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.9, pp.141-144, 1991-07-31 (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.9, pp.145-147, 1991-07-31 (Released:2018-02-01)

著者

尾崎 恭一

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.10, pp.12-24, 1992-10-23 (Released:2018-02-01)

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In the discussion on informed consent, we find some doctors may think they should not give patients some information, even if the patients think it indispensable. And vice versa. This results from moral gaps. Therefore, informed consent needs to bridge moral gaps. L. Kohlberg points out gaps among developmental stages as well as among ideas about values. He suggests bridging the former by making the latter comprehensible to all concerned. However, doesn't the person on the higher moral stage think the lower inmoral? No, according to Kohlberg, because the higher moral stage includes the lower stages as reintegrated components. But K. Wilber criticizes Kohlberg saying that the higher moral stage doesn't include the lower, unlike the higher cognitive stage. Which is right? In order to answer this question, I investigated the relation among stages and sent out questionnaires. Theoretically speaking, the higher moral stage doesn't include the lower stages, because unlike cognitive stages, moral stages don't have only cognitive structures, but also content formed by the structures, namely, the meaning of roles as human relations. The higher moral stage includes the lower cognitive structures, but no lower social meanings. Thus the morally higher person won't discuss things on the lower stage. Therefore, to bridge these moral gaps is possible only by raising the lower people up to the higher stages. And the higher stage 5 is easy to reach for adults, because they have already reached the cognitive stage necessary to reach moral stage 5. Furthermore this stage itself enables moral development by promoting role-playing, another antecedent of moral development. And my questionnaires also show that stage 5 can bridge moral gaps. Thus the discussion for informed consent must be based on moral stage 5. Concretely speaking, hospitals should offer not only doctors but also patients as many chances to participate in their everyday decisions as possible.

著者

森 忠重

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.10, pp.25-45, 1992-10-23 (Released:2018-02-01)

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The role of personalized treatment has always posed problems in considerations of Japanese medical history. Japanese medical treatments in medieval times were inextricably related to Buddhistic and ethnologic factors, just as European medical treatments were to Christian factors. To be more exact, Japanese medicine was almost totally influenced by Buddhism. The problems, however, exist in determining why medical treatments became Buddhistic or ethnologic, and how they became personalized. Wherever ideological paradigms were corrupted, naturalistic medical treatment would supplant the then existing personalized treatments. In this thesis, such replacement processes are traced back and considered in terms of the exorcisms and maledictions performed in esoteric Buddhism, relief measures taken for leprous patients, clinical examinations of the death of human beings, and in sensitivity to death in literary and religious terms.

著者

松島 哲久

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.10, pp.46-56, 1992-10-23 (Released:2018-02-01)

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The aim of this paper is to look for the ways the medicine of today might take root in the fundamentals of life, that is, in terms of environmental ethics. Highly technological medicine should be grounded in such fundamentals if it wants to be medicine for human beings. But in order to reach this goal we must consider the ambiguity that is intrinsic in bioethics. On the one hand, the historical current of ethics, according to R. F. Nash, is irreversibly expanding, taking the relevance of ethics out of itself and beyond its egocentric viewpoint. Bioethics should be also placed in this stream, so as to admit the rights of nonhuman beings. On the other hand, applications of high medical technologies cause us to restrict the boundaries of our humanity, and this brings about various difficult problems for bioethics. We should attempt to get over these difficulties by proposing a new medical system based on a self-organizing system. It must be open to all other social systems and would make possible the fundamental communication between the self and the other. To realize this system, I think, it is necessary to establish a new ontology that requires us to transcend anthropocentric ethics and to discover the continuity between nature and humanity.

