著者

串 信考

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.184-190, 2003-10-05 (Released:2018-02-01)

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In December 2000, The Welfare and Science Council of the Japanese Government released the final report concerning Assisted Reproductive Technology. That report agreed to the use of donor sperm, ova and for the In Vitro Fertilization and Embryo Transfer. I think that the final report of the Council has two problems. Firstly, it is objectionable that the client's brothers and sisters are included among the donors. This is an exception to the rule that the donor's name is withheld. Secondly, it is objectionable that children have a right to know their genomic parents. Children born by using donor sperm, ova and embryos, have three kinds of parents. They have real parents, foster parents and genomic parents. The right of these children to have access to the identity of their genomic parents is growing. The first and second problems are closely related. I try to clarify this close relationship in my report. The rights for children to know their genomic parents contradicts the rule of the anonymous donor. If these children know their genomic parents, the donor is not anonymous. I think that the client's brothers and sisters form majority of all donors. Children have been born by their uncles' sperm and their aunts' ova. The children are very shocked to learn their origins. The parent-child relationship becomes very complex. A new Council of the Assisted Reproductive Technology started in 2001. This Council discussed the rights for children to know their origins. But the Council members have, as yet, not formed any definite opinion. I think that the rights for children to know their origin is more important than the rule of anonymous donor, because children's rights take priority over parental desires.

著者

福島 智子

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.13-30, 2003-10-05 (Released:2018-02-01)

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The purpose of. this paper is to reconsider the ethics of truth-telling through analyzing the theory of Catholic bioethics and its practice in the in-home palliative care provided by the Association Romanini in Rome. Catholic bioethical theory obliges doctors to tell the truth only to the extent that their patients demonstrate the willingness and ability to accept it. Following Catholic ethics, medical staff of the Association Romanini first tell the truth to their patients' families, and then in discussion with these families decide whether or not it is preferable to tell the patients. In practice, however, they tend to refrain from telling the truth to their patients. This is primarily because they wish to avoid negative effects, such as the patient's 'loss of hope', and secondarily because establishing a relationship of trust between the medical staff, family, and patient is considered more important than the act of truth-telling itself. Family participation in decision-making is common in Japan as well. It has sometimes been criticized as a result of Japan's socio-cultural tendencies to emphasize group decision-making. Indeed, family decision-making may infringe paternalistically on the patient's autonomy. However, the case of the Association Romanini illustrates the importance of human relationships of trust - not only between the medical staff and their patients but also including their families - that cannot be reduced simply to contractual, clinical or 'provider-consumer' relationships.

著者

長岡 成夫

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.21, pp.1-12, 2003-10-05 (Released:2018-02-01)

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The word 'trust' is used in a variety of situations. We often use the word to describe the people's perception of institutions. For instance, WorldCom and Enron were called trustbusters, mainly because they did not fulfill the moral standards expected of their businesses. We also use the word to describe the relations between persons. Here, the ambiguity of "A trusts B" becomes more apparent. Sometimes it is used in the context of business transactions, meaning "B will carry out the contract he made with A." But we also use it to describe a particular aspect of personal relationships, such as "She has cared about my welfare so much, working long hours, and so I have full trust in her." Following Annette Baier's analysis, we can divide the meaning of 'trust' into two categories : reliance (reliance on others' particular attitudes and reactions, or on their dependable habits) and trust (a special kind of reliance, i. e. reliance on another's good will toward one). In the medical context, reliance can be strengthened by reducing medical errors and implementing measures to protect and respect patients' welfare, while it seems there are no easy prescriptions for medical professionals to earn trust, since it is difficult for a patient to see directly whether her medical providers have good will towards herself. All they can do is to create a climate of trust where trust could possibly grow. To aim at gaining trust directly will be self-defeating and sometimes even bring about undesirable consequences. Today many emphasize the importance in medical settings of trust relationships between lay and professional, as distinct from mere reliance relationships. I contend, however, that what is needed is to try to increase patients' reliance on medical providers' attitudes and the medical world in general, and if things go well, medical professionals may earn trust as a result of their efforts.

