Problems concerning the "mind" are now commonly discussued in various fields. The "mind" is an important factor in the issues of informed consent and terminal care and has always been one of the main themes in philosophy. Trials to scientifically clarify the relation between the mind and the brain have recently been initiated. This paper first states that it is necessary for us to employ a new philosophical concept in evaluating the results of brain research in molecular physiology, because the terms and systems used in this area are too old and inadeqete. Secondly, it is shown that there is a possibility to use some old philosophy approaches such as Augustinian philosophy in thinking of the present mind problem, if the re translation of the terms could be suitably made and the structure of his idea could be clearly understood. Lastly, applicatlon of the analysis by Angustine was made in practice to analyze the mind connections of medical staff, patients, and their families, and it shows that the understanding of the mind structure by Augustine is effective even in the modern medical field. This paper deals only with basic principles, but the author believes that the time has come to try to combine three areas, that is, the scientific research of the brain, the problem of the mind in philosophy, and actual mind problems in the medical fields.
Preface There two main factors of the European metaphysics of philosophical thinking: the first has been to think through experience even though the ideal thoughts should have a main position, the second has been to seek to know the self, just as Socrates did. However the Japanese researchers do not necessarily have such academical tendencies, when they try to read and understand European philosophies. Clinical philosophy, the elements of which should be the experience and the self, can be constructed and practiced by us in every day iife. 1. Death and the Dying The German sociological researcher Franco Rest asserts that the concept of death is unthinkable and only the concept of dying is thinkable. Because dying is the terminal part of an entire life. But this is not correct. Through ideal histories of care we can see that life and death are complementary. We must treat such a complementarity as a most important idea. when we think of what expenence is. 2. the Existential-Romantic Medicine Oliver Sacks. whose book Awakenings is very famous, proposes a existential-romantic medicine. He says. " this is the rationale of an 'existence' therapy: not to instruct but to inspire to inspire with art to combat the inert. to inspire with the personal and living, and, in the directest sense possible to awaken and quicken ". Existential-romantic medicine is directed to the personality, the freedom, and the identilication of the patients in the dialogue between the living I and I through the daily experience ofthe daily life. 3. Clinical Philosophy The clinical philosophy may be the tradition of the European metaphysics. At the same time it should be the possibility of thinking about human living concrete and the power of the healing.
Due to the practical features of nursing is inevitably involved in techniques. In other words in trying to enhance the quality of human life, people have performed techniques of nursing since ancient times. The acquisition of basic techniques in nursing, therefore, became a core of nursing education. However, in previous educational methods, technical patterns and handling were imitated repetitiously. According to Max Weber, acts must be distinguished from behavior, for the former signifies purposively oriented meanings while the latter does not. If we try to characterize the previous nursing method based on Weber's way of thinking, it can be said that the method is basically understood in relation to behavior. However, nursing techniclues should be directed at enhancing the quality of human life and therefore, the whole comcomplex system of nursing must be involved in acts signifying purposefully oriented meanings. In the earlier stage of learning of nursing techniques, students who lack knowledge the meaning of techniques tend to show mechanical and repetitious behavior. In the first stage of clinical training, students are not conscious of the meanings of technical acts and therefore are preoccupied only with the handling order of techniques. However, once they become conscious of the real relationship between clients and themselves, the purose of clients' lives is clearly acknowledged. Based on the above mentioned, I would like to clarify the relationship between acts in nursing techniques and purposes, reflecting on the learning process of nursing techniques in clinical training.
Medicine has discourse space filled with exchange and interaction between professionals and laypersons. How do Newspapers and magazines treat medical discourse? There have been many changes and controversies concerning cholesterol. After World War II cholesterol was considered to be a bad substance which generates atherosclerosis and should be lowered. However public health researchers showed that cerebral apoplexies among Japanese (specially farmers in rural district) occured because of the low-cholesterol in the blood. This result contradicted cardiologists' advice and the common sense. So the controversy started and continued. In newspapers and magazines either articles supporting the common sense or opposing ones appeared. There have been no articles dealing with both opinions of this controversy. From a point of view low-cholesterol in the blood as a risk factor of cerebral hemorrhage was shown after a progress of medicine. But from another point of view public health researchers could not overlook cholesterol, the substance in fashion. And the medical fashion of worrying about cholesterol has spread all over the country.