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.10, pp.57-70, 1992-10-23 (Released:2018-02-01)

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At first in this article I consider the ethical aspects of the mutilation of a living donor's healthy body for renal and liver transplantation. Transplantation can be permitted ethically with two catholic ethical principles, that is, the principle of totality and the principle of double effect. However, to perform transplans a balance between donors' risks and recipients' merits is necessary. For this reason, the following requirements should be satisfied. 1) These transplantations should be permitted only in cases where you have no alternative method for therapy. 2) These transplantations should be permitted only in cases where you have a therapeutic possibility of success. For this reason, ・ It is necessaly to limit them to appropriate medical centers. ・ It is necessary to select donors and recipients strictly. 3) It is necessary to reduce the risks of death for donors to a minimum. 4) It is necessary to make sure no pressore is applied on the prospective donor's during the decision-making process. 5) It is necessary to get clear informed consent from both donors and recipients. Especially in cases of liver transplantation, you should open the process of informed consent in principle. 6) It is necessary to prohibit the buying and selling of organs. 7) It is necessary to resolve cost problems, especially for liver transplantation. 8) It is necessary to require strict morals among medical staffs.

著者

大林 雅之

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.10, pp.71-79, 1992-10-23 (Released:2018-02-01)

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The study of genes, with the development of molecular biology, raises ethical issues in the basic and applied life sciences, including biotechnology and biomedical sciences. The ethical issues are connected with recombinant DNA experiments, the Human Genome Project, experiments on organisms with recombinant DNA in the field, gene diagnosis, gene therapy, etc. In this papar, I am particularly concerned with the structure of ethical problems in gene therapy and I consider it in terms of the biological meanings of genes. Ethical problems in the study of genes at the molecular level have occurred today because we can manipulate genes directly. However, when we know the biological meanings of genes, it is not easy for us to manipulate genes from the ethical point of view. The gene has three meanings: (1) It is the product of evolution, (2) It is what creates the identity of each human being, (3) It is the source of the continuity of the human species. Therefore, gene manipulation is connected with individual problems, the relations among generations, the problems between human beings and the ecosystem, and the whole world of organisms. When we consider the ethical problems in human gene therapy in terms of the three meanings of genes, we can see new problems concernings gene therapy as follows: Can we avoid the problems which appear among generations even if we can practice gene therapy not with somatic cells but with germline cells, given meanings (1) and (3) ? Moreover, will gene therapy exacerbate problems connected with the evaluation of genetic information for each person in terms of eugenics, given meaning (2) ?

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.9, pp.15-28, 1991-07-31 (Released:2018-02-01)

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Psychoactive drugs - e.g., antipsychotics, antidepressants, antimanics, anxiolytic sedatives - are now widely prescribed in industrialized countries. However the misuse and frequent over-use of these drugs, especially the tranquilizers, has often been discussed in the extant literature. While the public's understanding of the negative aspect of taking psychoactive agents has become more widespread, physicians (not only psychiatrists) often remark that there is a tendency on the part of patients to demand and acquire these drugs by exerting great pressure on physicians for whom it is often difficult not to comply. J. D. Wallace, M. D., has dubbed this the "tranquilizer on demand" syndrome. However, the patient's demand should not in itself be simply rejected by the physician, rather his or her demand should be taken into account. We need to consider the basis for the demand. The literature suggests that patients' knowledge concerning their own mental health and its appropriate treatment (e. g., psychoactive drugs) is typically limited and not based on an adequate understanding of medicine. Therefore physicians should consider very carefully (within the context of the physician-patient relationship) each patient's autonomy and unique response to the treatment modality. If the patient's demand for psychoactive medication is not warranted on the basis of sound medical judgement, then the quality of the demand itself should be analyzed. Only then can the physician transform the "demand" into the most beneficial treatment plan. The necessary conditions for this transformation are : (1) that the doctor has sufficient knowledge concerning the natural history of the presumed psychiatric disorder, (2) that the patient is fully informed and understands the appropriateness of his or her original demand, and (3) that the patient is prepared to accept the authority (though perhaps only limited) of the physician.

著者

村岡 潔

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.9, pp.42-55, 1991-07-31 (Released:2018-02-01)

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The aim of this paper is to interpret "medical fashions" as the nature of medical practice. They have a powerful effect on how we treat, whom we treat, what we treat and even the directions of medical science. In this paper, I discuss fashions in treatments, fashions in laboratory tests, fashions in diseases, fashions in surgery, and the relationship between 'medicalization and medical fashions'. I came to the conclusion that the role of "medical fashion" is not necessarily negative, but is essential to creative evolutions or changes in medicine, and that this model of "medical fashion" is very important and useful in understanding medicine as 'a variable system without an everlasting center'.