著者

原 敬

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.71-81, 2003-10-05 (Released:2018-02-01)

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The technology of drugs to treat physical pain has progressed and become widely available. Therefore, the number of persons terminally ill with cancer who suffer from physical pain has decreased in recent years. However, there is a fear that the treatment of such pain has become so routine, that the patient who discovers meaning through physical suffering is deprived of that meaning. It seems that the meaning attributed to physical pain by a person terminally ill with cancer differs from that of a patient after an operation. In the latter case, physical pain prevents the consciousness that faces life. On the other hand, in the case of the terminal cancer patient, pain is "the magnetic field" which fixes the consciousness that faces death. This magnetic field may fix that consciousness in such a way that it tends to face to life rather than death. It is said that for terminal cancer patients informed consent concerning pain management is as indispensable as is consent for other medical treatments. Some persons may think that there is no problem in the "routinization" of pain management, because a patient himself is holding the helm in this treatment and is able to control by his own will the physical pain which would act as a magnetic field fixing his consciousness on death, and moreover he is even able to escape the pain. However, if such treatment causes him to mistake his medical situation so as to believe that a terminally ill cancer patient can live comfortably without physical pain, informed consent is unable to be applied to him.

著者

池谷 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.21, pp.46-54, 2003-10-05 (Released:2018-02-01)

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Organ transplants receives scant social approval if the persons who offer to donate their organs are the weak. Acceptance that a brain dead patient is a dead person does not take root in Japan, and as of May 31, 2002 the number of liver transplants from brain dead persons is only 18 cases from 16 donors. On the other hand, the number of liver transplants from living donors has already exceeded 2000 cases albeit the registry of such cases is not exhaustive. The Japanese people recognize the donation from a living person as proper because the organ is transplanted from a healthy person to a weak one, but actually one third of the liver transplants from living donors is said to be transplants from a child to one of its parents. Thus whether or not the principle of "from the strong to the weak" is followed in all cases must be checked continuously. An ethical problem occurs in the case of the donation from the child to its parent, especially in the case of a young child who is living together with its parents. There were a few reported examples of such liver transplants : for example recently the offer from a 20-year-old daughter to her father was reported. The operating surgeon said that if the donor is over 20 years old, the organ donation is made by the free will and hence becomes possible legally. The surgeon further asserted that if the donors are under 20 years old, it is sufficient to wait until they become 20 years old. But the premise that parents are always the child's best advisers does not hold good under all conditions ; the decision-making of 20-year olds needs an environment where no social, economic, and religious pressure is exerted. When such an environment is lacking, the rational choice of an organ donation to one's parent is not guaranteed.

著者

水田 信

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.98-111, 2003-10-05 (Released:2018-02-01)

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When we talk about the 'quality of life' (QOL) we should inquire just into the 'quality' of human life. Generally speaking, a qualitative thing includes something original that has no substitute. Each person's existence is an irreplaceable life, and it has a unique value. QOL is a subject about the qualitative values of human life. The pursuit of QOL is the pursuit of a 'healthy' human life or 'happiness.' E. Fromm said that a person represents the whole human being, and that an individual is a physico-spiritual totality. He also said that the goal of a person in life is to be himself. According to Fromm, the fundamental human desire aims to conquer 'existential dichotomies,' such as 'life and death,' 'solidarity and aloneness.' Everyone shows one's answer depending on his/her character or personality. Only a 'productive character' can get happiness through its answer. That is the basic attitude by which 'human nature' and 'individuality' are brought into full play at the same time. Such a person gropes for a 'sane society'. And such a society ought to bring up sound persons. QOL as elements of a living environment are useful as conditions for happiness. However, the most important thing is the 'quality' of each one's life itself. This kind of QOL is shown by the basic attitude as 'personality.' A person who lives a well-filled life has a high quality of life. The scale of quality of life as the standard common to human beings is 'human nature,' which is also the foundation of human equality. This is the 'basis' of human rights. And each person will be the judge of the matter connected with 'happiness, making use of the activation of individuality. So, medical persons should not confuse QOL and 'social usefulness! Medical preference order is not a problem of QOL but purely a problem of medical technique.

