indispensable, and there could be no consent without information. Why is the term "informed consent" now the topic of discussion" ? This term suggests that modern medicine based natural science has lost humanism and regard recuperation. In spite of infestation of Paternalism, professional arrogance, pursuit of commercial benefit etc., not a few medical professionals live still in the illusion that the medicine were the representative system of humanism. There is another illusion that a patient could give consent as a free and independent individual. From the illusion comes the self-determination right of patient in his health care. If a individual were realy independent, is'nt "informed" consent self-contradictory? The informations given from doctors are often onesided and patients can be biased or even forced to give agreement. This kind of agreement can not be real and ethical consent. So long an individual were absolute independent there can be no consent but antagonism. Modern western philosophy established by Descartes stands on individualism or egoism. As an idea or a symbol of liberation of people from dictators, it had historical significance. But is any one realy absolutely independent and free? This question was already possible British empiricists. Hegle and Marx asserted that the free individual, thought to be a independent, self determining substance, cannot release himself from the contradiction of self-alienation. Husserl's Intersubjektiv and Watuji's Ningen (human relation in itself) suggest that a person can only be himself in a community of mutual dependence. This thought to one of the fundamental principles of Buddhism. The subject of the consent is not an individual, neither physician nor patient, but a community of physician-patient relation based on mutual trust and information. So the consent in this meaning or, in other word, accord is the principle of not only medical but universal ethics.

著者

岡本 天晴

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.13, pp.178-181, 1995-10-01 (Released:2018-02-01)

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"Informed-Consent" is a concept which has been developed and is functioning at the medical world in the United States. The concept is the patient-centered, valuing the rights of patients. On the other hand, the medical concept in Japan has still been based on so-called "Paternalism" which regards all the medical acts of doctors. People in general in this nation are indifferent mainly because of the lack of public awareness, and prevailing traditional attitude-undirected doctors and dependent and patients. Much discussion in Japan on the matter these days seems rather superficial, without solving the basic problems, there are differences of Japan-American culture, educational system, quality of medical treatment etc. On introducing and practicing "Informed-Consent" to Japan, as a Buddhist philosopher, the another feels the necessity to preserve "trust and empathy-relationship" between patients and doctors by gradual attitudinal change on both sides. My concern is result of the overly rapid introduction of the idea which may lead us to social problems seen in the States such as constant legal disputes overemphasizing the rights and duties of the medical treatment. The another therefore, calls the attention of medical practitioners to re-evaluate the Buddhistic concept of "Hohben (Sk.upaya)" which implies acts of "Deep Wisdom and Compassion" on the doctors' side to guide patients mentally and physically.

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.13, pp.182-187, 1995-10-01 (Released:2018-02-01)

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Recently in the field of health care in Japan, as in other countries, there is increasing number of people below that every person has a right to self-decision concerning health can, so that no medical intervention may be carried out without voluntary and informed consent. This argument is, of course, valid and persuasive, at last theoretical. However once we apply this principle to each and every case of health care, we immediately confront some difficulties. Because medical case has infinite variable, and in many cases we cannot forefully obtain free and informed consent. In the first half of this paper, we consider the theoretical and historical validity of the informed consent principle. In the second half, circumstances which make it difficult to take care of patients in accordance with the concept of informed consent will be pointed out.

著者

矢次 正利

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.1-3, 1996-10-01 (Released:2018-02-01)

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.14, pp.4-14, 1996-10-01 (Released:2018-02-01)

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Problems concerning the "mind" are now commonly discussued in various fields. The "mind" is an important factor in the issues of informed consent and terminal care and has always been one of the main themes in philosophy. Trials to scientifically clarify the relation between the mind and the brain have recently been initiated. This paper first states that it is necessary for us to employ a new philosophical concept in evaluating the results of brain research in molecular physiology, because the terms and systems used in this area are too old and inadeqete. Secondly, it is shown that there is a possibility to use some old philosophy approaches such as Augustinian philosophy in thinking of the present mind problem, if the re translation of the terms could be suitably made and the structure of his idea could be clearly understood. Lastly, applicatlon of the analysis by Angustine was made in practice to analyze the mind connections of medical staff, patients, and their families, and it shows that the understanding of the mind structure by Augustine is effective even in the modern medical field. This paper deals only with basic principles, but the author believes that the time has come to try to combine three areas, that is, the scientific research of the brain, the problem of the mind in philosophy, and actual mind problems in the medical fields.

