How can we judge medical treatment ethically? We could do so from common ethics, if such ethics existed. But they do not. Therefore we must know first of all how medical treatment can be judged from various ethical viewpoints. In this report, the main ethical viewpoints concerning sex selection in reproduction are investigated. In addition, what kind of ethics are necessary for agreement on the subject are studied. What are the main ethical views? First, these must mediate between incompatible views of value supporting conventional ethical views. The main ethical views are based on fundamental values, or they are formalistic and have no material values. Secondly these views must also be have social reality. Namely these must be produced by our society and be supported by it too. Such views include the theory of natural rights, utilitarianism and personalism. These three views take different attitudes toward motives for sex selection in impregnation selecting acts and their effects. The reason why they cannot reach the same conclusion is that these views insist on different values from each other, though such values are fundamental. Therefore in order to reach the same conclusion we must agree about fundamental values, i. e. in order to obtain common ethics we must form the same view of value. But it is one of the most difficult tasks. Because one's value consciousness depends on one's own community, in order to form it we must integrate various communities of various people. Can we integrate them merely by communications about ethics?
Why can we use animals for scientific experiments? Why can kill innocent animals to improve our life? Are human beings 'more equal' than the other animals? Those are very serious questions. The case for / against animal researches has many implications, which invite us to philosophical and ethical thinking. This paper examine these items. (1) Utilitarian and Kantian view on the moral status of animals. (2) Environmental ethics and bioethics on animal researches. (3) Reconsidering our system of rights and duties concerning animals. It is clear that the concept of 'person' plays an important role in the case for / against animal right. We must try to specify the reason why animals are not persons. One sort of 'speciesism' is proposed. This paper concludes as follows: to solve the difficult problems about experimented research animals, we must face the question of the ontology of life. Applied ethics always lead to metaphysics.
Kant's concept of Person, connected with the concept of dignity, is one of the most influential in medical ethics. No one call the dignity of person into question. A person should not be treated merely as a means, rather as an end at any time. In founding bioethics, Prof. Engelhardt, Jr. brings this concept up in dual strains: the person in the strict sense, whose definition is purely ethical and the same as Kant's; the person in a broad sense, a compromise between the person in the strict sense and the merely biological human. His purpose to extend the concept in its use is, on the one hand, to impute some rights to humans who have not enough intellectual faculties and need moral protection, which has merit in overcoming the extreme argument made by M. Tooley; on the other hand, to release primary persons from obligations to some humans who cannot play any social roles. Were there undue burdens, rights of subordinate persons may be legitimately ignored. Freedom of the will of real persons should be prior to protection of secondary persons. Thus, not only nonperson humans but, occasionally, assumed persons may be treated merely as means. Problems are as follows. 1. who determines the order of priority among assumed persons, or when these would be degraded to nonpersons? 2. may one who does not possess inner worth be designated as a person? 3. must a merely arbitrary, subjective desire of primary persons be still respected even at the expense of secondary persons or others? Indeed, in Kant's writings we come across the radical, well-known dichotomy : Person and Sache. Apparently Formula II of the categorical imperative does not forbid persons to treat irrational beings merely as means. Yet there seems to be no better way than by regarding so: when Kant uses the concept Person, it matters little to which the nonperson human belongs, rather how we ourselves as moral agents should act in the name of Person. A extensional use of Person to judge not quite rational beings, subjectum patients, objectively (gegenstandlich) would seem to be looked upon as a misuse or abuse. The concept Person urges upon us self-consciousness as rational subjects and to make every endeavor to be what we must be through actual acts, because we are animal rationabile, not yet animal rationale.
Recently, there has been vigorous discussion throughout Japan on the question of 'brain death and organ transplantation'. However, considering the process which shows various differences of how to think among people, must be pointed out an essential lack of reflection on the concept of 'Consensus'. This lack is natural as far as all other discussions on public affairs are concerned. This paper aims at determining the sense of 'Consensus' (the best one is a from of inventing some compromise through negotiation), at criticizing 'pluralism' (or Liberalism) that is a certain background for that sense, and as this result, at inquiring conditions under which the 'Social 'Consensus' could be formed. These conditions are as follows: (1) the logic of arguments (2) a value-right system supporting arguments or discussions (3) institutions forming discussions Furthermore, the above mentioned view is applied to the Japanese discussion on 'brain death and organ transplantation', and several desirable proposals about it are made.
