According to Viktor von Weizsaker, medical anthropology intends to introduce subjectivity into biology and medicine, but human disease is more than objective facts. Every human existence has to be regarded as a moral being and any illness essentially belongs to that person. Man is homo patiens. The differences between the mathematical or physical and the biological concepts of space and time are very important. In the perspective of von Weizsakers Gestalttheorie the living organism does not move itself in space and time but move the space with time. In regard to the ontological equivalence of body and soul it is not possible, for example, to speak of psychogenesis of angina pectoris. The concept of causality is in general too limited and total to understand the suffering man and his disease. The law of life is based on a ground relationship (Grund-Verhaltnis). Subjects and objects belong together, the biological phenomenon-like disease cannot be understood merely as an object without subject. The holistic approach is important for the relationship between physician and patient. The grounds of life cannot be known, and it is not the object of science. Both to become healthy and to become ill are based on the basic relationship, i.e. the relation of life to its grounds.

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The tendency to deal with the human body as an object has deeply permeated modern medical practice. In the area of nursing and care, I find no exception. However, if we carefully observe our body, we become aware that our hands encounter with each other as we hold out or withdraw them together. Nurses interact with many people including patients in the clinical situation. They can act first by using their body. There is no act without(the use)of the body. The basic attitude of the nurses in dealing with others is to act with consideration(or thoughtfulness)named 'care'. The nurses read patients' condition with their own sensitivity, then they make decisions as to what sort of physical help they could give. This situation does not imply a one-way relation between nurses and patients through their own intention or act. It indicates a condition of coexistence, affecting one another in a certain way through the action of both the nurses and patients. This also does not imply a man-thing relation. It is an intersubjective relation sensed through each other's body. I hope to search for the meaning of suffering by describing the intersubjective process derived from the encounter with a patient with illusionary leg pain as a methodological path with the idea that the human body is not at all an object in clincal reality. Furthermore the ultimate goal of the report is an attempt to overcome the duality of mind and body in medical practice.

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S. Kierkegaard pointed out that "despair" is a spiritual sickness, defining the human being-which is a synthesis of soul and body-as spirit in "Sickness unto Death". He said the possibility of this sickness is the human advantage over animal, and yet it is a drawback. V.E. Frankl, who was influenced in his thoughts and work by Kierkegaard, said that sickness is only in the sphere of psychophysical organization, not in the spiritual-personal sphere. Even neurosis is not a spiritual desease nor sickness in human spirituality. He also said that despair is human, and is not morbid. Frankl's "disease" has doubtlessly a narrower meaning than Kierkegaard's. However, can we acknowledge that "despair" is normal or sound in the human state ? As a matter of fact, there is a correspondence between some of Frankl's statements about "collective neurosis" and Kierkegaard's descriptions of forms of despair. So, we can expect that Kierkegaard's thought is useful to understanding Frankl's "logotherapy" or "existential analysis". Looking at it the other way around, it means that we can interpret Kierkegaard's ideas through knowledge of modern psychopathology. From this point of view, I would like to inquire into the essence of mental illness and to seak the key to recuperation from it.

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I. The Concept of the Diakonia It is important that we research the hospice care from the viewpoint of the deaconess movements, when we think of the care especially. The origin of the concept "care" can be found in the old Greek word "diakonein" in The New Testament. The etymology of "diakonein" is "to serve at table". i. Table The table symbolizes openheartness and a hospitality just as the Latin word "hospitium". This elemental idea is the open-minded dialogue with the place. ii. Meal The meal symbolizes life and the death. The eating means to sacrifice another living for oneself. The meal points to the unity of life and death symbolically. One life should be dependent upon another death and one death should support another life. iii. Obedience "To serve" symbolizes Obedience. The carer obeys the cared-for one according to the life which the former gives to the latter. And the carer learns from the cared-for one and receive the wisdom from that person who die. iv. The Principle of the Diakonia The concept of the diakonia is built of the following elements: the open-minded dialogue with the place, the unity of the life and death and giving life and receving wisdom. The ideas of the diakonia are concentrated upon the practice of Jesus Christ. Jesus said by himself that he was a deacon. The practice of diakonia in imitatio Christ is in The New Testament. The New Testament the be cared one should be the poor. II. The Deaconess Societies and their Care The practices of The deakoness are found from the ancient age to the recent times. But the first official society is founded by Theodor Fliedner in Kaiserswerth 1836. The most difficult problem of them has been the conflict between the religiose idea and the technics of the care. III. The Separation of the Deaconess Movements and the social Welfare The deaconess movements spreaded rapidly and widely to the Northern Europe. The ideas of the diakonia spreded also upon The church voluntary works in Denmark. And the elemental thoughts of the diakonia has been developed to the social welfare.