著者

佐藤 純一

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.9, pp.68-82, 1991-07-31 (Released:2018-02-01)

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Recently many publications in socio-culture and medicine have come out which assert the importance of "iyashi (healing)" in medical settings in Japan. Especially among traditional medical practitioners and their clients, such an assertion has been emphasized in connection with criticisms of modern medicine. They insist that there is not "iyashi (healing)" in modern medicine, but in their traditional medicine, although they never mention what "iyashi (healing)" is. This paper tries to clarify what "iyashi (healing)" means. It also argues against the view there is no "iyashi (healing)" in modern medicine. For this purpose, it describes the care given to patients having terminal cancer in modern Japanese medicine, by way of providing some "Medical Anthropology". Even today Japanese physicians deem it fatal and unethical to tell the truth about a diagnosis of terminal cancer to the patient. Instead, physicians give the patient a false diagnosis. For example they say that he has a benign ulcer when he has stomach cancer. Some physicians never give the patient any diagnosis of malignancy, just saying "No problem". But some members of the patient's family, usually elderly male members, are told the true diagnosis and are asked to conceal the truth from the patient. They are asked to support him by reassuring him that he will" recover, by physicians in charge. Nurses in charge obey the physicians' order to keep silence about the diagnosis. In this way, the dying patient is surrounded with "the lie" of his entourage, physicians, nurses and his family members, and goes without recognizing the terminal time and the true diagnosis. Focusing on this situation of patients having terminal cancer, this paper argues about Japanese "iyashi (healing)."

著者

粕谷 豊

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.9, pp.95-98, 1991-07-31 (Released:2018-02-01)

著者

大槻 真一郎

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.9, pp.99-102, 1991-07-31 (Released:2018-02-01)

著者

村田 敏郎

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.9, pp.103-106, 1991-07-31 (Released:2018-02-01)

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In Japan, the profession "pharmacist" as part of the medical care system was established in 1874. However, the object of this newly-formed profession has not been defined sufficiently at present. Because pharmaceutical practices have not been distinguished from the medical profession, pharmacists don't have their own practice in dispensing drugs, but work only as drug distributors. Consequently the profession of pharmacist is not regarded as a medical care activity, and the social position of pharmacist is appraised unfairly in Japan. The most important task, therefore, is to introduce the separation of pharmaceutical practices from the medical profession (BUNGYO) as in advanced countries. That system seems to be more reasonable not only for pharmacists but for both patients and physicians, even in Japan. And needless to say the pharmacist in Japan should study more, throughout their lives, in order to fulfill their obligations in the medical care system.

著者

菅野 耕毅

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.9, pp.107-112, 1991-07-31 (Released:2018-02-01)

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In order to look for a new image for pharmacists in medical service, I want to suggest the following from a legal point of view : First, a pharmacist should have the exclusive rights of dispensing over physicians. Secondly, a hospital pharmacist should have his own liability independent of his superior in the hospital. Thirdly, a pharmacist should have the freedom to open a dispensary anywhere, without control of others in the same profession.

著者

堀田 輝明

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.9, pp.113-119, 1991-07-31 (Released:2018-02-01)

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In Japan, pharmacists are generally regarded as specialists only of the materials which they treat. So, they are differentiated from the physicians and nurses who have close relations with their patients. Such a general view makes the job of a pharmacist charmless and uninteresting. Having close contact with patients, observing the effect of their medicine and guiding them in how to take it, are the proper work for a pharmacist. Today it seems that the serving-systems for medicine are becoming more clinical, and in the great hospitals, pharmaceutical systems are separated into smaller units of clinical specialization. That is the only way to raise the level of the pharmacist's activities and responsibilities.