The President's Address which I gave at the first entrance ceremony of the University of Occupational Environmental Health held in 1978 was entitled "The Mission of the University." The first article stated: "This university should educate students to become doctors who philosophize for themselves throughout their lives." The verb "philosophize" means to reflect seriously on great matters such as life and death,mind and body, etc. A philosophizing doctor integrates science and humanism with his or her person. In modern industrialized society, technology-oriented scientists and physicians tend to view nature as a set of external objects free for artificial intervention. This tendency presents many hazardous problems of bioethics. Modern Western rationalism is responsible for much of excessive dominance of science and technology. In contrast Oriental thinking views human life as being harmoniously incorporated in nature. In order to survive, the world must find a way to unify Oriental humanism with Western humanism. 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.
The basic standards for education in universities or colleges were revised on March 7th, 1991.The purpose of the revision is to simplify the basic standards and to show the fundamental principles of education in universities and colleges. After the Second World War, the Japanese Ministry of Education introduced a new education system for the purpose of establishing a more humanistic system. For the past 50 years, this system has been in effect also in higher education. The principle of this system is ideal and works very well in primary and secondary school education. However, in higher education, the time allotted for major subjects has been decreased from four years to two years resulting in a lower quality of professional education in Japan. Now, the Japanese Ministry of Education has started to feel anxiety regarding the future of Japanese higher education and has decided to improve this system. this revision will be the second one since the Meiji restoration. By this revision, Japanese universities and colleges will be able to draw up their own curricula. In return, they are asked to establish a self-evaluation system, which is necessary for accreditation. In many medical schools in Japan, the faculty for general education is being abolished and medical subjects are taught even in the first year. On the other hand, since medical ethics is very important today,medical doctors must be trained in this field. In this unsettled situation, lecturers of general education subjects must also be fully dedicated to the purpose of their medical colleges and strive to improve their teaching methods accordingly. I explained the situation of general education in medical schools in Japan and the principle of our medical college.
Since the 19th century, the more that medicine has advanced, the more the distance between medicine and other specialties such as philosophy, ethics, and law has increased. When science and technology are subspecialized, the number of subspecialists with narrow views is very likely to increase. Medicine is not an exception. To narrow this distance between medicine and philosophy, ethics and law, many attempts and trials are in progress almost throughout the world, especially in advanced countries. Probably the most interesting among them is in the United States of America (USA). In the USA, with regard to clinical ethics and medicolegal problems, the development of a new srecialty or of a new job, independent both from patients and physicians, is in progress, and the number of new specialists has been increasing since the 1980s. One new specialty of this kind is called "ethics consultation", and its specialists are called "ethics consultants" or "clinical ethicists". An attempt toward in progress has been made in Hirosaki, Aomori Prefecture in Northern Japan, since 1991. An association named "Seminar Medicine and Community" was founded. The numbers was 300 in October, 1993. Of them, 174(58.0%) and 89(29.7%) consisted of physicians and comedical staff, respectively. The remaining 37(12.3%) are specialists in philosophy, ethics, law and so on. Meeting are held once every three months, for discussions on selected controversial topics and traditional basic problems relating to health care and medicine from interdisciplinary viewpoints. In addition we publish a journal (Journal of Health Care, Medicine and Community) every six months. Papers are published in Japanese with English abstracts. Papers either from inside or outside Japan by any author who does not belong to our association will be accepted if judged by the editorial board to be "distinguished"
In medical education,as in general education,it may be asked whether those subjects included in natural sciences, humanities,foreign languages and sports are really necessary. The essential task of philosophy is to think deeply about the most fundamental problems of our world and life, and to critically judge them. It is, therefore necessary to teach philosophy as part of medical education. However,in recent years, the presentation of philosophy to students has become far from simple. Younger generations are less inclined to think seriously and deeply about life and merely wish to spend their youth pleasantly. When considering such tendencies,teachers of philosophy, such as ourselves, must seriously reflect on what we do and how we can change our own attitudes about the role of philosophy in education. The points of my speech are as follows. 1) The aim in teaching philosophy is to cultivate, to nourish and to develop the intellect of students through lectures on philosophy. We should therefore lecture not only on Western Philosophy but also our own Japanese traditional spiritual culture. 2) Contemporary topics such as bioethics and medical technology should also be covered in philosophy. Knowledge of these topics will deepen student's understanding of what a human being is and will eventually help create the image of an ideal doctor. 3) We must attempt to provide students with the critical faculties to consider and judge, and live their own lives.
