Heute ist der Tod zu einem Problem in der Gesellschaft und der Wissenschaft geworden. Aber das ist schon ein Problem, wie man sich sachgemass zum Todesproblem wenden kann. Weichen wir immer noch der ernsten Konfrontation mit dem Problem aus? Die Methode der modernen Wissenschaft und die Seinsweise des Menschen in der gegenwartigen Welt konnen diesem Problem nicht entsprechen, denn sie intendieren Todesausweichung, Todesvendrangung und Todes-vergessenheit. Die Tendenz zur Todesvergessenheit ist ein philosophisches Problem von heute. Wir konnen sie im Wunsch des Volks, "nach dem angenehmen Leben angenehm zu sterben", in der Metaphysik und der Religion der Unsterblichkeit der Seele oder im Bestreben der modernen Medizin, die ihre Aufgabe nur darin findet, Leben zu erhalten und zu verlangern. Viktor von Weizsacker (1886-1957) versteht Leben nicht als nur Leben, sondern als Leben und Sterben, also als das, was Tod als sein Strukturmoment enthalt. Er unternahm, das Subjekt in Biologie und Medizin einzufuhren. Wir konnen nicht verstehen, wie das Lebende als Subjekt entstehen, bestehen und vergehen kann, denn wir selber als Lebewesen befinden mitsamt alien Lebewesen uns in einer Abhangigkeit, deren Grund wir nicht erkennen konnen. Wir miissen dann das Lebende und dessen Grund unterscheiden, ebenso wie das Sterben als die Immanenz und den Tod als die Transzendenz. Diese biologische Differenz und die Koharenz dazwischen machen unsere ursprungliche Erfahrung des Todes. Der Tod im reli-giosen Begriff und der Tod im medizinischen Begriff sind zu unter-scheiden, aber sie sollen sich bei der Praxis in der Klinik vereinigen.
Health education that hides away senility and death is blind. Death education that talks only of death itself and the future life after death is empty. A critical synthesis of these two schools of education will be explored. In the lifestyle modification movement of modern health education, in which nurses set forth the notion of transcendent health, diseases and death are regarded as a failure or penalty for not maintaining a healthful lifestyle. This is false. Death education should be introduced into health education. The question is, in what way ? Death education as such lacks unity, in purpose, principle and method. Here we ask for a form of death education that could be harmonized with health education for everybody. Religious death education is not suitable for public health. Some look upon death education as a preparation to pass away in peace, that is good death. To set up, to evaluate and grade "Quality of Death (QOD)" -this is a parody of QOL -is problematic. Some regard death education as needed in order to live well. This is an existential narrative. Is meditation on death, however, a necessary condition of good life ? After all negative death education, in contrast to positive death education, is recommended : Education which shows the limitations of medical services and human self-control.
It is the purpose of this paper to argue the possibility of the application of discourse ethics (Diskursethik) to informed consent in bio-medical ethics. Discourse ethics, in general, is conceived as intersubjective acknowledgement of the validity-claims in acts of linguistic communication. The great progress in medical techniques is transforming the problems of substantial justification, i. e. grammar of life-form. Biomedical ethics also should take this current of time into consideration. The concept of informed consent forms important part of self-determination in medical care. It consists of the autonomy of the patient. And autonomy or self-detemination in medical care makes conditions for the patient's own intention, understanding and non-controlled. Self-determination in medical care contains the resistance to the abuse of paternalism in medical care and bio-medical experiments. But it is necessary in medical care,as many authors have pointed out,to balance self-determination, nonmaleficience and beneficience. Then what are these concepts founded on ? From the discourse ethics's view, self-determination (autonomy) and beneficience in informed consent adhere in dialogical communication as the validity-claims in acts of linguistic communication. The validity-claims are explicated through speech-act theory or pragmatics. Discourse ethics was proposed by J. Habermas about thirty years ago, but it seems there are few application studies. We are expecting more studies about the application of discourse ethics to medical care.