著者

中里 巧

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.15-23, 1996-10-01 (Released:2018-02-01)

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Preface There two main factors of the European metaphysics of philosophical thinking: the first has been to think through experience even though the ideal thoughts should have a main position, the second has been to seek to know the self, just as Socrates did. However the Japanese researchers do not necessarily have such academical tendencies, when they try to read and understand European philosophies. Clinical philosophy, the elements of which should be the experience and the self, can be constructed and practiced by us in every day iife. 1. Death and the Dying The German sociological researcher Franco Rest asserts that the concept of death is unthinkable and only the concept of dying is thinkable. Because dying is the terminal part of an entire life. But this is not correct. Through ideal histories of care we can see that life and death are complementary. We must treat such a complementarity as a most important idea. when we think of what expenence is. 2. the Existential-Romantic Medicine Oliver Sacks. whose book Awakenings is very famous, proposes a existential-romantic medicine. He says. " this is the rationale of an 'existence' therapy: not to instruct but to inspire to inspire with art to combat the inert. to inspire with the personal and living, and, in the directest sense possible to awaken and quicken ". Existential-romantic medicine is directed to the personality, the freedom, and the identilication of the patients in the dialogue between the living I and I through the daily experience ofthe daily life. 3. Clinical Philosophy The clinical philosophy may be the tradition of the European metaphysics. At the same time it should be the possibility of thinking about human living concrete and the power of the healing.

著者

花岡 真佐子

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.34-45, 1996-10-01 (Released:2018-02-01)

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Due to the practical features of nursing is inevitably involved in techniques. In other words in trying to enhance the quality of human life, people have performed techniques of nursing since ancient times. The acquisition of basic techniques in nursing, therefore, became a core of nursing education. However, in previous educational methods, technical patterns and handling were imitated repetitiously. According to Max Weber, acts must be distinguished from behavior, for the former signifies purposively oriented meanings while the latter does not. If we try to characterize the previous nursing method based on Weber's way of thinking, it can be said that the method is basically understood in relation to behavior. However, nursing techniclues should be directed at enhancing the quality of human life and therefore, the whole comcomplex system of nursing must be involved in acts signifying purposefully oriented meanings. In the earlier stage of learning of nursing techniques, students who lack knowledge the meaning of techniques tend to show mechanical and repetitious behavior. In the first stage of clinical training, students are not conscious of the meanings of technical acts and therefore are preoccupied only with the handling order of techniques. However, once they become conscious of the real relationship between clients and themselves, the purose of clients' lives is clearly acknowledged. Based on the above mentioned, I would like to clarify the relationship between acts in nursing techniques and purposes, reflecting on the learning process of nursing techniques in clinical training.

著者

松山 圭子

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.46-56, 1996-10-01 (Released:2018-02-01)

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Medicine has discourse space filled with exchange and interaction between professionals and laypersons. How do Newspapers and magazines treat medical discourse? There have been many changes and controversies concerning cholesterol. After World War II cholesterol was considered to be a bad substance which generates atherosclerosis and should be lowered. However public health researchers showed that cerebral apoplexies among Japanese (specially farmers in rural district) occured because of the low-cholesterol in the blood. This result contradicted cardiologists' advice and the common sense. So the controversy started and continued. In newspapers and magazines either articles supporting the common sense or opposing ones appeared. There have been no articles dealing with both opinions of this controversy. From a point of view low-cholesterol in the blood as a risk factor of cerebral hemorrhage was shown after a progress of medicine. But from another point of view public health researchers could not overlook cholesterol, the substance in fashion. And the medical fashion of worrying about cholesterol has spread all over the country.

