Hans Jonas proposes "Future-oriented" ethics in his writings : "Das Prinzipi Verantwortung" and "Technik, Medin und Ethik". It is "a commensurate ethic of foresight and responsibility " and in this ethical theory the concept of "responsibility" is central. According to these ethics the categorical imperative is as follows: "Act so that the effects of your action are compatible with the permanence of genuine human life"; that is, act so that mankind may exist. Now I analyze these writings and intend to make clear the principle of these ethics. Firstly, I analyze why such an imperative is enjoined, in relation to a problem of modern technology. He insists that the nature of human action has changed with modern technology, and that ethics should change with its changed nature, since ethics is concerned with action. Secondly, I analyze his grounds for such an imperative. Wishing to found its rational ground, he takes a plunge into ontology and struggles to draw the ontological proof of the command: that Man should exist. The naked ontic fact of mankind's existence is the basis of a valid claim to being and "ought to be." Then, proceeding to its subjective and psychological ground, he finds the archetype of all responsibility in the parents of the child, for the parents are receptive to the child's appeal, which finds its response in their mind. It is the feeling of responsibility. As a result of these analyses three things are clear: (1) the concept of responsibility is not the empty and formal one of every agent being responsible for his acts but the substantive one which makes him responsible for the particular object that has a claim on his acting; (2) the ontology of responsibility is not that of eternity but of time, for every agent can be responsible only for the changeable and perishable; and (3) the ethics which may be erected on the principle of responsibility must not remain bound to anthropocentrism.
In the follow reflection, I try to discuss about the essential being of life and to examine the philosophical-biological thoughts of Hans Jonas. According to Jonas, organic identity, which can be observed by the fact of metabolic regeneration, must be different from the physical identity of matter. He adopted the idea of freedom in order to clarify ontologically the phenomena of life. During the course of its life, an organism remains the same, while continually changing its material constituents. Therefore the identity of the form of a living thing is free from the physical identity of matter. Further, it is not the identity of a mere form, but of a self-constituting agent who realizes this living form of itself. We obtain this understanding of life from the experience of our body. The body is the only affair within the entire res extensa which reveals a sort of intimacy. The major problem of philosophical biology must be life, centered in the problematic existence of the living body. But the fundamental freedom of the organism, as realized in metabolic activity, is of a dialectical character, for, to realize itself and to continue itself, the living form needs material constituents and their constant refurbishment. It is a "needful freedom". The independence from the material universe indicates likewise a certain dependence on that universe. Life must die. Understood so, the unity or the bi-unity, as Jonas says, between subject and object, self and its world or freedom and necessity, remains a still unsolved problem. Neither mere partial monism nor dualism can hope to solve it. We need an new, integral monism, which must seek to absorb the radical polarity into a higher unity of existence. Viktor von Weizsacker asserted that the meaning of life is not its continuing to exist, but sacrifice. The fact of sexuality reveals this. Individuals and species die for others and live. The environment is nothing but the whole which lets living things live for and with others.
In the United States, the number of organ transplant cases has been rapidly increasing over the past fifteen years. Consequently, there has been a shortage of organs available for transplant operations so various measures have been sought to promote organ donations. For instance, many states have adopted a system where the reverse side of the driver's license functions as a donor card. The license holder along with two witnesses sign the consent making it possible for the license holder to donate his or her organs. Despite such schemes, however,the supply of organs has not met demands. As a result, there were instances where money changed hands to secure organs. Considered unethical, organ sales where eventually banned by law. In The United States, it is considered a moral and worthy act to voluntarily donate one's organs for science. A noticeable contrast to this can be found in Europe where organ donations are done on a contract basis. This reflects cultural-anthropological differences between the U. S. and Europe. In the case of Japan, people have great apprehensions about taking organs from the dead. This is due partly to a cultural background based on Confucianism; and partly to the on-going debate on defining what exactly constitutes "brain death". In addition, the act of giving in Japan has always had the element of mutual exchange; unilateral gift-giving without any form of reciprocation is unthinkable-which makes securing organs for transplant operations much more difficult. Japanese doctors, therefore, are required to call upon the people to donate organs as a gesture of good will. With these differing concepts of gift-giving in mind, taking the example of organ donations, I would like to discuss from a philosophical stand point what it means "to provide"or "to give" to someone. I also intend to expand my discussion to include western notions of "a gift" as a concept compatible with the idea of "charity" and "solidarity". Comparing these with the Buddhist concept of "dana", I would like to discuss "compassion", "bodhisativa-yana" (the way in which to attain enlightment), "dana-paramita" (discipline in training how to impart sacred doctorines to others), "atoma-paritoyaga" (the throwing away of the ego), "the field of good fortune", "repaying kindness" and "veneration". (Incidently, the English word donate stems from the Sanskrit dana.) By comparing these concepts, I would like to discuss methods of giving, the attitudes of those who accept and furthermore, the "things" that are givable and acceptable. By doing so, I hope that I shall be able to clarify the differences between the west and Japan regarding the notion of organ donations.
