著者

前野 竜太郎

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.22, pp.103-112, 2004-10-18 (Released:2018-02-01)

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The purpose of this paper is to show how the nonverbal communication is used by physiotherapists with physically handicapped and serious mental retarded children, during physiotherapeutic interventions. We used interview with physiotherapists, so to speak, real narratives of physiotherapists, who give physiotherapy to these children, because most of children couldn't even communicate. These interviews show the intimate relationship between physiotherapists and handicapped children, by analyzing the data from the interviews with physiotherapists. In the past, only few attempts have been made at this process of study, because we have to need more objective reliability and validity to research physiotherapy. It is difficult for us to study nonverbal communication more objectively, as it were, it isn't in our field. As physiotherapeutic intervention would be so much different from special education for handicapped children, we need more specific research from physiotherapy about them. In this study, we use the existential analysis method defined by Mourice Merleau-Ponty. It is entirely different from logo-therapy. We avoid using the sociological method of analyzing interview data. The findings of this analysis of data show that we have to transcend the wall of specialty and objectivity of physiotherapy; in other words, we need to be involved in an ambiguity, that is, non-perceivable dimension. Then we could live children with physical handicap and serious mental retardation together, in their world and their daily living. In conclusion, caring is the most important art during the physiotherapeutic interventions.

著者

石井 誠士

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

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

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

著者

金谷 光子 尾曽 直美

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

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

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

著者

宮坂 道夫

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

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

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

著者

佐藤 労

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

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

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

著者

堀田 義太郎

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

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

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

著者

浅見 昇吾

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

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

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

著者

服部 俊子

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.22, pp.27-35, 2004-10-18 (Released:2018-02-01)

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The aim of this paper is to deal comprehensively with various ethical issues concerning advance directives. Advance directives are oral or written statements which declare whether a person wants to receive life-sustaining treatment, in the event that they lose their decision-making capacity. There are two types of advance directives: the first is an instructional directive which identifies situations in which the patient would want specified treatments. The second type is a proxy directive, which allows the patient to designate someone to make decisions on their behalf. Advance directives are recognized in some form by the laws of every state. Despite the fact that advance directives have been available for more than twenty years, few adults have completed any type of advance directive document. In order to explore the cause of these law numbers, I survey relevant federal and California legislation and considered the legal issues surrounding advance directives. Then I consider the ethical arguments concerning advance directives. First, I discuss the ethical issues of advance directives in terms of the principle of autonomy and the doctrine of informed consent. Second, I discuss the conceptual problems of advance directives, which are rooted in the principle of autonomy. Finally, I reconsidered "the principle of autonomy" underlying advance directives.

著者

船木 祝

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.22, pp.17-25, 2004-10-18 (Released:2018-02-01)

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Bei der Forschung an importierten ES-Zellen handelt es sich um eine aktuelle Frage der deutschen Bioethik. Die deutschen Vertreter der verschiedenen Bereiche versuchen, aus zwei Gesichtspunkten bezuglich des Begriffs 'Menschenwurde'diese Frage zu behandeln: zum Ersten Menschenwurde als Eigenschaft des Gegenstandes and zum Zweiten Menschenwurde, welche sich im Umgang mit Menschen verwirklicht. Aus dem ersten Standpunkt lasst sich behaupten, dass die importierten ES-Zellen als pluripotente Zellen keine Gegenstande der Menschenwurde seien. Daher konnten die Wissenschaftler diese ES-Zellen fur wissenschaftliche und medizinische Zwecke nutzen. Im Gegensatz dazu lasst sich nach dem letzteren Standpunkt sagen, dass die Menschenwurde der menschlichen Embryonen kein Faktum, sondern eine Entwicklungsform darstellt. Daher hatten die umgebenden Menschen die Aufgabe, einen Ungeborenen zu schutzen und seine individuelle und moralische Entwicklung zu ermoglichen. Meine Lekture einiger japanischer Berichte uber die Behandlung der Probleme der menschlichen embryonalen Stammzellen legt die Vermutung nahe, dass dem obigen zweiten Gesichtspunkt in Deutschland fast keine Rechnung getragen wird. Man legt also das Gewicht vielmehr auf die medizinische Perspektive als auf das Leben der menschlichen Embryonen. Der zweite Gedanke bezuglich der Menschenwurde konnte aufschlussreiche Hinweise zum Umgang mit dem menschlichen Leben geben.

