The purpose of this paper is to contribute to making a better life in leprosariums by providing viewpoints to change leprosariums as isolation hospitals into communities of living. Although it is very hard for many residents who are advanced age and without any relatives to go off of leprosariums, the court found the isolation policy for recoverists of leprosy illegality in May 2001. Leprosariums are obliged to change, for example, homes for the aged. What I do not try to do here is to impeach someone. I make proposals, however, based on the interview to the Niirada branch school of Oku senior high school students in the Nagashima-aiseien leprosarium. The subjects of the interview meet the following two requirements: firstly they have been expected a remarkable activity out of leprosariums from their boyhood; and, secondly, they live in leprosariums again at present after the living out of leprosariums. As a consequence of the analysis, I propose attaching importance to the high regard for resident's self respect under the isolation policy and the understanding of the human relations in leprosariums, in addition to the request for substantial medical service, to better the present condition of leprosariums.
Although numerous attempts have been made by scholars to show what "person" is, little agreement has been reached. The purpose of this paper is to point out some of problems inherent in the arguments and review how the concept is treated from a Bioethical perspective. First, various arguments involving "person" in the field of Bioethics are surveyed. Most of these arguments pertain to the criterion of "person." These arguments originated in the works of Locke and Kant and are influenced by the characteristics of modern reason: self-consciousness, autonomy. Next, the two most recent arguments made by Beckmann and Secker are illustrated in order to clarify where the criterion of "person" is. Beckmann understands autonomy in terms of "the claim to the rights," whereas Secker rethinks autonomy from a viewpoint of "human's duty." The question now arises as to whether Beckmann concentrates autonomy as human's right to recognize person as "corpus" and if Secker might misunderstand it as autonomy caused by the other without much consideration of its public character. In both cases there must be something more to understanding autonomy as a whole. Therefore it is insufficient to grasp the concept of "person" only from autonomy. In discussing "person," we must avoid reducing it to a definition with a single meaning. We should ponder its difficulty and impossibility. Let us look deeper into "person," tracing the history of the concept of "person" now. For example, according to Sakaguchi, person (persona) once had the character of not only fixation but fluidization. Meaning that "person" has the character of interdependency and interrelationship in any society. In conclusion I will re-formulate the concept of "person" as the "topos" of the possibility of communication. Now "person" is given a new phase of meaning and will open the door to a totally different society which gives a "person" a new standpoint as a real key.
Bei der Forschung an importierten ES-Zellen handelt es sich um eine aktuelle Frage der deutschen Bioethik. Die deutschen Vertreter der verschiedenen Bereiche versuchen, aus zwei Gesichtspunkten bezuglich des Begriffs 'Menschenwurde'diese Frage zu behandeln: zum Ersten Menschenwurde als Eigenschaft des Gegenstandes and zum Zweiten Menschenwurde, welche sich im Umgang mit Menschen verwirklicht. Aus dem ersten Standpunkt lasst sich behaupten, dass die importierten ES-Zellen als pluripotente Zellen keine Gegenstande der Menschenwurde seien. Daher konnten die Wissenschaftler diese ES-Zellen fur wissenschaftliche und medizinische Zwecke nutzen. Im Gegensatz dazu lasst sich nach dem letzteren Standpunkt sagen, dass die Menschenwurde der menschlichen Embryonen kein Faktum, sondern eine Entwicklungsform darstellt. Daher hatten die umgebenden Menschen die Aufgabe, einen Ungeborenen zu schutzen und seine individuelle und moralische Entwicklung zu ermoglichen. Meine Lekture einiger japanischer Berichte uber die Behandlung der Probleme der menschlichen embryonalen Stammzellen legt die Vermutung nahe, dass dem obigen zweiten Gesichtspunkt in Deutschland fast keine Rechnung getragen wird. Man legt also das Gewicht vielmehr auf die medizinische Perspektive als auf das Leben der menschlichen Embryonen. Der zweite Gedanke bezuglich der Menschenwurde konnte aufschlussreiche Hinweise zum Umgang mit dem menschlichen Leben geben.