Many people now pay attention to the concepts of IC and autonomy of patients in health care. Nurses also begin to notice that it is necessary to change the traditional way of decision making in nursing care. Especially many American nurses believe that ethical decision making for nursing care must be led by patients' autonomy, because patient autonomy is the most important principle in bioethics. It is also related to human dignity. The concrete way of ethical decision making in nursing care is presented by the book; <Bioethical Decision Making for Nurses> by Thompson, J. E. and H. O.. They present the 10 steps to bioethical decisions. Step One : Review the situation Step Two : Gather additional information Step Three : Identify the ethical issues Step Four : Identify personal and professional values Step Five : Identify the values of key individuals Step Six : Identify the value conflicts, if any Step Seven : Determine who should decide Step Eight : Identify the range of actions and anticipated outcomes Step Nine : Decide on a course of action and carry it out Step Ten : Evaluate the results In this paper I explain this model theory concretely through some Japanese clinical cases. I believe that we can make an ideal method of carrying out bioethical nursing care by reviewing today's problem of decision-making in nursing care.
It seems that there are two pairs of standpoints from which people observe the issues of life today. The first one is to grasp life as a matter of either quantity or quality. The second one is to consider the issues of life based on either the human-centered view or the nature-centered view. One of the views which grasps life as a matter of quantity is the biological view of life. It recognizes the value in the length and strength of life. Today's medical technique which puts supreme value on the prolongation of human life can be placed in this category. On the other hand, one of the views which see life as a matter of quality is the person-centered view of life. It recognizes the value and the dignity of life in its degree of maturity. This view, seeks the way in which human beings enrich and mature their lives. Traditional religions and ethics basically take this position. Today, these two standpoints come into keen confrontation with each other, as modern medical techniques make rapid progress. For example, today's medical technique makes it possible to control life itself. However, here a new and controversial problem comes out; that is, whether or not the prolongation of life takes precedence over the dignity of human life. In other words, this confrontation requires us to establish a new bioethics. As to the human-centered and the nature-centered views, the former basically sees a distinctive difference between the life of other creatures and that of human beings. In obedience to human desire, it aims at conquering and ruling nature. Today's scientific technology can be placed in this category. On the other hand, the nature-centered view sees the equality of all lives, for all lives equally possess sanctity. Furthermore, this view recognizes the mutual dependence of all lives, including animals and plants. The Buddhist view of life can be placed in this category. Although modern scientific technology has elevated the standard of living, it has also caused the destruction of nature. Here another controversial problem emerges; that is, whether or not satisfying human desires takes precedence over the sanctity of life and nature. This problem requires us to establish new environmental ethics. If we merely stand on either the biological view of life or the person-centered view of life, we understand life in utilitarian terms and do not realize the intrinsic meaning of life. To establish both the new bioethics and environmental ethics, we should regard the standpoint which sees life as a matter of quality and the nature-centered view as important. If human beings do something because they have the technique to do it, it may lead them to a self-destructive end. I believe that human beings should have a modest attitude toward life and nature.
From ancient times, medical care was only symptomatic therapy. The postmortem dissection of the human body had been inhibited as an immoral action for a long period. Even Hippocrates, who opposed the scientific method on the observation and the treatment of the patients, made some errors in his medical hypothesis because of lack of knowledge about the anatomy and physiology of the human body. Since the Renaissance, the advancement of medicine was remarkable according to the discoveries and progress of natural sciences. As an example, the postmortem dissection of the human body was allowed and revealed the structure and functional mechanism of human beings. It brought a lot of knowledge concerning the cause of the diseases. Subsequently radical therapy and preventive procedure for many diseases were established during recent two centuries. According to the recent remarkable progress of chemistry and physics, diagnostic tools became more accurate and easy to use. Even the heart can be transplanted from a case of brain death, into a patient whose heart is severely ill, if the social conditions allow. However, these striking advances of medical procedures sometimes lead the patients to a mentally confused condition, such as the rejective mental reaction against the pure scientific and too unemotional behavior of medical staff. In order to prevent these unfavorable mental reactions of patients, all medical and associated staff should realize the importance of the mental care of patients.