著者

永田 まなみ

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.82-97, 2003-10-05 (Released:2018-02-01)

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This paper discusses the debate in the Journal of Medical Ethics over the ethics of care between P. Allmark and A. Bradshaw. For the last 20 years, since C. Gilligan's work, the possibility of an ethics based on the concept of care has drawn considerable attention. Allmark argued that an ethics of care could not be based on the premise that care encompassed moral values because the word "care" itself could be applied to good or evil situations. Bradshow argued that care ethics could be comprehensible only when linked to the Judeo-Christian tradition. Allmark said that Bradshaw's care ethics had normative and descriptive points in so far as defined what should be cared for and haw it should be done, but that she did not respond to his assertion that a moral sense might not be derived from care itself, and also that her understandings about care contained philosophical and historical difficulties. Allmark is justified in arguing that, in general usage, care is a neutral term, and that as a result it can not be said to have moral overtones. Care can be used in the moral sense only if its subject and methods are clearly defined. Further, Allmark's attempt to cast doubt on Bradshaw's view of nursing care as a God-sent profession based on the Judeo-Christian tradition is acceptable from the viewpoint of modern nursing. In the context of nursing, however, it is beyond doubt that the subject of care is the sick and that the recovery of her health is intended. The discussion of care must include a very significant way of thinking by nurses in order to achieve the level of care desired, and it should rest on a foundation of respect for individual persons. The whole discussion of care in this context cannot be invalidated simply because the term "care" is also used in torture.

著者

朝倉 輝一

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.21, pp.55-70, 2003-10-05 (Released:2018-02-01)

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The fact that the conception of care has drawn our attention expands the definition of the moral realm of Kantian moral theory. It means that we must listen attentively to the "excluded other." And we must resolve the dichotomy between "reason, culture, and law belonging to man" and "nature and sensation belonging to woman." Therefore the concept of care should make us think anew about the relationship between care and the other in health care. Because I do not think that a modern moral theory that includes care which adequate to the way of life lived in complex modern societies can be formulated without some universalist specification of impartiality, I find it more fruitful to construct the concept of care not as a rejection of universalism, but rather as a contribution to the development of a non-formalist, contextually senstive, and postconventional understanding of ethical life. I will describe two conceptions of "care and the other" that delineate both moral perspectives and interactional structures in health care. Following Seyla Benhabib, I shall refer to the first as the standpoint of the "generalized" and the second as the "concrete" other.

著者

田中 孝美

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.20, pp.166-173, 2002-11-10 (Released:2018-02-01)

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People living at home with chronic respiratory failure must struggle to live in the face of various difficulties and distress. But their experience has not been investigated up to now. This study focuses on the experience of people living with this chronic respiratory failure. It is also an experiment in practical nursing research. Four patients and their families agreed to be participants. The patients are sufferers of chronic respiratory failure undergoing long term oxygen therapy at home. The methods used fieldwork at such places as outpatient departments, patient group activity situations and the patients' homes. Several formal and informal interviews were also conducted over a period of six months. Through fieldwork and interviews, I endeavored to come into contact with their actual sense and experience of life. I have described the findings under three headings : "Breathing and Moving", "Living with Suffering", and "Devising Life Strategies". First, I describe the experience of "Breathing and Moving". The participants actually feel that each and every breath supports their life. They must concentrate their consciousness to breathe in order to make each movement, and choose every movement carefully. For those people living with chronic respiratory failure, the simple act of breathing becomes the primary action supporting their life. They cannot entrust their lives to their body's automatic breathing, but must always be conscious of their breath. Second, I describe the experience of "Living with Suffering": The participants find hope and courage for themselves from contact with other patients' lives. When they observe something, they perceive a meaning in it to apply their life. They face the inevitability of life, and make new efforts to live themselves. Thus they maintain their will, and resolve "I want to do this" or "I don't want to become that". Lastly, I looked at the concept of "Devising Life Strategies": There are produced from their earnest desires. The patients devise the strategies themselves through a long groping process. The strategies may be called a technique for living. However, it is important to emphasize that they do not talk freely about the Strategies to medical workers. In conclusion, those living with chronic respiratory failure live in a world experienced through their body. Understanding of their subjective experience is produced through contact between the lives of patients and that of the researcher. The world of meaning and emotion world cannot be approached merely from an objective perspective.