The aim of this paper is to deal comprehensively with various ethical issues concerning advance directives. Advance directives are oral or written statements which declare whether a person wants to receive life-sustaining treatment, in the event that they lose their decision-making capacity. There are two types of advance directives: the first is an instructional directive which identifies situations in which the patient would want specified treatments. The second type is a proxy directive, which allows the patient to designate someone to make decisions on their behalf. Advance directives are recognized in some form by the laws of every state. Despite the fact that advance directives have been available for more than twenty years, few adults have completed any type of advance directive document. In order to explore the cause of these law numbers, I survey relevant federal and California legislation and considered the legal issues surrounding advance directives. Then I consider the ethical arguments concerning advance directives. First, I discuss the ethical issues of advance directives in terms of the principle of autonomy and the doctrine of informed consent. Second, I discuss the conceptual problems of advance directives, which are rooted in the principle of autonomy. Finally, I reconsidered "the principle of autonomy" underlying advance directives.
In this paper, I examine one discussion of Disability Studies, 'the political economy of disability.' The political economy of disability focuses on the norm of modem society from which people with disabilities are excluded. The study of the political economy of disability shows that modem societies are based on the norm known as the 'work based' distribution system. The norm dictates that people earn the right to goods through working. But not all people are able to work or want to working. In these cases, modem societies face the 'distributive dilemma' (D.A. Stone). To resolve this dilemma, modem societies need to consider the second standard of distribution, which is a 'needs based' distribution system. In this system, an important role as the category of 'disability.' 'Disability' is a category used as one of the criteria that decides who deserves to receive goods based on the 'needs based' distribution system. This criterion relies on clinical and medical diagnosis. My point is that the insights of the political economy of disability are right, but the crucial problem remains. The problem lies in the standard and the measure itself that evaluates the condition and the position of the people in society. I consider the problem of standard which is defined by medical diagnosis. In conclusion, I will show that the political economy of disability is posing acute question on dominant norm in modern society.
Im erstaunlichen Ausmass des Fortschritts der neuen medizinischen Technik in den vergangenen Jahrzehnten bekunden sich Moglichkeiten der Lebensgestaltung und -vernichtung, von denen man noch nichts ahnen konnte, als in der Zeit des nationalsozialistischen Regimes eine ungeheure Vernichtungsmassnahme realisiert wurde. Viktor von Weizsacker veroffentlichte noch wahrend des Nurnberger Arzteprozesses vielleicht als einziger akademischer Mediziner einen Aufsatz: "Euthanasie" und Menschenversuche(1947). Er ausserte sich dabei nicht zur Schuld oder Unschuld von Personen, fur ihn sass auf der Anklagebank auch der Geist der Medizin, der den Menschen nur als Objekt nimmt. Er konzentrierte sich daher auf die Frage: Wie war es moglich? Was fur eine Medizin war es denn, die so terrorisierbar und verfuhrbar war? Die Totung unheilbarer Geisteskranker und weiterer Gruppen von sogenanntem "lebensunwertem Leben" wurde erst im nationalsozialistischen Staat als legalisiert bezeichnet. Damit verschob man das Problem der Medizin auf die juristische und politische Ebene. Eben diesem widerspricht Weizsacker und er macht die Unterlassung zum Thema seines medizinischen Gutachtens. Aber es handelt sich nicht um das Verstandnis eines medizinfremden Vorgangs, sondern um eine Selbstentfremdung, um eine Degeneration der Medizin selbst. Er fragte also nach dem Anteil der modernen Mediziner uberhaupt und prufte arztliche Motive and Willensbildung. Der Einsicht Weizsackers nach waren drei Motive fur die nationalsozialistische Lebensvernichtung zu prufen: Unwert des Lebens, Mitleid und Opfer. Ich verstehe diese Auswahl im Zusammenhang mit den drei Fragen des Damons an Jesus Christus in der Wuste im Neuen Testament. Das Problem der Euthanasie ist dann das der Dreieinheit von Aberglaube, Mystik und Macht oder Wissenschaft, Religion und Politik, das von "Der Grossinquisitor" in Die Bruder Karamasoff Dostojewskis, das der menschlichen Freiheit. Bei den Vernichtungsmassnahmen des Nationalsozialismus spielte der Opfergedanke als eine Verschmelzung von Toten und Erlosung eine entscheidende Rolle. Aber weder der Unwert des Lebens noch das Mitleid, noch der Opfergedanke in der Art seiner Anwendung sind imstande, die sogenannte "Euthanasie" des NS-Regimes zu begrunden.