著者

酒井 明夫

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.13, pp.123-131, 1995-10-01 (Released:2018-02-01)

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In the history of medicine, some periods can be divided by the change in the physician's role concerning the course and prognosis of disease. In ancient times, the principal factor in determining the prognosis of a disease shifted from divine or supernatural forces to natural principles that were advocated by the authors of the Hippocratic corpus. During this period when both physician and patient maintained their relationship in account with natural principle, prognosis was so heavily dependent on natural forces that the physician's role was limited to a supplementary one. After a long medieval period, the physician's role underwent a change from advocacy to subjugation of natural principles. In the eighteenth century, as Foucault indicated, the old clinic was replaced by anatomically articulated medicine. With this change, the age of paternalism came, sustained by the clinical effectiveness of the physician's experience and skill. However, as biomedical knowledge was accumulated and enhanced, people's expectation and confidence moved from physician's skill to the corpus of biomedical knowledge, that actually controlled the outcome and prognosis of disease. The concept of informed consent, first introduced on October 22, 1957, not only signified the epochmaking addition of the patient's will to the decisive factors for outcome and prognosis of disease, but also reflected that the physician's role hand become that of a catalytic agent between the sum of medical knowledge and patient. The introduction of informed consent, on the one hand, eliminated the physician's image as representative of healing, and on the other hand, gave the contemporary physician a new task, the investigation of the patient's uniqueness and the formation of a comprehensive notion of the clinic in the context of the physician-patient relationship.

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.13, pp.132-139, 1995-10-01 (Released:2018-02-01)

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The concept "consent" and "同意-doi" in the concept of the informed consent are discussed. Studying this point may constitute one of the angles from which to clarify the question, "What is informed consent ? " Firstly, the words "consent" and "同意" were each studied as to their meaning. By showing the connotation and denotation of the "同意" first and then the connotation and denotation of the "consent, we clarified the difference between the "同意" and "consent" and something in common with each other. The word "同意" in Japanese has diverse meanings and ambiguity and is often used in ways far removed from its original meaning. It has less of the "positivity" and "directivity toward others" inherent in the word "consent". In this respect, the word "同意" is rather close to "assent" that is of sensitivity admitting no reason. Secondly, the "同意" is a thing that arises in relationships between people, so the personal relations in which the "同意" is effected were studied. Japanese essentially give more precedence to the personal relations than to the self. This could give rise to the "同意 against one's will" and "the '同意' not with the substance of the issue but with the other party". In short, the meaning of the "同意" is primarily based on the other person being Japanese and is acceptable only in that context. In thinking about what informed consent is, all arguments will lose sight of the direction, if no thought is given to the original meaning of the word, culture that gave rise to that word and characteristics of the place from where that word was imported.

著者

川越 厚

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.13, pp.140-145, 1995-10-01 (Released:2018-02-01)

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In modern medicine, diseases are not apt to be dealt with as a whole but only as a part. Illness, which emphasizes a patient as a whole with sufferring, needs cares which bring him a total healing as a man with dignity of life. The definition of the terminal stage of cancer differs from man to man, but the decision should belong to the right of autonomy of the patient himself. Dr. C. Saunders, a founder of modern hospice, described the principles of hospice cares sa follows. Firstly, hospice care should be aimed not to cure but to care which brings the patient comfort. Secondly, palliation should be done only for symptom control, mainly for pain relief. Thirdly, individual care for patient and his family should be devoted. Lastly, the care should be carried out by multidisciplinary care team. Home hospice, which enables the patient to receive hospice service at home, is not the matter of place but it includes an essential problems, namely, whether the patient can keep on the host's position of his own life or not. Domiciliary hospice thus brings about total care for the patient and the family.

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.13, pp.146-149, 1995-10-01 (Released:2018-02-01)

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Many problems emanate from the modern science and technology that laid the foundation for modern medicine. They generally tend to lose whole system or balances compared with previous period. Even in the most advanced sphere of medicine we encounter the limits of modern science in two directions which we will examine as follows. First, we should restore the real definition of illness which appears to have been lost in modern medicine, second, to retrieve the wholeness of mankind from the dualism of humans having separate dimensions of mind and body. When we talk about the idea of illness, we ought to presume simultaneously what health is, or what health means, and not be allowed to illness as an exceptional issue with regared to health. For we have a gift for spontaneous recovery as Hippocrates once commented. Moreover, we must clarify the biological and philosophical structure of life itself and flou mind effort in the area of preventive medicine. All human illness must be based on the idea of "mind-body interaction" only on which healing could be realized. Particularly we must appreciate the patient as a real individual to whom philosopher since Descartes could not attain in proper meaning, because even the same disease appears with different symptoms in different patients. In order to closely new aspects of real individuals, we should evaluate the ethical relationship between patient and physician in which dialogue plays an important role, and narrative contexts or temporal axis for this purpose are very valuable J. Dewy mentioned that morality is a continuing process not a fixed achievement.