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Scientific knowledge based on the modern European concept has achieved an emphatic success in promoting advanced technology, particularly since the middle of the 20th Century, and has blessed us with enormous benefits and convenience. On the other hand the pervasion of belief in 'science as a panacea' without realizing its robotic nature, led human to the confrontation with the danger of 'geo-catastrophe.' Moreover it exerted such a profound influence on every corner of our social life and even permeates the human 'psyche' (way of thinking, emotion, will, or value-consciousness of individuals) that it precipitated the crisis of 'psycho-catastrophe.' It is no exaggeration, in this sense, that "we nowadays are struggling for lives in quest of meaninglessness." (L.Mumford) A recent controversial issue of "Organ Transplantation from Brain-Death Donors" typically reflects the dilemma of human beings. If we reflect upon our onus for the whole humankind in the past, present and future, along with a hope of ensuring their welfare in the coming Centuries, we need to reexamine and redefine the true quality of "the 'life' which belongs exclusively to humans."

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This paper attempts to reconsider the etiology of modern medicine (or bio-medicine) from the view points of medical anthropology and medical sociology. The discussion of causality in modern medicine fundmentally depends upon biological factors and theories, and seems to neglects socio-cultural factors and theories. At first in this article, the another criticizes the origin of modern medicne, emphasizing the importance of the viewpoint of socio-cultural contexts. Next, based on historical-theoretical-anthropological studies of modern medicine and non-western medicine ("traditional medicine"), it is strongly proposed that the origins of both traditional medicine, and also modern medicne, derive from theories bound with the respective culture. Therefore we can think the modern medicine as a kind of traditional medicine. A tentative theoretical model of origins in order to inquire into all origins is proposed. In the kind part of this article, after describing the new concept of the origins of modern medicne, which depends upon probability and epidemiology, the new concept is examined with this tentative thoretical model.

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In 1990 The Japan Medical Association translated the Englisch concept "informed consent" as "explain and consent" into Japanes and made a report on informed consent. In the report it is said that informed consent will make an opportunity to reconstruct a new human relationship between physicians and patients in our country. But how is informed consent possible ? The aim of this paper is to consider informed consent from three aspects, i.1. legal, ethical and philosophycal theory and to establish the theoretical foundation for informed consent. The consideration of the paper is as follows. 1. Concept of informed consent. 2. Informed consent. for whom ? 3. Can we introduce informed consent directly into our country ? 4. Acceptance and modification of the informed consent concept. 5. Never treat a person simply as a means, but always as a goal. 6. The meaning of informed consent. -From consent to agreement.- 7. Conclusion. -Metaphysical meaning of informed consent.-

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When we consider the ethical and social responsibility of nursing, we should note the concept of nursing advocacy, which is often used as a key word in nursing ethics in U. S. Nursing advocacy holds the view that nurses are responsible for advocacy of patients rights and interests. We can find out different model theories on nursing advocacy in many literature on bioetics and nursing ethics. For example, there is the legal rights model of G. J. Annas, the values-based model of Kohnke, the respect forpersons model by C. P. Murphy and the social advocacy model of Freeman. However, we do not have yet have a conclusive theory on it. We can draw some points on nurses' roles in informed consent between physicians and patients by using the concept of nursing advocacy, For example, nurses can give more explanations to patients to make up for a lack of medical informations by doctors. Moreover, they can help patients to understand information better by asking doctors in place of the patients, In this way, nurses can help patients to make decisions according to their own values. Nurses should do their best to keep best interests of patients, However, to enable nursing advocacy, nurses' rights as patients' advocates should be respected by physicians and other health care personnel.

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In Japan, informed consent (IC) is not carried out satisfactorily in order to improve the situation, medical social work (MSW) is essential. While the need for MSW is increasing, it is yet recognized in the medial world of japan in four of the reasons for this fact are as follow (1) Medical doctors take the initiative in the field of medicine and patients become more passive. As a result publish do not try to ask for MSW support. (2) In Japan, medicine only means diagnosis, treatment or nursing of diseases. Solution psychological or social problems of a patient are not considered medical matters, even though they may be related to disease or treatment. (3) Right now, medicine is not administered through team work, and MSW, activities which received patient asking and coordination of medical activities do not operate smoothly yet. (4) In Japan people tend to think that maintaining a good relationship is much more important than realizing their own will or desire. These four factors hinder IC. Now it is necessary to solve these problems. The solution of this problem would also bring the proper situation to make progress IC and establish MSW concretely, which would contribute to IC.