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.21, pp.209-221, 2003-10-05 (Released:2018-02-01)

著者

箭内 任

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.22, pp.7-15, 2004-10-18 (Released:2018-02-01)

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Although numerous attempts have been made by scholars to show what "person" is, little agreement has been reached. The purpose of this paper is to point out some of problems inherent in the arguments and review how the concept is treated from a Bioethical perspective. First, various arguments involving "person" in the field of Bioethics are surveyed. Most of these arguments pertain to the criterion of "person." These arguments originated in the works of Locke and Kant and are influenced by the characteristics of modern reason: self-consciousness, autonomy. Next, the two most recent arguments made by Beckmann and Secker are illustrated in order to clarify where the criterion of "person" is. Beckmann understands autonomy in terms of "the claim to the rights," whereas Secker rethinks autonomy from a viewpoint of "human's duty." The question now arises as to whether Beckmann concentrates autonomy as human's right to recognize person as "corpus" and if Secker might misunderstand it as autonomy caused by the other without much consideration of its public character. In both cases there must be something more to understanding autonomy as a whole. Therefore it is insufficient to grasp the concept of "person" only from autonomy. In discussing "person," we must avoid reducing it to a definition with a single meaning. We should ponder its difficulty and impossibility. Let us look deeper into "person," tracing the history of the concept of "person" now. For example, according to Sakaguchi, person (persona) once had the character of not only fixation but fluidization. Meaning that "person" has the character of interdependency and interrelationship in any society. In conclusion I will re-formulate the concept of "person" as the "topos" of the possibility of communication. Now "person" is given a new phase of meaning and will open the door to a totally different society which gives a "person" a new standpoint as a real key.

著者

岩倉 孝明 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.21, pp.222-225, 2003-10-05 (Released:2018-02-01)

著者

児玉 正幸

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.21, pp.167-175, 2003-10-05 (Released:2018-02-01)

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The medical staff of Obstetrics and Gynecology Department, Kagoshima University was considering plans to conduct clinical trials to test the embryos of Duchenne muscular dystrophy patients, but they were unable to gain approval from the Japan Society of Obstetrics and Gynecology. Groups and organizations that support the handicapped pointed out that there are problems with trying to make life and death decisions based on such tests. They argued that such testing implies a desire to lower the level of social services for the handicapped and to inflame the public's prejudices. In other words, the tests are considered as another example of discrimination towards families with a history of genetic disease, in the tradition of discrimination in jobs and marriage. However, as long as the freedom of the clients (the parents of the unborn child) for whom the tests are conducted is preserved, and their right to decide what to do with the results is protected, this reproduction medical technology does not threaten the constitutional rights of the handicapped, as provided in Articles 13, 14, and 25 of the Japanese Constitution. Allowing parents to decide whether to give birth to a handicapped child is not inconsistent with a policy aimed at improving welfare services.

著者

宮脇 美保子

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.21, pp.140-152, 2003-10-05 (Released:2018-02-01)

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Nursing is an emerging profession trying to fulfill the criteria that define a true profession. The professional work of nursing is approached in a scientific manner. The nursing process is defined as an intellectual activity meant to be approached regularly and systematically now that the nursing process is the accepted method of professional practice. However, the nursing process is not the only capability required of nurses. The nursing process is nothing more than a problem-solving process by which nurses meet patients' needs. The patient's set of problems, referred to as the "nursing diagnosis," is undergoing international standardization. To standardize is to risk overshadowing the care that originally motivated the more scientific approach to solving patients' problem. Still more, with the increased complexity of medical care, nurses have taken over more and more of the activities associated with medical practice. Consequently, in the actual reality of practice, nurses sometimes lose sight of caring. What is the primary expertise to which nursing lays claim? So far, nurses have always valued the idea of caring for persons. Has nursing abandoned its caring role? Caring means that persons, the subjects of nursing care, are treated not as objects or impersonally but always in a way that considers the essence of the person, i. e., the opposite of mechanization and depersonalization. Also, what patients want and need most from nurses has been and still remains quality, humanized care. Therefore, nurses are challenged to enhance and develop the caring tradition of nursing as expressed through the nursing process.