著者

鈴木 正子

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.20, pp.204-211, 2002-11-10 (Released:2018-02-01)

著者

大鹿 勝之

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.20, pp.154-165, 2002-11-10 (Released:2018-02-01)

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If the meaning of self-determination is 'voluntary determination about one's own fate and course of action while remaining free from controlling interferences from others', the following patient decisions are comprehended as self-determination: (1) choosing unwillingly one treatment considering various circumstances; (2) choosing one treatment from choices represented by a doctor; (3) choosing one treatment from more choices than the above, getting information on various treatments from other sources than the doctor's information; (4) leaving one's own decision about treatment to the doctor. An explanation of these four situations follows:(l) an unwilling decision is self-determining, because this decision is derived from free will. With regard to (2) and (3), (3) is maybe more self-determining than (2), fer a patient gets the information through his/her own efforts. However, both are self-determining because both are voluntary decisions. (4) Though the patient gives up his/her own determination to choose the treatment, he/she decides voluntarily to give up his/her choice to the doctor. Therefore, patient decisions are self-determining in these four situations. For this reason, if self-determination is understood to be of great advantage to a patient, it needs to consider its relationship with the various situations, for example, how to inform the patient about his/her condition and various treatments, and the circumstances.

著者

樫 則章

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.20, pp.216-222, 2002-11-10 (Released:2018-02-01)

著者

宮越 一穂 棚橋 賓

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.20, pp.223-225, 2002-11-10 (Released:2018-02-01)

著者

高久 史麿

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.20, pp.192-203, 2002-11-10 (Released:2018-02-01)

著者

小林 英司

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.20, pp.212-215, 2002-11-10 (Released:2018-02-01)

著者

前田 義郎

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.20, pp.139-153, 2002-11-10 (Released:2018-02-01)

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The 'personhood' argument is one of the basic principles of bioethics. But various forms are possible within this principle. The high evaluation of the patient's will is one form of personalism. The superiority of a person's value over a life's value is another form. But the famous 'personhood' argument today maintains a personhood is 'a necessary condition for the right to life'. This argument is linked with 'the denial of the right to life for potential persons' and 'the criticism against the speciesism'. This argument indeed provides some guidelines for abortion and the vegetative state, but it will admit almost any cases of the recent reproductive technology, especially ES cells. So, I want to define the person again from the viewpoint of 'moral personalism'. In this paper, I want to introduce my interpretation of Kant's 'categorical imperative', and then try to define a person on the basis of it. 'A categorical imperative' can be interpreted as 'a practical categorical syllogism'. We can discover two conditions for valid categorical syllogisms. And from these conditions moral practical laws can be deduced. Then, I define 'a person' as 'one who can perform such practical reasoning and act according to it'. A person means a moral being. This definition makes a new understanding on 'autonomy' possible, too. This definition of person is made from the viewpoint of the 'faculty', not the 'actual will'. Therefore we can consider the difference between 'a human being' and 'a chimpanzee', and also can view 'a potential person' as a person potentially possessing this faculty. This argument is not based upon a necessary condition for right to life, but upon the moral value we must esteem. I believe that from this point of view we can give some guidelines to the recent reproductive technology, ES cells.