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In the history of medicine, some periods can be divided by the change in the physician's role concerning the course and prognosis of disease. In ancient times, the principal factor in determining the prognosis of a disease shifted from divine or supernatural forces to natural principles that were advocated by the authors of the Hippocratic corpus. During this period when both physician and patient maintained their relationship in account with natural principle, prognosis was so heavily dependent on natural forces that the physician's role was limited to a supplementary one. After a long medieval period, the physician's role underwent a change from advocacy to subjugation of natural principles. In the eighteenth century, as Foucault indicated, the old clinic was replaced by anatomically articulated medicine. With this change, the age of paternalism came, sustained by the clinical effectiveness of the physician's experience and skill. However, as biomedical knowledge was accumulated and enhanced, people's expectation and confidence moved from physician's skill to the corpus of biomedical knowledge, that actually controlled the outcome and prognosis of disease. The concept of informed consent, first introduced on October 22, 1957, not only signified the epochmaking addition of the patient's will to the decisive factors for outcome and prognosis of disease, but also reflected that the physician's role hand become that of a catalytic agent between the sum of medical knowledge and patient. The introduction of informed consent, on the one hand, eliminated the physician's image as representative of healing, and on the other hand, gave the contemporary physician a new task, the investigation of the patient's uniqueness and the formation of a comprehensive notion of the clinic in the context of the physician-patient relationship.

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The concept "consent" and "同意-doi" in the concept of the informed consent are discussed. Studying this point may constitute one of the angles from which to clarify the question, "What is informed consent ? " Firstly, the words "consent" and "同意" were each studied as to their meaning. By showing the connotation and denotation of the "同意" first and then the connotation and denotation of the "consent, we clarified the difference between the "同意" and "consent" and something in common with each other. The word "同意" in Japanese has diverse meanings and ambiguity and is often used in ways far removed from its original meaning. It has less of the "positivity" and "directivity toward others" inherent in the word "consent". In this respect, the word "同意" is rather close to "assent" that is of sensitivity admitting no reason. Secondly, the "同意" is a thing that arises in relationships between people, so the personal relations in which the "同意" is effected were studied. Japanese essentially give more precedence to the personal relations than to the self. This could give rise to the "同意 against one's will" and "the '同意' not with the substance of the issue but with the other party". In short, the meaning of the "同意" is primarily based on the other person being Japanese and is acceptable only in that context. In thinking about what informed consent is, all arguments will lose sight of the direction, if no thought is given to the original meaning of the word, culture that gave rise to that word and characteristics of the place from where that word was imported.

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In modern medicine, diseases are not apt to be dealt with as a whole but only as a part. Illness, which emphasizes a patient as a whole with sufferring, needs cares which bring him a total healing as a man with dignity of life. The definition of the terminal stage of cancer differs from man to man, but the decision should belong to the right of autonomy of the patient himself. Dr. C. Saunders, a founder of modern hospice, described the principles of hospice cares sa follows. Firstly, hospice care should be aimed not to cure but to care which brings the patient comfort. Secondly, palliation should be done only for symptom control, mainly for pain relief. Thirdly, individual care for patient and his family should be devoted. Lastly, the care should be carried out by multidisciplinary care team. Home hospice, which enables the patient to receive hospice service at home, is not the matter of place but it includes an essential problems, namely, whether the patient can keep on the host's position of his own life or not. Domiciliary hospice thus brings about total care for the patient and the family.

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Many problems emanate from the modern science and technology that laid the foundation for modern medicine. They generally tend to lose whole system or balances compared with previous period. Even in the most advanced sphere of medicine we encounter the limits of modern science in two directions which we will examine as follows. First, we should restore the real definition of illness which appears to have been lost in modern medicine, second, to retrieve the wholeness of mankind from the dualism of humans having separate dimensions of mind and body. When we talk about the idea of illness, we ought to presume simultaneously what health is, or what health means, and not be allowed to illness as an exceptional issue with regared to health. For we have a gift for spontaneous recovery as Hippocrates once commented. Moreover, we must clarify the biological and philosophical structure of life itself and flou mind effort in the area of preventive medicine. All human illness must be based on the idea of "mind-body interaction" only on which healing could be realized. Particularly we must appreciate the patient as a real individual to whom philosopher since Descartes could not attain in proper meaning, because even the same disease appears with different symptoms in different patients. In order to closely new aspects of real individuals, we should evaluate the ethical relationship between patient and physician in which dialogue plays an important role, and narrative contexts or temporal axis for this purpose are very valuable J. Dewy mentioned that morality is a continuing process not a fixed achievement.

