According to Faden and Beauchamp, informed consent is a process of communication between a patient and a physician that results in the patient's authorization to undergo a specific medical intervention. The Japanese Medical Association, however, defines informed consent as "explanation by physicians and agreement by patients". Using the JMA definition, informed consent has been practiced by many physicians and patients in Japan. Not all patients, however, are satisfied with this method of decision making. The purpose of this paper is to discuss how this communication should be undertaken among stakeholders concerned with medical decision making. In the first part of this paper, two methods of communication are analyzed, one based on the JMA interpretation and the other based on Faden and Beauchamp. In the former, communication consists of a physician's explanation and the patient's consent. In the latter, communication is undertaken through the physician's recommendations and presentation of reasons why the patient should take the physician's advice, the physician's understanding of the patient's concerns and interests, the physician's explanations, and the patient's consent. In the second part of the paper, these two methods of communication are compared with actual cases of informed consent in health care. The paper then demonstrates that the two methods of communication are insufficient in the case of opposing opinions among stakeholders or when stakeholders have no understanding of each others' interests. The paper concludes that it is necessary for communication in health care to take place in two steps. The first involves uncovering the stakeholders' interests. The second involves determining the best solution based on those interests. It is a so-called consensus building process that incorporates these two important communication steps.
In December 2001, the Ministry of Health, Labor and Welfare issued a policy document titled "A Grand Design for the Promotion of Use of Information Technology in Health". The document describes a number of scenarios to be realized over a period of five years involving the provision and use of health services by means of information technology. Goals include the deployment of an electronic health record system to 60% of all hospitals with more than 400 beds.In order to promote such efforts, policies are needed to ensure the security of information and the protection of privacy. A law protecting personal information was passed in 2003 and came into effect in 2005. This paper discusses this law and examines its meaning, its significance, and its potential problems. The increased gathering and use of information in medical care environments does not always lead to more patient-centered care. Satisfaction with the gathering and protection of this information is important to patient outcome and may affect the ability of the physician and other medical staff to elicit patients' concerns, consider patients' psychosocial needs, and involve patients in treatment decision making, all of these being communication techniques that fall under the umbrella of "patient-centered" care.
Bioethical problems in medical care are widely discussed and debated. Because medical care must involve some degree of caring between the care-giver and the care-receiver (the patient), bioethics then must also be concerned with theories of caring. Milton Mayeroff argues that being concerned about others is an essential role for the human being; thus, he views caring existentially. He claims that caring about another human fosters self-actualization and autonomy in the acting person. This study concludes that, because people need to care for others in order for themselves to flourish, a theory of caring is the foundation to being human and to self-actualization.
Nurses often face ethical dilemmas involving issues of conscience and responsibility. Etymologically, "conscience" (συνειδησιs, conscientia) involves getting to know meaning of one's own act together with the internalized other. In order for a person to protect his or her identity when exposed to danger, conscience is "the internal surveillance organization" which judges orders according to his or her subjective restraint-norm" in relation to a specific act and features "a cognitive element and an influence-element". Not only does it mean the internal moral sense for distinguishing right from wrong freedom of an inside, but also it is inevitably accompanied by an external act in some form, such as an act or an omission. It is possible, however, that one's appeal to conscience makes a wrong decision because of incorrect information, groundless belief etc. But nurses should be allowed to refuse to carry out particular treatment or procedures based on personal appeal to conscience. Therefore the nurse appealing to conscience must undertake a step-by-step process of justification in order to fulfill a duty of care by carefully considering the patient's safety and welfare, based on acceptance of consequence and exact information. Administrators must discern whether the nurse appealing to conscience makes judgment based on appropriate knowledge and correct information and whether the proposed result is safe and acceptable. If so, administrators have a duty to support that result.Although the appeal to conscience is a fundamental right and can reveal someone's dishonesty (the whistle-blowing), it is not positively accepted in Japan. The dignity of each person's identity cannot be protected only by nurse's appeal to conscience. Consequently nursing practice committees or other ethics committees should discuss this and similar issues which include refusal based on a nurse's appeal to conscience.