著者

伊藤 幸郎

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.9, pp.120-125, 1991-07-31 (Released:2018-02-01)

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In 1872, the westernized Japanese government of the Meiji Restoration proclaimed a law which legalized the separation of pharmacy and medicine, imitating the tradition of western countries in those days. However, traditional Japanese (and also classical Chinese) medicine identified diagnosis with therapy, and most of the physicians had long been accustomed to compounding drugs by themselves at a patient's bedside. Even the westernized physicians continued to maintain the right to prepare drugs, which was permitted by an exceptional provision in the above-mentioned law. Moreover, the Japanese government in the Meiji era adopted the German medical system as a desirable model for Japanese medicine. This choice resulted in the introduction of a physiciancentered medical model following the German social system in the 19th century, in which doctors regarded other health professionals, including pharmacists as physicians' servants. Since then the social standing of Japanese pharmacists has been unduly low, far lower than in Europe, where this profession maintained a position called "the Great No.1 ", viz. the most trusted profession. For this reason the students of present Japanese pharmaceutical colleges have gloomy prospects for their future and have little pride in their profession. To overcome these gloomy prospects it is necessary to reform the physician-centered medical system, making it a patient-centered one based on equal standings of all health professionals. At the same time, more interest in human values should be introduced into both medicine and pharmacy, which are too science-oriented and dehumanized today. If the medical system is reformed in such a favorable way, the pharmaceutical students will have pride in their profession and will be able to take active parts in the clinical field. However there are still many obstacles to be overcome before the realization of this ideal.

著者

平山 正実

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.8, pp.13-24, 1990-07-31 (Released:2018-02-01)

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I want to clarify the relation between paternalism and the rights of self-determination by using medical disorder models. I have used one case to clarify the question of paternalism and the right of self-determination, using the case of real psychiatric patients: one in a self-reliant situation, one depending on others, and one chaotic situation. Paternalism and its limitations are examined for each situation. I conclude that ordinary people who are around psychiatric patients should take responsibility to help such persons.

著者

山本 善次郎 坂本 堯 高橋 勝

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.8, pp.25-34, 1990-07-31 (Released:2018-02-01)

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A survey on terminal care was conducted in St. Marianna University School of Medicine in 1988. The results show: a) ST. Marianna staff members have a strong interest in terminal care; b) few of them consider religious support necessary for terminal patients; c) St. Marianna staff members recognize it's time to discuss hospice and hospice care earnestly. In our country, religious indifference is really quite persistent in this generation. Nevertheless, many terminal patients want religious support as well as psychochiatric support. With considerable experience of clinical pastoral care for terminal patients in the hospital, we are convinced that they need religious support.

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.8, pp.35-51, 1990-07-31 (Released:2018-02-01)

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Today's marvellous medical advances confront us with a verysevere problem, namely the criteria for establishing death, such as brain death. Technical advances in medicine now permit maintenance of cardiac and respiratory functions in human beings for a few days after massive or total destruction of the brain. This fact has presented us with delicate and difficult problems, especially in relation to organ transplantation. Namely, when a human being's brain functions are lost irreversibly and yet his cardiac and respiratory functions are maintained by an artificial life-support system, does he live or not? Up to now the signs of life have been seen as vital signs (body temperature, pulse, respiratory rate and blood pressure etc.). But if these signs are maintained by artificial methods, are they truly vital signs? Physicians say that even if a life-support system works, cardiac function will stop in a few days or a few weeks. But this short term is quite important for organ transplantation. At that time each organ except the brain is maintained through artificial circulation of blood. Therefore physicians who agree to organ transplantation stress that brain death is the true death of human beings, for the purpose of legal removal of organs. But many ordinary people have complex feelings about it. They don't easily admit a family member's brain death because of their warm pink bodies. Here we have a severe problem. In this article I have focussed on these problems and have tried to think of the redefinition of death in modern society from different perspectives, that is, philosophically, psychologically, medically, culturally and legally. And finally in conclusion my thoughts are presented.

著者

長島 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.8, pp.52-64, 1990-07-31 (Released:2018-02-01)

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Schelling's philosophy of nature has two sources, one is Kantian and Fichtian transcendental philosophy, the other is the contemporary natural science of his time. In this essay, I discuss Schelling's life-concept against the background of the medical dispute of Brown's "lrritabilitat (Erregbarkeit)-Lehre" in Germany at the turn of the 19th century. Schelling's central interest in life-organisation is the individual mediating his environment. In this context, he accepts Brown's "lrritabilitat-Lehre" through Roschlaub's revision of it and A. v. Haller's concept of "Sensibilitat". So he criticizes its "Ungegrundetsein" and develops it into his triad of Erregbarkeit-Sensibilitat-Bild- ungstrieb. He then inserts this triad into his theory of nature.