The report deals with a theoretical connection between nursing ethics in the clinical setting and the bioethical ground underlying them. Special attention is given to the concept of "informed consent", which is often discussed in relation to bioethics. Clinical medicine today is now shifting its emphasis, previously placed on medical cure, to nursing care. One of the reasons for this change, in my opinion, is that advanced techniques in medical treatments having now reached a stage where many incurable diseases have actually proved curable, only truly incurable ones, such as chronic diseases of the aged, remain with us and they certainly require much more nursing care than medical cure. It is, therefore, undeniable that the importance of nursing care in clinical practice is now greater than ever. Achieving a higher level and quality of nursing service for patients is inseparable from both developing nursing skills and improving nursing ethics. In order to realize the latter purpose, nursing care ought to be designed to meet the needs of patients. Patients, on the other hand, decide themselves what they need: to help them have the power of "self-determination", they are entitled to obtain any information necessary for them to decide what they really need. The traditional idea of "patient-centered nursing", consequently, should be changed to the concept of "informed consent". So as to make this concept work efficiently in the clinic, relationships between patients and medical staff are expected to improve. This report is an attempt to elucidate these problems which arise at the crossroad of nursing ethics and bioethics under the following five sections: (1) Beginning of bioethics, (2) The concept of "informed consent", (3) A criticism of paternalism, (4) On the idea of "quality of life", (5) Establishing a back-up system in nursing.
I. Care as the core of healing [figure] 1. The philosophical foundation of care - human integrity of soul and body - 2. The essence of care -sympathy and compassion- II. Medicine for life and death 1. Care and cure - Care looking on the human body as a vessel of sickness - Cure looking on the human body as a substance of disease 2. The unification of primary care and terminal care - every care situation is potentially terminal care - - every care situation is actually primary care - III. The visual point of bioethics 1. Responsibility to others - on response to the sick - inhumanity of reproductive medicine and transplantation medicine - 2. Healing as human activity - absence of death-ethics - - how to live depends on how to die - - difference of the medical death and the departure from this life - IV. Healing for the Sick 1. Care on the self-supporting ability - vis medicatrix naturae, vis moriendi naturae - 2. Care as art - care to support and to comfort the sick - - indispensability of caring documents based on life review therapy - I (the sick) am unable to carry the burden without your support. The doctor cures sometimes, relieves often, but comforts always.
Three main ethical issues were introduced and discussed. They were: 1. "Unethicalities" latent in medical practice and nursing-Things not generally permitted in society are from time to time permitted in the world of medical practice and nursing. Things which are vilified or proscribed as unethical acts in the rest of society are permitted in the name of " care and cure", and if one were to list them they would appear as follows. (1) Secrets of others cannot help but be learned. Facts which the patient and his/her family would like to keep secret must be clearly written down, preserved in records, and reported upon. (2) The bodies of others are touched and observed. (3) Necessity compels injuries to the skin, veins, and organs of others. (4) The cells/tissues and body fluids of others must be collected and examined. (5) Substances and energies which humans normally do neither ingest nor are exposed to must be imparted to the bodies of others for the purpose of diagnosis and treatment (6) Foreign objects such as suture materials and medico-chemicals are left within the human body. (7) Experimental acts must be performed not only on animals but also occasionally on humans. 2. Minimum ethical requirements in nursing and care 3. Ethical dilemmas in nursing and care with special reference to the future of the nurse-client relationship, nurse-nurse relationship and nurse-physician relationship.
The need of terminal care has been pointed out for a long time, but its practice has not come to be common in clinical work. This is mainly because of the lack of philosophy and methodology of terminal care. To practice terminal care it is indispensable to have a philosophy and methodology of comprehensive medicine based on whole person medicine (Balint, M.), which pursues the possibility of humanistic medical care. In the context of whole-person medicine, the bio-psycho-socio-existential medical model is the basic viewpoint to understand a patient. Furthermore, to perform comprehensive medicine, mutual respect between the current occidental medicine and the traditional oriental medicine with an interface with psychosomatic medicine is essential. Especially to care for a cancer pain patient, this viewpoint is indispensable. The core of psychosomatic medicine is Balint's medical interview, in which a patient is accepted, supported, and assured by a medical professional. In this interview, the medical professional works as a medicine (Balint, M.), that is to say, it is "therapeutic self (Watkins, J. G.). Logotherapy (Frankl, E. V.) is one method of the psychotherapy the main approach of which is to seek after a patient's meaning of life. "Life review interview" (Butler, R.) is one of the concrete methods of logotherapy. Through logotherapy, some cancer patients could gain awareness of their own meaning of life, then overcame cancer, and created their own new life. That is to say, they could live with cancer. The common attitude of such patients is "gentleness and toughness", through the experience of cancer. A nurse always takes care of a patient who is a human being with some disease. In the practice of nursing, a nurse meets many patients and observes many lives, which are living and dying. Nursing is one of the most humanistic occupations.