Amyotrophic Lateral Sclerosis (ALS) is a motor neuron disease which evokes complicated questions in the Japanese health care system. In order to address these questions, we must analyze a wide range of ethical, legal, and social issues, paying special affention to the ethics of withholding and withdrawing mechanical ventilation. In the first section of this paper I provide a brief review of the facts concerning Japanese patients with ALS: (1) the effect of the patient's own wishes on choices concerning mechanical ventilation; (2) the barriers to home care, especially the burden placed on the families taking care of patients on ventilation, e.g. removing sputum from patients' tracheas; (3) the barrier for institutional care, e.g. the limitation of health care resources; and (4) the limited range of choices at the end stage of a patient's life. The second section is an ethical analysis of the preceding issues: (1) the relation between autonomy and dignity, which have been dissociated in recent ethico-legal arguments regarding end of life issues; (2) Consideration of the justice of allocating resources which may empower patient's autonomy and dignity. In conclusion, Sen's ideas on capability will be used as the foundation of arguments for increasing the allocation of resources to care for patients with ALS, and to expand the range of choices patients can make as to living with or without mechanical ventilation.
What is meant when a doctor says, "You are healthy" after the health examination? Is it possible to diagnose a person to be healthy? In fact, this question comes from a confusion between science and values. Health is not a scientific term but a value-laden, normative concept. So your doctor can only say "I couldn't find any disease," not "You are healthy." Clinical medicine textbooks describe many diseases, but they never give a working definition of "health". There are many diseases to be diagnosed but only one "health." "Health" is unique for each person and stands outside any medical investigations. When one tries to define health he will tend to fall into a circular discussion: Health is an absence of diseases and disease is a lack of health. One typical definition of health has been given by the WHO (1946). The WHO defined health as a state of complete physical, mental and social well-being. Some critics say that the WHO definition merely replaced the word "health" with "well-being." Many philosophers have proposed non-circular, positive definitions of health. However, like the WHO, they eventually fall into theories of happiness, which are very important, but cannot be applied to medicine as science. In contrast to clinical, the textbooks of public health education have rich descriptions of health. Public health officers also stress the importance of health. As shown in the slogan "health promotion," the health and disease of a population is recognized as a quantitative concept which may increase or decrease. In conclusion, health examinations don't diagnose a person as being healthy. All we can do is a massscreening of diseases. The true meaning of health depends on each person's view of happiness and as such, it is not a pure medical problem.
The duty to be a good medical doctor is considered from a viewpoint of Kant's ethics. Consideration of this article is begun with the so-called "lie paper" of Kant. A consequentialism of utilitarianism in this paper is criticized as follows. Even if a goodness of means to lie is guaranteed by a goodness of an end to save a life of liar's friend, the connection between a means and an end is not necessary but rather contingency. A goodness of means is not always guaranteed. And an act which is performed out of duty is good by itself because the duty is affected with a sentiment. There are two kinds of duties, complete or incomplete. The former is legal duty, the latter virtuous. A virtuous act is recognized as an example that a man conducts morally, which is an expression of a moral law. This act is admirable and respectable because of an expression of a moral law. It compelles an observer to become good and to be a good doctor that a man observes those who conduct the virtuous act.
Diese Arbeit versucht, die Moglichkeiten von Ludwig Sieps Naturbegriff bzw. Kosmosethik zu prufen. Zuerst werden einige Besonderheiten der Konzeption Sieps deutlich gemacht, indem Sieps Theorie mit der Kritik von Anton Leist, Ursula Wolf und Dietmar von der Pfordten konfrontiert wird. Wir gehen sozusagen einem Streit um das Klonen des Menschen in der "Frankfurter Rundschau" nach. Dann wird eine neue Konzeption von Jurgen Habermas in Betracht gezogen. Habermas hat in seiner Schrift "Die Zukunft der menschlichen Natur-Auf dem Weg zu einer liberalen Eugenik?" zum ersten Mal grundsatzlich zu Problemen der Bioethik Stellung genommen und ubt heftige Kritik an Siep. Aus dem Vergleich zwischen einem Kosmosethiker und einem Diskursethiker ergibt sich, dass beide Theorien nicht vollkommen plausibel sind. Zuletzt wird ein neuer Ansatz zur medizinischen Ethik empfohlen.