Recently, it has been discussed that decision-making regarding the use of the most advanced medical techniques, i. e. gene therapy, and organ transplantation, needs ethical standards based on "bioethics". The fundamental concepts of bioethics are "self-determination" by the patient based on his autonomy and "persons theory", which means that reasonable persons can only have self-consciousness or a self-concept. However, limitations of bioethics have been indicated because of its basic concept. This concept differs from the ideas of the psychoanalysis and Buddhism that "ego" itself, which bioethics relies on, cannot be relied upon. Dr. Taro Takemi advocated Seizon and Life Sciences based on the Seizon law of Buddhism at the same time that bioethics appeared in the USA. Seizon means not only survival but also adaptation. In this paper, the foundation and limitations of Informed Consent and Persons, which are the fundamental concepts of bioethics, are discussed, concluding that there are possibilities of using bioethics in Japan and developing bioethics as Seizon and Life Sciences, which is global bioethics.
The birth of Dolly, a cloned lamb, shocked the whole world and triggered a worldwide dispute over the issue of cloning. Although there are many different approaches toward this matter, ethical ones are mainly considered here. Starting with rethinking why the news of Dolly was so shocking, I will make it clear that two kinds of cloning exist. Religious dimension will be argued after this by studying "Declaration in Defense of Cloning and the Integrity of Scientific Research, " which was signed by world-famous scholars. Marketing-related problems with human cloning also will be mentioned as a subject for our discussion. Following these considerations, the view of Dieter Zimmer in Germany, which is biological or biologistic, will be dissected into approvable and refutable parts. Then finally, the approach proposed by Jiirgen Habermas will be discussed, which brought ethical self-understanding into focus. It becomes obvious through examining these different approaches that both religious and marketing approaches are not so original with regard to the controversy over human cloning and have a tendency of being overwhelmed by 'normalization of new technologies, ' like previous procreative medical technologies. Although in Zimmer's biological approach there surely are some points worth considering, it as a whole is not theoretically strong enough. It is Habermas's ethical self-understanding or, so to speak, moral self-consciousness that is very unique as an ethical dimension on human cloning. There remain, however, several doubtful points; they therefore must be elucidated in order to reach a deeper understanding of human cloning on the philosophical and ethical level.
The present paper discusses "a tendency to regard the human body as an object", in which many young students in Japan adhere to implicitly. Furthermore, medical staff also adhere to the same tendency as the students. It is the purpose of this paper to propose both restraints on the tendency. Firstly, this paper shows a implication in one's naive experience in death with dignity. Patients' aspect of the body shows two views of patients' ideas on the human body : my body as private property and the state of affairs of my body as a diseased person. Secondly, this paper criticizes medical staff for their theory that it is possible for them to interpret the patients' condition according to statistics. This theory shows that the medical staff view the body as an object of operation for them. Finally, we confirm the difficult point of the tendencey, which is that this tendency suppresses the individuality, condition and expression of the body.
The purpose of this study is to describe health professionals' involvement in patient-centered medical practice and to suggest solutions to various problems. In today's advanced medical society, the health profession is facing issues in patient-centered medical practice. However, in cases of the progressive cancer, the physician usually tells the patients' family first about the patients' diagnosis and prognosis prior to informing the patient. This is a problem because in these cases it is truly an infringement on the rights of the patient to know his or her condition. All of the patients have to be respected as individuals. The problem is often assumed that the idea of informed consent came from America and therefore there is a cultural difference between Japan and the West. In Japan, fundamental human rights are guaranteed under the Constitution. In reality, there has traditionally been a lack of individualism and a deficiency in concern about human right among the health profession. In recent years, as things are changing so rapidly, patients are growing in recognition of their rights and the general public has a fairly wide knowledge of medicine. There is increasing dissatisfaction within medical care that ignores informed consent. Who does the patient's life belong to? The patient needs to know about his or her health information first and then to decide if whom how to inform family members of his or her medical condition. I believe that we must respect the autonomy of every individual. That respect includes health professionals protecting the patient's right of self-determination.
A 62 year old man died of SAH at an Okinawan hospital in Dec. 1996, and his kidneys were transplanted after his death by consent of one daughter. Afterwards other members of his family, i. e. his wife, his son and his three other daughters, went to court over the inappropriate therapy and donation. We were asked to check a copy of his clinical chart tendered by the hospital, the letter of complaint of his family members, and the questionnaire to the hospital and answers from the director of the hospital. We pointed out 3 major issues : (1) Did he receive reasonable treatment? Was his brain death diagnosed correctly?, (2) Was the informed-consent of his family members for his organ transplantation stated clearly?, and (3) Did the co-ordinators give adequate information and make valid agreement? Did they confirm the donor's will? Did they confirm consensus of the family for donation? We cannot find out rational answers to the questions above. The patient was a mentally handicapped person, and the doctors abandoned his treatment soon after his arrival to the hospital. Once the opinion of his organ donation was made by one daughter 3 days after his admission, the doctors ignored any wish against donation by other family members. We believe that the happiness of the donor family is one of the most essential factor for organ transplantation to plant its roots in Japan. In this case, the family got no happiness but serious confusion. This case could be an extraordinary case, but because we have only a few means to check up the adequacy of organ donation in this country, this might not be an exceptional case. The difficulty to access medical data by the family must be dissolved immediately.