著者

工藤 せい子

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.20, pp.174-183, 2002-11-10 (Released:2018-02-01)

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The purpose of this quasi-experimental study was to foster ethical sensitivity among nursing students. Nurses and nursing students face many moral and bioethical problems in clinical practice. The development of ethical sensitivity in nursing students has paralleled the development of nursing as a profession. The subjects (n=19) were students who entered the Training Course for High School Teachers of Nursing Faculty at Hirosaki University Japan in 1999. The method of this experience of death with people in their immediate circle while a small number of students had experiences of great impact. Some students were very sympathetic to the experiences of others and felt the experiences of their counterparts as their own experiences. The discussions about death were meaningful for the students. They are well motivated to be nurses in the future and therefone had to think about many kinds of death first person death, that is their own death, second person death, that is death of their relatives, and had no other choice but to be involved in many third persons deaths. They thought seriously about how to take third persons deaths and the discussion contained the essential points concerning what "death" is and "deaths of the first, second, and third persons." The discussions had a favorable impact on the students and motivated them to think more deeply about death. In concusion, discussions about death help to raise the ethical sensitivity of students.

著者

田村 京子

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.20, pp.1-15, 2002-11-10 (Released:2018-02-01)

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Since the "Law of Organ Transplant" was enacted in 1997, transplants of organs from brain-dead patients have been performed in Japan. I interviewed physicians working for a hospital providing organs from brain-dead patients. The results are reported here. The discussion points are as follows: 1: There are four specific physician related roles to be found in the process of extracting organs from a brain-dead patient, as follows: A physician engaged in life saving (Physician for emergency), two physicians who diagnose brain death (Neuro internal physician and neurosurgeon), two physicians who manage a donor (Anesthetists), and two physicians supporting the extraction (Anesthetists). 2: The physicians had different opinions depending on their role. In particular, the anesthetists in charge of donor management felt that good quality medical treatment was not being provided, since the medical conduct was only the same as that for ordinary patients in the Department of Anesthesiology. 3: The anesthetists really felt that death occurred upon the extraction of the heart of the brain-dead patient. 4: Because the provision of an organ in an organ providing hospital is conducted under a division system, and feedback from a transplant hospital to an organ providing hospital is not conducted, physicians from the organ providing hospital could not understand the conditions of the recipient and could thus not evaluate transplants from the braindead patient. 5: Because observance of the law is more important than medical conduct, physicians don't need to ask questions about treatment that concern them.

著者

松川 俊夫

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.20, pp.56-66, 2002-11-10 (Released:2018-02-01)

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The concept of 'imperfect duty (or right)' is forgotten in modern ethics. But this concept is very efficient for medical ethics. For example, if we examine the duties of a physician and the rights of a patient by giving our eyes to imperfect duties and rights, we can get a clue to the fine understanding of the physician-patient relationship. Now that paternalism in the physician-patient relationship is said to be rejected, the autonomy of the patient is a kind of trump card. And many bioethicists and laymen adjudge that the physician-patient relationship must base itself on the 'contract.' But Japanese 'SEKEN1 ('the world' or the traditional Japanese human relationship) between a physician and a patient postulates one sort of physician's paternalism. And the physician-patient relationship based on a contract would bring some moral hazard to a physician. We must understand what is the moral problem in the physician-patient relationship, and the examination of imperfect duties (and rights) will lead us to the solution of that. In many respects, we follow the study of the history of ideas on the imperfect duty in Millard Schumaker's "Sharing without Reckoning."

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.20, pp.43-55, 2002-11-10 (Released:2018-02-01)

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Concerning the issue of Informed Consent, it is still common in Japan for ethical standpoints tobe easily affected by the legal viewpoint, though law and ethics should be under different jurisdictions. In the dispute about actual legal judgments, there are three points at issue. They are as follows: 1) Respecting doctors' judgments as professionals 2) Patient responsibility, based on the premise that patients can deal with their medical situation rationally 3) Respecting the understanding and judgment of individual patients Each point has its own merit and demerit, but the author thinks that the third idea, that is, respecting individual patient's understanding and judgment, is the most suitable when considering the concept of Informed Consent from the ethical point of view. Under the present situation, when we looked into prior judicial precedents, judgments have mainly been made on the basis of the first idea of respecting professionals' opinions. Furthermore, there are some cases where judgments were made from an ambiguous viewpoint, mixing the two or three points mentioned above. Under these circumstances, the author thinks that, in Japan, ethics should voice more about the issue of Informed Consent, and should make efforts to bring judgments based on Informed Consent closer to the ideal and appropriate form regardless of any legal dispute from the past.