Because there may be limitations in the scientific method of discovering and treating patients' "problems," the narrative approach has become increasingly important. These limitations have been pointed out by scholars from various fields. Hermeneutic view point has it that clinical knowledge is mostly based on the doctor's assumption and differs greatly from the world in which the patients live their lives. What should those in the nursing profession choose as a means of understanding patients? There is a Social Constructionist view that understanding is obtained through "language." When the sick patient tells about the world in which he/she lives in certain words, he/she has decided not to tell in other words. Then the patient's world appears before us as he/she tells. The patient organizes his/her world through telling as well. After over three years of interviewing with Ms. K, who was stuck with her mal-treating mother, we verified what telling brought to her, and how it was connected with understanding herself. Listening to Ms. K's narrative was linked to understanding her world in which she lived her life. It also brought a certain order to her confused history. As a result, her regrettable past came to have possibility for the future, altering her mentality so much as to make it possible for her to say "I have done my best" and "I have been living so well."
The purpose of this paper is to show how the nonverbal communication is used by physiotherapists with physically handicapped and serious mental retarded children, during physiotherapeutic interventions. We used interview with physiotherapists, so to speak, real narratives of physiotherapists, who give physiotherapy to these children, because most of children couldn't even communicate. These interviews show the intimate relationship between physiotherapists and handicapped children, by analyzing the data from the interviews with physiotherapists. In the past, only few attempts have been made at this process of study, because we have to need more objective reliability and validity to research physiotherapy. It is difficult for us to study nonverbal communication more objectively, as it were, it isn't in our field. As physiotherapeutic intervention would be so much different from special education for handicapped children, we need more specific research from physiotherapy about them. In this study, we use the existential analysis method defined by Mourice Merleau-Ponty. It is entirely different from logo-therapy. We avoid using the sociological method of analyzing interview data. The findings of this analysis of data show that we have to transcend the wall of specialty and objectivity of physiotherapy; in other words, we need to be involved in an ambiguity, that is, non-perceivable dimension. Then we could live children with physical handicap and serious mental retardation together, in their world and their daily living. In conclusion, caring is the most important art during the physiotherapeutic interventions.
The medical education program in Japan has recently undergone significant revisions. Since 2004 doctors have been under a legal obligation to continue postgraduate clinical training for two years. In order to reform undergraduate medical education, the Ministry of Education, Science, Sports and Culture former a committee for that purpose in 1985. The committee proposed a careful selection of content designed to improve the medical education curriculum, problem based teaching and bed side teaching. The University Chartering Standards Law was implemented in 1991 to generalize the education program and to impose an obligation of self-evaluation on each university. In 1999, the Task Force Committee on Innovation of Medical Education for the 21st Century proposed an integrated medical curriculum, early exposure, small group learning, a tutorial education system, a core curriculum, a medical student evaluation system for entering to a clinical clerkship, and an evaluation system of educational and faculty development. In 2001, the Model Core Curriculum of medical education was announced, in which the teaching of medical ethics became part of the core material and was taught at the same time as liberal arts and basic and clinical instruction. However, the Model Core Curriculum of pre-medical education does not include human and social sciences. Since 2002, a trial of a nation-wide medical student evaluation system for entering to clinical clerkship has conducted. Many medical schools have recently established a department of medical education and have held workshops on medical education for faculty development. The Japan Society for Medical Education Working Group of Education of Medical Ethics proposed a medical ethics education curriculum and presented a manual for each of six strategies of medical ethics education. The Japanese Association for Philosophical and Ethical Researches in Medicine has begun to study the Model Core Curriculum in an attempt to standardize medical ethics education, and has proposed a program consisting of lectures for qualifying instructors of medical ethics education.
In the last three decades, euthanasia has been a topic of continuous debate in the Netherlands and elsewhere. I is obvious that euthanasia has medical, moral and legal aspects, but it also has cultural, social and political dimensions. In the Netherlands, after three decades of debate and practical experience, euthanasia is since April 2002 regulated as a legitimized medical intervention under particular conditions. However, the legal regulation of euthanasia does not mean that the practice has lost its controversial and contentious character. In this presentation I will focus on four issues. First, the legalization of euthanasia in the Netherlands, identifying the characteristics of the new law. Second, rules and regulations in European countries will be compared, especially the laws in Belgium and the Netherlands. It is also clear that the medical practice of euthanasia varies significantly among European countries, contrary to the implicit assumption that physicians in the Netherlands practiced openly what was hidden in other countries. Third, the issue of legalization, and the various moral and pragmatic arguments pro and con legalizing euthanasia, will be analyzed. Finally, different approaches to death and dying seem to emerge from the euthanasia debate. Three approaches are distinguished: controlled death, preventive death, and palliated death. The increasing focus on the patients' quality of life is an opportunity for the emerging approach of 'palliated death', going beyond the images of 'controlled death' and 'preventive death'.