This study analyses private papers written by women who underwent sterilization. First, a comparison is made with the model of E. Suchman who pointed out "illness behavior" and "stages of illness". In the present study, frequency of words in women who underwent sterilization treatment were analyzed by using WORD-SEP (frequency of word program). This is the Zipf's law. Zipf interpreted this fact as the one to express the fundamental basis of human behavior for "least effort". This progrum analysed the structure of the word frequencies in computer programming languages and manuals of computer by the same method as Zipf. We would turn from the argument of fining the other human activities regarding the various human behaviors whether they show a similar pattern as was found by Zipf or do they show a different pattern. We could approach the study of the structure of human needs of women who underwent sterilization. In light of the result, these words such as "watashi","onna", "jibun" and "ko" contained the arguments towords the problems. This paper will focus on these issues and further hypothesis of these issues.
With regard to the social welfare of disabled persons, I will consider the relationship between feelings of pity for them and discrimination against them. In Japan, most people today who have not been in close contact with disabled persons feel pity for them. Is this feeling of pity an expression of discrimination against them? In this paper, I will describe and analyze the nature of this feeling and make the following points: 1) A feeling is experienced passively, so we cannot modify it at the same time that we are feeling it. Therfore, feelings of pity for disabled persons are not in themselves equivalent to discrimination against them. It is possible to interpret them as such, but this interpretation only presents discrimination as a problem without a solution. 2) Referring to Arbert Memmi's definition of discrimination in context of racism, I will consider the way in which discrimination is the result of a relationship between individuals and society. Discrimination shuld be understood at the social level, namely in its relationship to social structure and social organization. Only then can we find measures to resolve it. 3) Pity for persons with disabilities is no more than a groundless conviction held by non-disabled persons, and is a reflection of the lack of communication between these two groups. 4) We should start from the fact that people, both with and without disabilities live in the same world at the same time, and thus learn to naturally accept heterogeneuty and variety in people.
The fieldwork in medical philosophy aims at the innovation of the whereabouts of the meaning occurrence and the reasoning process. The fieldworker searches for the structure of the daily life of oneself who has lived for a long time. He reflects on the meaning system of his daily life, and searches for a contact point with some different meaning system. The fieldwork in medical philosophy is inward. It is to search the base layer of the research object and the researcher. It is to clear identities which are the standard of the value judgment. The researcher must avoid by the existing organization, the part and the name from what he thinks about with the medical spot and the member. It is a problem like a principle whether what it is, and depends on the meaning system. Research reports can often be warped by the readers' meaning structure. It is a political problem. If the researcher controls his work in accordance with the existing definition with the medical treatment, nursing, doctor, nurse etc., it will mean the death of thinking .
Some cases of "brain death"-heart transplantetion in Japan have been performed in 1999 after a long- period of time following the Wada scandal of 1967. The problems of whether "brain death" is the termination of human life or not have not been solved medically, socially or ethically, even though the new organ transplantation law, including the description-a brain-dead body, was enforced during a brief discussion in 1997. The main reason was that the authorized Takeuchi criteria of the Ministry and Welfare in 1985, and 1997 together, stated that brain death is not a concept on death, but a clinical concept on statistical study on brain-death cases of our country. So, the "brain-dead" person in transplantation is the weaker patient compared with the recipient patient. In 1996, Professor Abe was arrested for the accidental homocide of a hemophilia patient injected with non-heated blood. The patient later died of AIDS after the injections. Professor Abe routinely carried out these types of injections till the middle of 1985 through a subordinate doctor of Teikyo University. I think that Professor Abe is the weakest person compared with the AIDS patient, who was supported by patients groups, lawyers, public prosecuters and the mass media. Being a specialist on blood medicine, he could know the risk of blood from the USA possibly comtaminated with AIDS, reading the some new English articles 10 years ago, but he never discontinued the use of the blood therapy. The reason was that at that time, there was no consensus on the non-heated blood for hemophilia as the origin of "AIDS", medically (no strong arguments on the blood were done for the origin of the AIDS in the blood group meeting, and so strong debate was done on the strict relation between the serological findings and fatal signs of AIDS patient in the infection group meeting), socially, and legally. And secondly blood therapy was the only routine method to treat the bleeding of hemophilia. Thirdly this legal and fanatic investigation against Prof. Abe was performed 10 years after the injection based on long years of medical data. He is the victim of irrationalism and fascism in the medical society including both doctors and patients of our country, because in Europe and American countries where the more strict discussions on the relation between the blood use and AIDS signs have been continued these 10 years medically, socially and legally, no arrest of the clinical doctors has been found in the investigation till now.