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This article presents the author's statement in the symposium on "Disease and Healing", that medical care based in Western medicine tends to cure the disease alone, but dose not care for the sick as a whole. Man is mortal, destined to age and sometimes falls ill. Besides cure, man needs care of others. As nursing has its origin in the mother-care of helpless infants, it is related to the care of all humanity. It has extended its functions of taking care from the sick to the aged, the helpless, the handicapped and so on. Historically speaking, however, it used to be believed that sick people were a type of convict and should be discriminated. It was not until the nineteenth century that the distinction between being ill and illness itself was established, because of the development of not only Western medical science such as pathology and bacteriology but also the idea of human rights. Sick people retrieved their honor, but at the same time, only disease became cured. The sick themselves did not recovered from the illness in some cases. Nowadays, human being faces the problems of advanced age. Even though man is mortal, man must live a life worth living. The role of nursing should be broadened. If there are persons who need any help physically and mentally, nursing must give a hand to take care of those persons although they may be dying, so that they are able to heal themselves at least mentally during their life.

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In hospice care practice, it is very improtant to recognise the real meaning of imformed consent concerning telling the truth of the status of the disease to the patient. The another discusses the merits and demerits of imformed consent in terminal care practice.

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The notion of "informed consent" appeared recently as an ethico-medical term. But the concept is not new. Where people want to live peacefully with others consent has always been indispensable, and there could be no consent without information. Why is the term "informed consent" now the topic of discussion" ? This term suggests that modern medicine based natural science has lost humanism and regard recuperation. In spite of infestation of Paternalism, professional arrogance, pursuit of commercial benefit etc., not a few medical professionals live still in the illusion that the medicine were the representative system of humanism. There is another illusion that a patient could give consent as a free and independent individual. From the illusion comes the self-determination right of patient in his health care. If a individual were realy independent, is'nt "informed" consent self-contradictory? The informations given from doctors are often onesided and patients can be biased or even forced to give agreement. This kind of agreement can not be real and ethical consent. So long an individual were absolute independent there can be no consent but antagonism. Modern western philosophy established by Descartes stands on individualism or egoism. As an idea or a symbol of liberation of people from dictators, it had historical significance. But is any one realy absolutely independent and free? This question was already possible British empiricists. Hegle and Marx asserted that the free individual, thought to be a independent, self determining substance, cannot release himself from the contradiction of self-alienation. Husserl's Intersubjektiv and Watuji's Ningen (human relation in itself) suggest that a person can only be himself in a community of mutual dependence. This thought to one of the fundamental principles of Buddhism. The subject of the consent is not an individual, neither physician nor patient, but a community of physician-patient relation based on mutual trust and information. So the consent in this meaning or, in other word, accord is the principle of not only medical but universal ethics.

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"Informed-Consent" is a concept which has been developed and is functioning at the medical world in the United States. The concept is the patient-centered, valuing the rights of patients. On the other hand, the medical concept in Japan has still been based on so-called "Paternalism" which regards all the medical acts of doctors. People in general in this nation are indifferent mainly because of the lack of public awareness, and prevailing traditional attitude-undirected doctors and dependent and patients. Much discussion in Japan on the matter these days seems rather superficial, without solving the basic problems, there are differences of Japan-American culture, educational system, quality of medical treatment etc. On introducing and practicing "Informed-Consent" to Japan, as a Buddhist philosopher, the another feels the necessity to preserve "trust and empathy-relationship" between patients and doctors by gradual attitudinal change on both sides. My concern is result of the overly rapid introduction of the idea which may lead us to social problems seen in the States such as constant legal disputes overemphasizing the rights and duties of the medical treatment. The another therefore, calls the attention of medical practitioners to re-evaluate the Buddhistic concept of "Hohben (Sk.upaya)" which implies acts of "Deep Wisdom and Compassion" on the doctors' side to guide patients mentally and physically.

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Recently in the field of health care in Japan, as in other countries, there is increasing number of people below that every person has a right to self-decision concerning health can, so that no medical intervention may be carried out without voluntary and informed consent. This argument is, of course, valid and persuasive, at last theoretical. However once we apply this principle to each and every case of health care, we immediately confront some difficulties. Because medical case has infinite variable, and in many cases we cannot forefully obtain free and informed consent. In the first half of this paper, we consider the theoretical and historical validity of the informed consent principle. In the second half, circumstances which make it difficult to take care of patients in accordance with the concept of informed consent will be pointed out.

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