The distinction between general education classes and specialized classes has been discarded in the amendment of regulations for university curriculum (July 1,1991). As a result, universities can now draw up their own curricula. However, the amendment also stipulates that universities "must give specialized education to the students as well as to take appropriate measures to enhance broad knowledge and comprehensive ability to make decisions and to enrich the humanity of the students." Philosophy classes, as a part of the curriculum, should also be given at medical schools in line with the ministry's policy on curriculum compilation. Generally speaking, students take philosophy classes merely as one of the liberal arts classes (history of philosophy, introduction to philosophy etc.). The goal of the classes is to show students the various issues concerning philosophy. But it is also, if not more,important for medical students to acquire "broad knowledge" as is stipulated above: That is to say, to be familiar with the philosophical ways of thinking and to appreciate the world of philosophy, in itself, so that students develop the ability to see problems and to solve them on their own. Science, medical science included, has developed remarkably and has benefited people in many aspects. On the other hand,however, it has also over-defined and over-simplified the human existence to a point where science how endangers the very existence of human beings. We have become suspicious of the optimistic view that one day science and technology will solve all the contradictions of modern civilization. It is philosophy, based on liberal ideas, spirit and above all, human love that would enable people to evaluate modern civilization for what it is and to question the raison d'etre of human existence. I would like to discuss the role of philosophy taught in medical schools as an important part of general knowledge, and also to illustrate what the students might face in taking such classes.
The paper discusses the image of an ideal physician, and also mentions how such physicians may be nurtured. Ideal physicians are expected not only to listen carefully to what patients and their family members have to tell them but to give them hope, to pray for them and to face them with integrity. Further, they need to have deep insight about themselves, know their own limitations well, and at the same time should be able to maintain reason and conscience in their approach to patients. The above has to do with ones' attitude as physicians, or a character question visa-vis their becoming ideal physicians. Naturally, any good physician must be one who is knowledgeable and equipped with good technical skills in the field concerned. In rearing ideal physicians, the following points need to be taken into account: 1) Physicians are expected to treasure even 'negative events' they have had in their own personal history such as their own experience of becoming sick, similar cases, including the deaths, of family members, the days of disappointment / frustration and to remember them as they face patients; 2) During their freshman and sophomore years at medical college, they should be exposed to opportunities of directly meeting the sick and the disabled; 3) It is recommended that they take part in rope playing featuring moot ethics committee, medical courts, and others.
Law school and medical school in the USA are what we call professional schools where graduate students work. These two professional schools have similarities in both their educational systems and problems. Generally speaking, undergraduate students in the USA study general education courses in colleges or universities and then select a major which is specialized but not professional. General education in the USA is rather different from "ippan kyoiku" in Japan. Students in Japan study "ippan kyoiku" without reference to their own Majous, less of them,so students have no motivation to accomplish it. they are not very interested in "ippan kyoiku", including philosophy. Philosophy education is now in crisis. We are facing the reformation of college education. Medical schools are not free from the changes. I propose that this Symposium should suggest a new model of the education of philosophy in the new curriculum of Medical schools in Japan. That suggestion should have some effects on the reformation going on.