Medical social workers have to meet a wide range of needs of patients and their families as citizens and persons involved in the total daily medical care. Especially in transplantation treatment the existence of social workers is indispensable for helping patients with their own decisions for their own benefit from psychological and social viewpoints. In actual team medical care, it is important to promote the medical staff 's further understanding of patients with regard to the advocacy and respect of their own thinking from the standpoint of a third party. The role and importance of social workers in transplantation treatment is discussed, torough a case the authors were involved in, by examining the process of self-decisions by a patient and his family. The actual case here was a patient who, as a citizen, desired a heart transplant after many years of fighting against diastolic cardiomyopathy and succeeded in receiving it in the United States. The importance of medical social workers has not been fully recognized in Japan. As a result there is still a persistent shortsighted view that their role is no more than to exhort and persuade patients in response to their complaints. This paper discusses and tries to define the differences in roles and specialties between transplant coordinators and social workers as the key persons in transplantation treatment on the basis of the actual case and a field report on the actual heart transplant in the United States.
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.
Not a few people in Japan are killed in active euthanasia. However, most cases are hidden, as active euthanasia is prohibited in any situation. Consequently some people are killed by immoral ways, for example involuntarily or cruelly, though they could survive with handicaps, or though they could die calmly in voluntary active euthanasia. Voluntary active euthanasia should be permitted legally, and the Involuntary one should be prohibited strictly. Why is Voluntary active euthanasia prohibited? Because people think that no one has the right of death and believe in the theory of the slippery slope. But everyone has the right of self-determination. Does this right imply that? And cannot we put the brake on unlimited killing performed under active euthanasia? In order to answer these questions, I first investigated how the right of self-determination is justified by two theories which differ from each other:social contract theory and utilitarianism. This call give an impartial solution for them. The solution is that each person has the right to decide all one's own affairs and even commit suicide if the right is not misused and makes no one unhappy. Secondly I studied the meaning of death for the dying person, especially with regard to its positive meaning, i.e. the completion of his life. It is important what he does as the last act in his life when he suffers terribly from fatal wounds or diseases. Is it morally good that doctors prolong the severe pain of the patient as long as possible? It is bad that they rob him of self-determination and his happiness. He doesn't only have the right to die,but also should exercise the right in oder to get rid of his fatal pains. Thirdly I think through the new legal systems which permit the right to die and prevent patients from misusing it. Judging from the above, these systems must be based on the principles of self-determination and state of necessity. In the case of voluntary active euthanasia, to help one commit suicide can be legally justified. However, to kill one based on the one's serious request cannot justified, but only irresponsible for the murder.
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
"Medizin in Bewegung" ist die Gesammtbenennung einer anthropologisch orientierten Heilkunde, die in den 20er und 30er Jahren von den grossen Lehrern der Heidelberger Klinik in Gang gesetzt und in Unruhe gehalten wurde and der spanische Medizinhistoriker Lain Entralgo den "Durchbruch eines neuen Weges in der Geschichte der Medizin" kennzeich-nete und schon im Jahre 1950 "Heidelberger Schule" nannte. Dem Wortsinne nach bedeutet "etwas in Bewegung": dass etwas angelaufen war, in Fahrt gekommen ist, aber noch nicht ans Ende gelangen konnte, so dass wir uns noch in einem "Durch gangsstadium" befinden. Die Medizin steht ja - in Praxis wie Theorie - "in dauernder Bewegung". In Bewegung geriet die moderne Medizin nicht nur durch eine ganze Serie von atemberaubenden Techniken, sondern auch durch eine Reihe von kompensatorischen Bemuhungen um die psychische Seite and die soziale Schicht der Krankheit. Damit verbunden war ein neues arztliches Denken: Es ging jetzt weniger um die Erforschung der Ursache von Krankheiten als urn eine neue Beziehung zum Leben and zum Leiden des einzelnen Kranken. Drei Personlichkeiten werden uns in dieser "Heidelberger Schule" immer wieder begegnen: Ludolf von Krehl(1861-1937), sein Kollege Richard Siebeck(1883-1965) und deren Schuler Viktor von Weizsacker (18861957). Wir sind heute uberinformiert an einem enormen Verfugungs wissen, aber verkumert an Orientierungswissen "Seit dem Anbruch der Neuzeit sind die Volker reich an Wissen, Gedanken, Erkenntnis, aber arm an Weisheit", sagt Viktor von Weizsacker. Weisheiten aber vermitteln uns kaum noch die Wissenschaften. Weisheit haben wir aus anderen Quellen zu suchen: in den Bekenntnissen der grossen Philosophen, der Kunstler, der grossen Glaubenden aller Volker und aller Zeiten. Eingeordet in das dynamische Spannungsgefuge zwischen Verwurzelung und Entfaltung mochte ich hier drei charakteristische Momente der "Medizin in Bewegung" zu bedenken geben: 1. Die Heilkunde als eine Philosophie des gesunden und kranken Leibes; 2. Die Heilkunst als eine Wesenslehre der erkrankten Person, und 3. Die soziale Wirklichkeit des Patienten und damit eine Medizin der Mitmenschlichkeit.
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.
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.
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.