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.21, pp.126-139, 2003-10-05 (Released:2018-02-01)

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Anthropologists such as Kleinman 1 and Helman 2 have pointed out that any society, whether Western or non-Western, exhibits pluralistic health care (or medical) system. Within these societies there are many persons or individuals who offer the patient their own particular way of explaining, diagnosing, and treating ill health. In the pluralistic health care system, we can identify three sectors of heath care or medicine ; the popular sector, the folk sector, and the professional sector. In order to rethink the symmetry (or equality) in the doctor (or healer) -patient relationship in each sector, this paper compared the relationships found in the three sectors. A healer and a patient in the popular sector can be equal because they are able to share the same basic values of health care and their positions, therefore, are at anytime interchangeable. Both in the professional sector and in the folk sector, a doctor (or a healer) and his/her patient cannot be equal because their positions are not interchangeable due to the professional dominance and medicalization of everyday life, especially in the professional sector. In conclusion, a lay people's empowerment by releasing health care knowledge and skills from the professional dominance and by sharing them could bring about a change in the pluralistic health care system that equalizes the doctor-patient relationship to the healer-patient relationship in the popular sector.

著者

西村 ユミ

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.21, pp.199-208, 2003-10-05 (Released:2018-02-01)

著者

井上 澄江

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.21, pp.112-125, 2003-10-05 (Released:2018-02-01)

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In Japan, when a patient who does not have the ability to agree to his/her own health care has to receive certain care, family members usually agree to it without clear legal authority. However, it is thought that some patients need an agent with clear legal authority in order to respect their self-determination in health care. I think that an agent with clear legal authority can consent to health care on behalf of a patient in Japan, due to the new guardianship system for adults implemented in April of 2000 because of the increasing number of demented elderly people. If we make use of the adult guardianship system, the self-determination of an incapable patient is more likely to be respected because acts of a guardian can be supervised by a supervisor and a family court. In Germany, when a person without the ability to agree to health care receives certain health care, an agent with clear legal authority has to be assigned. In addition, when an incapable patient receives health care that involves a risk of death, it is necessary to obtain permission from a court. In Japan as well, there are some cases in which medical care decisions are required to be subjected to examination by an outside organization, such as a court or a hospital ethics committee. However, at present, a treatment policy cannot be decided by a court in advance of the treatment, and hospital ethics committees do not work sufficiently. We must first fortify the system of hospital ethics committees. We also need a third organization, for instance an independent governmental agent which has a quasi-judicial function and which decides a treatment policy in advance of the administration of the treatment.

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.21, pp.191-198, 2003-10-05 (Released:2018-02-01)

著者

重野 豊隆

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.21, pp.153-166, 2003-10-05 (Released:2018-02-01)

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In the argument concerning informed consent, the concept of "non-directives" has been used as a protector of patients' self-determination. This concept is especially important for medical counselors. Ethical pradoxes arise when placebos are used both in medical experimentation and in a clinical setting. A placebo is a substance that the health care professional believes to be pharmacologically or biomedically inert for the condition being treated, the placebo effect sometimes be produced without nondisclosure, incomplete disclosure, or deception. Nevertheless, a placebo is less likely to be effective if used with the patient's knowledge. This raises the question of whether nondisclosure of placebo use is morally permissible. Most controlled trials are randomized clinical trials, which are generally preferred to observatinal or retrospective studies on grounds that their results have a higher degree of validity. Even if they had no preference for one treatment over the other, some patients may have refused conventional randomization because of its uncertainty. However, some critics suspect that disclosure of information became distorted, perhaps unconsciously, when the physician knew the assigned treatment in advance. Clearly, the process of obtaining informed consent under prerandomization merits unusually careful scrutiny to ensure adequate disclosure. On the other hand, a placebo is clinically given to a patient at the medical staffs' discretion without informing the patient about its use. The therapeutic use of placebo involves intentional deception or incomplete disclosure. This parodoxe is resolved when a patient has a chance to get a second-opinion.

著者

勝山 貴美子

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.21, pp.176-183, 2003-10-05 (Released:2018-02-01)

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The term "care" has lately attracted considerable attention in the various fields, such as psychology, education, medical treatment and social welfare. Especially, in the realms of medical treatment and social welfare, concerns arise due to the rapid progress of the aging of society, the change in disease structure and the rapid progress of medical technology. As for care in medical treatment, there is recognition that patients or clients are the center of medical treatment, because the meaning of "care" focuses not on the sickness itself, but on the living person with an illness. It is important for medical staffs to realize the dignity of the patient's personality through their care. There is an interactive relation between patients and nurses, and therefore they have their own individual values, appraisal standards and interests. I think that care is recognized and/or adjusted between them accordingly. When offering nursing, a relation with the family of a patient and nurses is also important. Because 11 hink that a family is an important person for a patient. However, there is not the study how nurses understand a patient's family, and what nurses expect of them.