The purpose of this paper is to examine the construction of a world of subjective meaning for Mr. A, who experienced depression in middle age. As a methodological tool, I use the theory of relevance advanced by Alfred Schutz. This paper first examines how Schutz' theory explains how, in social constructivist terms, "subjective reality turns into objective reality," and clarifies the temporal status of internal time consciousness. The paper then examines Schutz' construct of different sets of interests, or relevances: topical, interpretive, and motivational.In conversations between Mr. A and the author over four years, Mr. A's "narrative" changed. According to the theory of relevance, major changes of subject are seen in the evolution of Mr. A's statements from "I cannot go to work," "I am labeled as someone who cannot succeed in work," and "I feel tense at work" to such statements as "I want to break free from this vicious circle." By examining such statements the theory of relevance is able to clarify the meaning in epoche how Mr. A perceives the problems that he faces and how he attempts to deal with them. The author shows how Schutz' concept of relevance, as an intersubjective category, is able to reduce the distance between the actor and the observer. Using the concept of relevance, the author shows that an interviewer or hearer will come to an interpretive understanding of a speaker producing meaning compositions, by way of contrapuntal analysis, while, as if an accompanist, the hearer stands close to the speaker.
Generally speaking, it is existential pain, that is, spiritual pain, that distresses terminal patients to the very end. But spiritual pain isn't a concern only to terminal patients. It's fundamentally a concern that all people, as mortal beings, must address. This paper examines the search for spiritual relief. A key concept in this search is the "turning of outlook on life and death". This means that a thorough realization of the certainty of death becomes an unconditional affirmation of life. The reality of death invalidates any "meaning" or "value" that we place on our lives. At first glance, this invalidation seems to result in a negative situation. But a thorough realization of the certainty of death evidences "something beyond human power" that refuses to be given "meaning" or "value" by human beings. This "something beyond human power" is "life itself", or the "being itself" that we tend to miss in daily life. In the sense stated above a thorough realization of the certainty of death is something special. Recent thinking is that terminal patients can reconfirm the meaning or value of their lives through "narrative" . This paper, however, proposes that spiritual pain is a important clue to "something that can't be described" and therefore eliminates the need to ascribe "meaning" or "value". This paper proposes that there is no answer to the question "What is the meaning of life (or death)?" and that spiritual pain cannot be relieved by seeking the answer to this question. Paradoxically, spiritual relief can be found by living with the uncertainty of death and the mystery of life, not by removing these through "narrative".
The purpose of this paper is to give a new perspective to human illness. A good deal of discussion has been held on the difference between "illness" and "disease", especially from the viewpoints of medical anthropology and medicine for total health. However, no perspective yet adequately describes and appreciates "illness" as a complete experience forming part of human life. One problem with developing such a perspective is the concept of "illness" itself. It is well known that we sometimes achieve mental or spiritual growth through our experience of illness. But we usually say we "grow through our struggle with illness", instead of saying we "grow through our illness". When we use the first expression, illness is considered something to be overcome. But illness has another aspect, which Gabriel Marcel called "mystere", in contrast to "probleme". "Probleme" is that which we can analyze, answer to, and take measures to deal with from outside. In contrast, we can only "live" mystere by ourselves, and in mystere, questing itself is at the same time a kind of answer to it. So, as we can learn from Buddhism, we must view illness as an essential human life-experience having a secret treasure. A second problem concerns the limitation of the frameworks of medical professions that use the term "illness". From the perspective set out above, these frameworks are too narrow to fully describe and appreciate our experiences of illness. In other words, these frameworks tend to reduce the "mystere" of illness to the "probleme" of it. We must therefore focus carefully on the narratives of patients who live their own mystere of illness and endeavor to understand them from the viewpoint of "wisdom of illness", which means going beyond the framework offered by medical professionalism.
As a result of recent developments in reproductive and regenerative medicine, the moral status of the zygote and the embryo is becoming increasingly important. This paper considers them from the perspective of "potential persons" and investigates issues arising from this perspective. In particular I critically examine Tooley's personhood theory. First, I examine the "interest principle" as a core of Tooley's theory. (1) On the normative character of "interest", Tooley insists interest is necessary for an entity to have a right to life, but I insist interest is a necessary and sufficient condition for invoking others' moral consideration toward the interest-holder. (2) On the interest of potential persons, I prove the possibility of acknowledging it. (3) On the "particular interests principle", I argue conscious interest isn't the only possible interest for persons. Thus I show the "interest principle" isn't sufficient for determining personhood. I then propose another principle for determining personhood: an "ends in itself" argument based on "moral ability". Those who destroy an entity regard it as merely a means, and then being an end in itself is decisive for a person. Next, I discuss being "end in itself" based on moral ability and conclude we can regard potential persons as potential holders of that ability. Finally, I consider the concept of "potentiality". Tooley argues that the destruction of potential persons is morally equivalent to contraception. I clarify the assumptions underlying this argument by examining his "three potentialities" argument and "moral symmetry principle". He considers potentiality in terms of causality (the cause-effect relationship). When considering living entities, however, I propose we consider potentiality in terms of teleology (the parts-whole relationship, and the process aiming at goals). This paper aims to establish a framework for protecting potential persons as potential moral agents. It concludes that this is fully possible.