We will discuss a case involving a patient with dissociative disorder who has been in bed due to "lumbago" for the last 20 years starting at 32 years of age. Pain in this patient, differing from general "pain" associated with the presence of a specific organic base, lacked an organic base, and the mechanism of the pain was unclear. However, this symptom was similar to conventional pain with respect to invasibeness, limitation of activity and reduction of objective QOL. However, the patient did not consider the limitation of activity an important issue. There was a marked "dissociation between QOL as subjective satisfaction and objective QOL". With respect to this aspect, a relationship between "pain and QOL" in this patient significantly differed from that in patients with other physical diseases. In this patient, "pain"appeared as a conversion symptom as an unconscious strategy to relieve intolerable stress. Therefore, it was speculated that relief of pain may lead the patient to an inconsistent status of "strategy for strategy ".causing an aporia that a new successful strategy causes the patient recurrent intolerable pain. Therefore, in this patient, a "coping strategy" to prevent pain rather than improve pain should be established. A system that facilitates "positive and aggressive posture and management against pain" must be prepared from both individual and environmental perspectives. Psychiatric vulnerability in this patient may give the patient a marked handicap with respect to "improvement in QOL". However, it is suggested that an approach such as psychological therapy may relieve "pain" without an organic base, resulting in the disappearance of a dissociation between improvement of objective QOL and subjective satisfaction.
In 1997, the American Medical Association conducted a large-scale national survey of physician-assisted suicide and euthanasia. This survey showed that a surprising 6% of the member physicians of the As-sociation had met requests from patients for assistance with suicide or euthanasia at least once. Most of these patients had terminal cancer, and the doctors who had carried out assisted suicide and euthanasia were generally not familiar with palliative care. The problem of physi-cianassisted suicide and euthanasia has become a general trend among developed countries for the past decade. To help solve this problem, palliative care is beginning to be considered in the light of psycho-oncology. Since the late 1980s, many studies have reported that cancer patients' wish to die comes largely from their depression, lack of social support, and pain that is not controlled well. Palliative care specialists think that if palliative care gains substantial popularity, it will make physician-assisted suicide and euthanasia less frequent.
In this article, I will chiefly demonstrate the assertion that the right to die cannot yet be justified. And I will carry out this demonstration from the following five aspects. First of all, the way of society and culture should not be ignored, for the right to live and the right to die are also dependent upon the way of society and culture. Particularly noteworthy is the horizontal development of society and culture. In the long run, if this development is enough to preserve all the lives of people sufficiently, people may not claim the right to die. Secondly, I notice the problem of the method of the ethical question itself, which academic practices have often overlooked. Because this problem has effected the justification of the right to die as I will show later. Third, we must clearly distinguish the right to die from inevitable death by reason of historical limitations. This argument, of which many sholars often have forgotten, should be unavoidable. Fourthly, we may be informed of some problems about the right of self-determination. Because even if the authentic right to death is guessed on the basis of the right of genuine self-determination, that case cannot often be brought into materialization. Fifthly, we should direct our attention to self-preservation of life itself and to social intensification of a disposition to this self-preservation. I have confidence that the evidence of demonstration which can be acquired from those aspects mentioned above in this article may be sufficiently strong to override the justification of the right to die.
