著者

服部 健司

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.16, pp.12-23, 1998-10-01 (Released:2018-02-01)

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It is not the purpose of this paper to give a new model or definition of health concept and to legitimate it, but to reflect critically on the way to use or investigate this tempting and puzzling concept. Recently health has ballooned to be very pseudohypertrophic. It is a synonym for happiness in respect of totality and ideality. After Kant, these concepts should not be used "constitutively", but may be used only "regulatively". Health measurement is an example of misuse. Another misuse is positive health, in which QOL is frequently stressed. Originally QOL has been used in the social sciences, the social policy processes, or in clinical practices for individual patients. Positive health, in addition, tends to apply QOL to healthy persons. This abuse is due to pseudohypertrophy of health concept; health as flourishing human life or self-fulfilment. In respect of health concept, from medical philosophy to medical ethics, from the clinical to the preventive dimension, the dual transition of our concern is proposed.

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.15, pp.167-169, 1997-09-20 (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.15, pp.107-118, 1997-09-20 (Released:2018-02-01)

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

著者

牧野 尚哉

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.15, pp.135-136, 1997-09-20 (Released:2018-02-01)

著者

花岡 真佐子 池川 清子

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.15, pp.85-94, 1997-09-20 (Released:2018-02-01)

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

著者

岡本 天晴 櫻庭 和典

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.15, pp.72-84, 1997-09-20 (Released:2018-02-01)

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

著者

尾久 裕紀

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.15, pp.64-71, 1997-09-20 (Released:2018-02-01)

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

著者

渋谷 健

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.15, pp.119-134, 1997-09-20 (Released:2018-02-01)

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

著者

丸山 マサ美

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.15, pp.26-32, 1997-09-20 (Released:2018-02-01)

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This study analyses private papers written by women who underwent sterilization treatment. First a comparison is made with the model of E.Suchman who pointed out "illness behavior" and "stages of illness". How big is the pain of infertility as a result of the enormous stigma attached to the inability of giving birth to one's own child? The sense of desperation is followed by hope-and then desperation again and again. Why are children of any value? Because of a particular passionate desire of caring for and nurturing children? The medical procedures they underwent and the many "failures" they experienced are described. But they say, "If we lived in a world in which infertility is not seen as a 'disease' that can be 'cured', these technological accidents and experimental procedures could be avoided." That is, pressure from society can turn a fertility problem into a curse which provokes feelings of guilt, above all the desperate belief that, 'I have to try one more time, one more procedure.' : What is "illness", and What is the object of "treatment" ? After all, this study is an analysis of the content of papers concerning cognitive factors of illness behavior.

著者

宮越 一穂

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.15, pp.48-63, 1997-09-20 (Released:2018-02-01)

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From America and Europe, there is a great abundance of reports of large-scale randomized clinical trials on various medical problems. They have brought important findings to medical practice. Such knowledge is available in all over the world, including Japan. However, in Japan, we have little experience of randomized multicenter clinical trials, and only a very small number of patients have participated in these studies during the initial period. There are still many diseases and many patients with intractable pathophysiological conditions, and many requests to relieve them or to improve their health, using high-level technology. Why do megatrials fail in Japan? While some have indicated that Japanese physicians have paid scant attention to or have had no experience of large-scaled, multicenter, double-blind, prospective, or randomized clinical trials. I would rather point out the following : we have the health insurance for all Japanese ; the coverage is for anyone, anytime, anywhere in the country, and for any type of conventional treatment ; so most Japanese individuals have little pressure to develop or to resolve medical problems. However, since the consultation time is only about three minutes, the physician does not have enough time to explain details on the clinical trial, therefore the condition of informed consent is poor in Japan. In addition, the peer review system has little tradition and there is no neutral powerful agent as the FDA. Consequently patients are not confident in physicians and the Japanese health care system in general.

著者

関 修

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.15, pp.33-47, 1997-09-20 (Released:2018-02-01)

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1. Medical Philosophy, Ethics and Problems of Homosexuality. The various concepts of sexuality were invented by psychopathology in the late 19th Century. In the DSM-III-R of 1987, homosexuality suddenly became normal from abnormal. However transgender remains an illness, as it was before. It is only a political problem. Another important problem is about AIDS. In Japan, there is discrimination between AIDS caused by medicine and AIDS caused by other factors. 2. Homosexuality as Thought : Situation of modern French Thought. In France, The "May Revolution" of 1968 caused the foundation of a new university : Paris 8th (Vancennes). One of its founders, Rene Scherer began his first lecture on sexuality in the faculty of Philosophy. His partner, Guy Hocquenghem, founded FHAR. Recently, Red and Black-Homosexuals in France after 1968 by F.Martel was published. However, Prof. Scherer has told me it is a defective book. 3. Thought of G. Hocquenghem : concerning homosexual desire. The originality of Hocquenghem's thought seems to lie in his idea of forming "a group of subjects" through the anus. The creation of relations among others by anality stands against ideas of couples. Being homosexual is not a means to attain self-identification, but a means to be out of self, to become a foreigner. It is also an escape to an infinite drifting from a stiff identity. 4. The Voice of M. Foucault : Homosexuality as a form of existence. Foucault's thought about homosexuality summarizes two points. First, to be homosexual is not correct ; to become homosexual is correct. He takes "gay" to create a new form of existence. Therefore, he does not think coming-out to be inevitable. Secondly, his problem is to begin to love among individuals. It means that "I" is more essential than sexuality. Here there seems to be fascination for passivity. 5. Conclusion : In Japan, they say "gay" is already out of fashion : now "queer" replaces it. However, such nomenclature is only a matter of fashion. To my regret, regular studies on gayness or queerness are not carried out in Japan. Now, it is necessary to study homosexuality as thought. That means to meet various thoughts not only to introduce and imitate them but to get involved in them : to have a mind of "hospitality". That is a critically needed task in Japan.

著者

奈倉 道隆

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

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

著者

品川 信良

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

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

著者

池川 清子

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

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

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

著者

石井 誠士

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

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

著者

川口 孝泰

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

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

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

著者

桝形 公也

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

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

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

著者

五十嵐 靖彦

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

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

著者

服部 健司

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

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

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

著者

本田 勝紀

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

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

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