著者

石渡 隆司

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.13, pp.150-154, 1995-10-01 (Released:2018-02-01)

著者

小山 千加代

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.13, pp.155-159, 1995-10-01 (Released:2018-02-01)

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This article presents the author's statement in the symposium on "Disease and Healing", that medical care based in Western medicine tends to cure the disease alone, but dose not care for the sick as a whole. Man is mortal, destined to age and sometimes falls ill. Besides cure, man needs care of others. As nursing has its origin in the mother-care of helpless infants, it is related to the care of all humanity. It has extended its functions of taking care from the sick to the aged, the helpless, the handicapped and so on. Historically speaking, however, it used to be believed that sick people were a type of convict and should be discriminated. It was not until the nineteenth century that the distinction between being ill and illness itself was established, because of the development of not only Western medical science such as pathology and bacteriology but also the idea of human rights. Sick people retrieved their honor, but at the same time, only disease became cured. The sick themselves did not recovered from the illness in some cases. Nowadays, human being faces the problems of advanced age. Even though man is mortal, man must live a life worth living. The role of nursing should be broadened. If there are persons who need any help physically and mentally, nursing must give a hand to take care of those persons although they may be dying, so that they are able to heal themselves at least mentally during their life.

著者

谷 荘吉

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.13, pp.160-163, 1995-10-01 (Released:2018-02-01)

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In hospice care practice, it is very improtant to recognise the real meaning of imformed consent concerning telling the truth of the status of the disease to the patient. The another discusses the merits and demerits of imformed consent in terminal care practice.

著者

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.13, pp.164-168, 1995-10-01 (Released:2018-02-01)

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.13, pp.169-173, 1995-10-01 (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.13, pp.1-7, 1995-10-01 (Released:2018-02-01)

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According to Viktor von Weizsaker, medical anthropology intends to introduce subjectivity into biology and medicine, but human disease is more than objective facts. Every human existence has to be regarded as a moral being and any illness essentially belongs to that person. Man is homo patiens. The differences between the mathematical or physical and the biological concepts of space and time are very important. In the perspective of von Weizsakers Gestalttheorie the living organism does not move itself in space and time but move the space with time. In regard to the ontological equivalence of body and soul it is not possible, for example, to speak of psychogenesis of angina pectoris. The concept of causality is in general too limited and total to understand the suffering man and his disease. The law of life is based on a ground relationship (Grund-Verhaltnis). Subjects and objects belong together, the biological phenomenon-like disease cannot be understood merely as an object without subject. The holistic approach is important for the relationship between physician and patient. The grounds of life cannot be known, and it is not the object of science. Both to become healthy and to become ill are based on the basic relationship, i.e. the relation of life to its grounds.

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.13, pp.8-15, 1995-10-01 (Released:2018-02-01)

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The tendency to deal with the human body as an object has deeply permeated modern medical practice. In the area of nursing and care, I find no exception. However, if we carefully observe our body, we become aware that our hands encounter with each other as we hold out or withdraw them together. Nurses interact with many people including patients in the clinical situation. They can act first by using their body. There is no act without(the use)of the body. The basic attitude of the nurses in dealing with others is to act with consideration(or thoughtfulness)named 'care'. The nurses read patients' condition with their own sensitivity, then they make decisions as to what sort of physical help they could give. This situation does not imply a one-way relation between nurses and patients through their own intention or act. It indicates a condition of coexistence, affecting one another in a certain way through the action of both the nurses and patients. This also does not imply a man-thing relation. It is an intersubjective relation sensed through each other's body. I hope to search for the meaning of suffering by describing the intersubjective process derived from the encounter with a patient with illusionary leg pain as a methodological path with the idea that the human body is not at all an object in clincal reality. Furthermore the ultimate goal of the report is an attempt to overcome the duality of mind and body in medical practice.