The attempt to characterize the modes of death in terms of the personal pronoun originates in the life attitude that rights of patients shuld be respected against the dehumanization tendency sometimes found in medical practices. In this regard, the characterization of patients' death in terms of the second pronoun (you) rather than the first (I) or the third pronoun (he or she) is understandable. However, we feel some doubt about the adequacy of labeling the mode of human death with personal pronouns when we begin to ask the validity of the characterization from the standpoint of the meaningful mode of nursing. The reason why we feel this way is that the very attempt to characterize the mode of death in terms of the personal pronoun seems to be based on the mechanical and dualistic reductionism of modern science leading to the dehumanization tendency of medical practices. In confronting various modes of deaths of patients in medical practices, what we are asked for is to capture the holistic mode of human beings rather than to characterize them in terms of personal pronouns. In order to capture the real mode of a person who is dying, we have to avoid the objectification of her or his existence, or rather, to take part in the process of his or her dying mode intersubjectively. This indicates that we as medical professionals have to change our scientifically oriented life attitude into the holistically encountered life attitude toward persons who are dying.
Many terminal patients pass away in cure-oriented medical centers. In these cases, there are often serious discrepancies in attitudes toward dying patients and death itself between health care workers (h. c. wokers) and patients and/or their family members. Death means "the first person" experience to patients, "the second person" experience to their family members, and "the third person" experience to h. c. wokers. Patients and their family members are used to being hurt psycho-socially in the process of life-prolonging- treatments. In addition, they are also used to not being satisfied with their needs of human dignity by h. c. workers who adhere to a bio-medical paradigm. Surely, it is not as easy for h. c. workers to keep "the second person" attitude toward a patient's death the same as that of a patient's family members. However, medical treatment as a human service should contribute to coping with the overall needs of patients and their family members. It is very true that patients and their family members have relationships with h.c. workers not to contribute to the development of medical science, but to receive their own physical, emotional, spiritural, and social comfort. Therefore, h. c. workers shuld embrace both a human life model as well as a bio-medical model. If h. c. workers are aware of their own real personhood, including life and death, prior to their professionalhood, they will provide their professional skill humanistically to each person who benefits from service. Providing psycho-social supports empower patients and their family members to be well and maintain their quality of life. In addition, h. c. workers themselves may learn the attitude toward death as "the second person". Finally, h. c. workers need to discuss why maintaining "the third person" attitude is detrimental to patients who are dying.
This report concerns a method of the final terminal medical treatment. Recently, the viewpoint of the "death of the second person" has been discussed. Firstly, the general idea of the "death of the second person" was explained in comparison with that of the "death of the third person". The "death of the third person" means a functional physical stop. And the "death of the second person" means the death of the "person" existing in face-to-face relations. However, the "Patient-Physician Relationship" must be the "relation of the second person" so that a patient may be considered a person. Secondly, in light of modern medical treatment, whether these relations could be realized or not was examined, but modern medical treatment has put too much emphasis on the current era of technology and systematic organization. Therefore, it seems impossible to adopt the idea of the second person to the "Patient-Physician Relationship." Thirdly, an attempt to present an ideal model of the "Patient-Physician Relationship" in which such an idea can be realized as a moral framework was examined. In other words, a model that incorporates all of the important ethical appeals that result from human relationships was considered. However, this moral framework must result in the neglect of the person himself. Fourthly, it was asked what will be done in medical treatment regarding the limitation of natural science. It is not that medical treatment is a substitute for religion. We must recognize that modern medical treatment is "powerlessness" Under this recognition, according to Jaspers' interpretation, the meaning of Hippocrates' proposition " latros philosophos isotheos" becomes clear.
With remarkable developments in palliative care, we can surely control the physical pain of patients with serious disease. However, it may be more painful for patients to live with the fear of death as they wait for death to finally occur. The sense of life harbored in Japanese is quite different from that of western countries where life is based on modern science. Many Japanese patients with incurable diseases prefer not to undergo aggressive treatments which can only delay the time of death. Many Japanese are averse to the organ transplans from brain dead donors, because they believe that body is tightly associated with the soul and can hardly recognize that brain death is real death. Patients in the terminal state develop not only an independent mind which seelks maturity as a human being, but also a dependent mind which fears isolation from other people. They usually hesitate to request anything in order not to trouble others, while at the same time, they also want others to comply with all their request. Japanese people don't like to complain about the fear of death, because they have their own culture in which one's death becomes honorable if he/she accepts it as a natural process. Therefore, Japanese patients tend to suppress their fear of death and some manifest physical symptoms as a result. Most Japanese patients don't intend to express theemselves after they perceive that death is coming. They would like to continue their usual way of living until death, and wish to die without suffering during their sleep.