This paper analyzes the notion of sexual perversion from a philosophical stance. Sexual perversion is difficult to analyze because the notion of sex is itself ambiguous and unclear. Alan Soble identifies five central distinctions within the conceptual philosophy of sex that define the concept of the sexual act as 1) involving contact with a sex organ, 2) serving a procreative function, 3) producing sexual pleasure, 4) relying on intention or purpose, 5) being defined in terms of sexual desire. However, none of these definitions is sufficient. The philosopher Thomas Nagel set out a psychological standard that remains useful today. He defined the purpose of sexual desire as one of communication among the participants. According to Nagel, sex has an overlapping system of sexual perceptions and interactions: it involves a desire that one's partner be aroused by the recognition of one's desire that he or she be aroused. Nagel's theory, known as the "communication model", proposes a purpose for the sexual act and attempts to explain the essence of perversion. It proposes that the act of blocking off the communication results in the perversion. This model has a number of problems, however. For example, it implies that sexual relations between regular partners are inferior to novel encounters because less remains to be communicated sexually. Why is such a conclusion derived? Because the communication model is built up with equivocal and ambiguous structure, it involves both external and internal moral criteria. The coexistence of both types of criteria is the source of the model's problems.
Etiology is the study of the cause of disease or illness. The development of bacteriology in the 19th century saw the corresponding development of "specific etiology", which postulates that infectious diseases are caused by pathogenic organisms, such as the tubercle bacillus, that invade the human body and bring about a failure of homeostasis of the human being. Specific etiology has for two centuries been the central dogma of modern medicine used to explain the causality of numerous diseases, such as infectious diseases, cancers, and genetic diseases, by using models of a unique pathogenic agent, a bacteria or virus; a cancer cell; or an "abnormal" gene as the pathogen of the disease, respectively. The aim of this paper is to criticize the role of specific etiology by examining its social role and logical weaknesses, by examining the deterministic character of the etiology, and by comparing the "pathogen-carrier" ideology derived from the etiology with the pluralistic etiology of hygiene in the 19th century. This paper concludes that specific etiology can easily mislead medical professionals and lay people in that their understanding of "pathogen-carrier" ideology results in their perceiving infected persons as dirty and dangerous as the pathogenic organism itself, with the result that the infected persons are victimized and discriminated against.
About fifty years ago, Hisayuki Omodaka set out a "philosophy of medicine" comprising three important and closely related philosophies: the philosophy of science, the philosophy of life and the philosophy of medicine. Medicine has changed dramatically since Omodaka's time, especially with the development of molecular biology, which has brought new forms of diagnosis and new therapies for patients and in turn altered humanity's view of life. The purpose of this paper is to reexamine Omodaka's philosophy of medicine to determine whether it continues to offer some benefit to modern medicine. Omodaka described the human body as having two conflicting and mutually dependent natures, one without extensibility ("α") and the other with extensibility ("β"). The former enables our bodies to be active and is the reason our bodies function harmoniously. We now know that scientific approaches describe in detail the molecular mechanisms of life, with genes having the ability, for example, to begin transcription after transcriptional factors bind to the specific binding motif located throughout the DNA. This reflects the nature of "α". Therefore, molecular biology does not necessarily deny or devalue Omodaka's philosophy of medicine. Omodaka explained that the purpose of his philosophy of medicine was to reflect the present state of medicine, clarify the principles on which that medicine was based, and try to establish better medicine for the people. As has been discussed by many authors, science does not have the ability to reflect science itself. The nature of science lies in "control", as pointed out by Henri Bergson. Therefore, in order to clarify the principles of medicine, develop better medical education and provide better medical care, scientific methods are not sufficient, and a "philosophy of medicine" is indispensable to the achievement of a better medicine.
Article 3 of Japan's Organ Transplant Law requires the national and local governments to work to foster public understanding of transplantation medicine. This requirement, however, has not been adequately fulfilled. Consequently, public awareness and understanding of organ transplantation are not necessarily widespread. As a result of this context, organ transplants from living donors are rapidly increasing in Japan. Kidney transplants from living donors performed in Japan to date number more than 1,500, and these, along with liver transplants from living donors, are becoming common. At the same time, developments such as debate over the nominative donations to relatives and organ-swap transplants are stimulating reconsideration of existing concepts of organ transplantation. This article examines the current organ donation environment in Japan and proposes a direction for Japan to take in future.