Die vorliegende Untersuchung geht der Frage nach, ob und inwiefern zwischen dem menschlichen Leben einerseits und dem Nutzen fur die Menschen andererseits eine Abwagung moglich ist. Diese Abwagung legen die stellvertretenden Positionen sowohl im japanischen Schlussbericht uber die Behandlung der menschlichen Embryonen als auch in der deutschen Stellungnahme des Nationalen Ethikrats zu therapeutischem Klonen ihrer Argumentation zugrunde. Im Gegensatz zu dieser Vorgehensweise betont Dietmar Hubner die Prioritat des Abwehrrechts menschlicher Embryonen gegenuber dem Anspruchsrecht der Wissenschaftler. Anselm Winfried Muller seinerseits weist darauf hin, dass man mehr fur Tun verantwortlich sei als fur Lassen. Bei der Embryonenforschung musse man eine grosse Verantwortlichkeit fur den Tod von Embryonen tragen als fur das Ausbleiben von moglichen Fortschritten bei Behandlungsmethoden, welche Kranken zugute kommen konnten. Daruber hinaus gibt Muller Aufschluss uber die radikale Instrumentalisierung. Aus dieser Erorterung lasst sich erkennen, dass die Menschenwurde beim Forschungsklonen starker verletzt wird als bei der verbrauchenden Embryonenforschung, da im ersteren Fall ein Embryo von vornherein nur fur die Nutzung erzeugt wird. Meine Analyse der Differenzierung sowie der Rangordnung bei den Autoren verdeutlicht, dass man nicht bei der oben genannten Abwagung bleiben darf, sondern die Probleme des Embryonenschutzes unter einem anderen Gesichtspunkt betrachten sollte.
The reason why the Japan Society of Obstetrics and Gynecology has placed severe restraints on preimplantation genetic diagnosis of embryos (PGD) since 1998 lies, except in the fear that PGD will cause discrimination against handicapped people as well as result in life screening, in the following two assertions. (A) PGD technique is still in its research phase, it has low accuracy and its safety has not been established. (B) Restraints will act as a brake on reckless applications, i.e. on commercialistic developments, of PGD. (For example, the clinical application of PGD not only to genetic diseases or recurrent spontaneous abortion due to chromosomal abnormalities, but also to genetic enhancement of mind and body on non-medical grounds) However, the former assertion is being denied by the latest study of actual results over a period of 10 years at the world's three most active PGD centers (the Reproductive Genetics Institute, in Chicago, Illinois; Saint Barnabas Medical Center, West Orange, New Jersey; and SISMER, Bologna, Italy) by Dr. Munne's team. According to Dr. Munne's article (Over a decade of experience with preimplantation genetic diagnosis: a multicenter report. Fertil Steril 82: 292-294, 2004), a total of 754 babies have been born from 4,748 PGD attempts at these three centers, with 207 pregnancies still ongoing. Five misdiagnoses following PGD practice (three cases of trisomy 21, one case of cystic fibrosis and one case of fragile-X syndrome) have been published. The safety of the PGD process is validated by the estimated number of already more than 1000 apparently healthy children born after PGD worldwide. As for the latter assertion, we are of the opinion that this ethical position and the long delay in gaining permission for a single case, discriminates against couples who undergo PGD for reasons of infertility as well as fertile couples who consider this technique for reasons of recurrent pregnancy loss or for being at risk of transmitting genetic diseases to their offspring. Considering the usefulness of PGD in alleviating the load on the mother's womb by pre-birth diagnosis, all applications of PGD based on medical grounds (such as genetic diseases or recurrent spontaneous abortion due to chromosomal abnormalities) should be approved.
The German philosopher Juergen Habermas, who emphasizes the significance of communicative rationality in constructing social theories, has recently made active proposals in bioethics. To the extent that he insists on duties analogous to moral ones with regard to the moral status of animals, he remains in step with the opinions of some English-speaking ethical theorists. Indeed his acceptance of communications between men and other animals is consistent in part with the position of Peter Singer, who represents such opinions and objects to differentiating between humans and animals with reference to moral duties. However, Habermas fears that valuing various lives only for their sensible capacities, regardless of special differences, might result in assignment of priority to the lives of healthy higher animals over those of handicapped babies, and therefore maintains that we are after all different from the other animals in moral status. This conclusion by Habermas is built on the philosophical edifice of Max Horkheimer and Theodor W. Adorno, the author of the Dialectic of enlightenment, in accordance with the idea that we should not instrumentalize the living activities of humen beings. This is why he insists that research in reproductive medicine should be carefully considered. Accordingly, his attitude toward bioethics results in a kind of anthropocentrism, though we must not overlook the need for expansion of communicative relasions between humans and other animal species. The opinions of Habermas on bioethics have affected the ethics of nature, as outlined by Angelika Krebs and Martin Seel under the influence of Frankfurt School in the contemporary Germany.
In this paper, I examine the condition of living organ donation. In the first part, I show that the principle of voluntary donation is the key to living organ transplantation. In the second part, I examine the debate on living organ donation, especially the moral character of related donation. In the third part, I show that the need for guarantee of voluntary consent for organ donation requires an alternative living organ transplantation system. In order to guarantee the voluntariness of the living-donor, we need to choose another system that does not restrict the donor to related people. In the conclusion, it is recognized that if we should guarantee of the principle of voluntary donation, we would have to undertake this status as a potential donor. If we wouldn't undertake this status, we should refuse the organ-plant medicine itself.
Genetic information that results from genetic testing reflects the patient's condition, and a part of it is shared with genetic relatives of the patient. Therefore, in cases in which a patient's genetic information indicates the presence of genetic disease, his genetic relatives may suffer (or have suffered) the same disease, as well. The informational consequences of genetic testing cannot be evaded. Thus, in genetic testing, the issue of treatment of genetic relatives is of great importance. The issues of breaching of confidentiality and the duty to warn by physicians have been discussed in accepted theories of bioethics. In such theories, the duty to warn genetic of risk of disease relatives is considered a benefit to them, though this does not take into account the disadvantages to genetic relatives of being informed of disease, e.g.,, distress after being informed that they have the risk of genetic disease. In this paper, I discuss handling of such information from a viewpoint other than that of breaching of confidentiality by physicians. It is important to recognize that genetic relatives have two rights, 'to know' and 'not to know' about their risk of genetic disease. In modern medicine, we accept the principle of self-determination. But, in genetic testing, we must take account of the genetic relatives' rights at the same time. I examine how genetic relatives should participate in genetic testing.
How philosophy and social sciences are reconcilable in the field of bioethics has long been a disputed theme. The former tries to find universal values among different human beings, believing there should be, whereas the latter presupposes diversity of values and morals among the different people of the world. The notions of informed consent and autonomy in bioethics, originating in the US, have now been disseminated to other parts of the world. But are they to be applied universally to every moral situation and to all people who have notions of family, community, illness etc quite apart from those in the west? This paper provides criticisms from social scientists toward traditional bioethics, saying that it fails to provide social and cultural contexts surrounding ethical dilemmas. If bioethics is to be seen as providing health care ethics based on "universal" human values, it should also accommodate the particular values and needs of those who have been underrepresented up until now. One way to mediate between a particular human culture and a universal ethical framework would be to employ ethnography as a means to reflect upon its own cultural assumptions and eventually fill in the gaps between cultural particulars and universal human values.
In July 2005, I investigated the conditions of the dental ethics committees of 29 universities and dental colleges in Japan. Of these, 16 responded to questions sent to them. In this report, I consider the problems pertaining to these dental ethics committees. Some committees are composed of members who are either dental specialists, or dental specialists and natural scientists. However, according to the criteria of the guidelines drafted by the Board of Bioethics and Security of the Ministry of Education, Culture, Sports, Science, and Technology, there must be at least one external member and one female member on each such committees. In response to the question concerning the ethical problems involved in the process of review of dental research conducted on human subjects, these committees stated that they have almost no such problems. I suspect that the committees' members are unfamiliar with eminent declarations such as, the WMA Declaration of Helsinki and other guidelines, and are not sensitive to ethical issues,; therefore, their review process is thus probably not fair. Such committees also appear insensitive to the ethics of dental education, since they do not provide guidance to students in collecting extracted teeth with informed consent. On the other hand, the ethics committees that follow the criteria of guidelines are sensitive to internal issues, e.g., how the committees are authorized and what qualities are required of members. There is thus a gap in quality among committees. However, this investigation does not clarify the sorts of problems that should be considered ethical. An increase in review of ethical committees is expected. I believe that it is important for such committees to communicate with eath other in clarifying ethical issues, eliminate the gap in quality among committees, and adequately consider their authority and obligations as well as, the requirements concerning the qualities of their members.
The purpose of this study was to attempt to determine general ideas for addressing ethical issues in nursing practice. The author interviewed nurses who had experienced cases involving care and related ethical issues. The interview data were analyzed using qualitative research methods. The subjects of analysis were the following three cases: 1. A client who was transferred to the hospital for reoperation but died shortly before operation; 2. A client who was in and out of the hospital for more than 10years because of incurable illness; and 3. A client whose last wish was fulfilled in the form of a Christmas party. Analysis showed that ideas for addressing ethical issues converged into two categories. The first included ethical issues, including "role as the client's advocate," "coordination between the client's wishes and the doctor's policy," and "paternalism and maternalism". The other category included issues related to caring, including "learning from the client," "formation of a strong bond resulting from mutual relationship," "involvement as a team," and "departure from medical rules". There were, in addition, three keys to addressing ethical issues that did not fit into either category: "hope for peaceful settlement of affairs," "hope for successful communication," and "wish to be treated indulgently". These three keys are useful both in care for patients and addressing ethical issues.
This research is intended to consider ethical problems posed by the legal precedents established in cases concerning posthumous reproduction in Japan, Britain, and America. In Matsuyama, Japan, a woman gave birth through artificial insemination using the frozen sperm of her deceased husband. The undisputed facts in this case are as follows: The biological father, who was undergoing treatment for leukemia, clinically donated a sample of semen in 1998 to be preserved for artificial insemination, since said treatment had the potential of rendering him sterile. After his death in 1999, his wife gave birth to a child in 2001. The child was conceived through in vitro fertilization embryo transfer using the husband's preserved semen. The Matsuyama District Court ruled in November 2003 against recognizing the legal relationship between the deceased father and the child born from posthumous reproduction. The wife appealed this ruling. In July 2004, the Takamatsu High Court subsequently ruled in favor of recognizing the legal relationship between the deceased father and his child. I examined six cases similar to the case in Matsuyama involving posthumous reproduction. There were four such cases in Japan, one in the United States, and one in Britain. In the case in Matsuyama, Japan, relatives of the deceased husband testified in court that the wife in question intended to bear child through posthumous reproduction. In one case in Japan, a wife seeking posthumous reproduction told her doctor that she wanted to artificially inseminate her husband's mother as well. This is did not involve the cases in Britain and the United States. In Japan, the family's consent is required for the organ transplants. I believe that there is a family characteristic peculiar to the Japanese with regard to posthumous reproduction.