Modern Japanese traditional medicine established in the mid-18th century suffered devastating damage due to the execution of the Medical Law (established in 1873) as an integral part Japan's modernization policies. Today, Japanese traditional medicine is a counterculture community on the periphery of modern mainstream medicine, whose practice changes in accordance with social changes. As a traditional medical movement, it has unique ethics that are constantly evolving. The traditional medical movement of a physical technique, which is known as "Noguchi-Seitai" and whose system and theory were established in 1927, passed through two transformation stages, one in 1956 and the other one in 1968. The movement become a community emerging concomitantly with medical techniques continuously alternating between a host and a guest, and the medical practice based on the psychosomatic transformations arose from self-training by the medical practitioner and the patient. Those transformations and generations are revealed from the conceptual viewpoint of "Education as Transformation" (Richard Katz, 1981).

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What is integrative medicine? Integrative medicine refers to the integration of modern western medicine, traditional medicine, and complementary and alternative medicine. The definition of integrative medicine states that it takes into account the whole person (body, mind, and spirit). However, the meaning of the concepts of "integration" and "spirit" is not very clear. This paper aims to clarify these concepts and introduce dimensional anthropology. Dimensional anthropology was advocated by V.E. Frankl. He regards the human being as "a somaticmental (or psychic)-spiritual oneness and wholeness." In addition, he emphasizes that only the spiritual core warrants and constitutes oneness and wholeness. He called this view of the person dimensional anthropology. Human beings are free and responsible. Frankl refutes scientific determinism or scientism because these positions neglect freedom and responsibility of human beings. Determinism or scientism is one form of nihilism. An awareness of the spiritual dimension helps us identify the "existential vacuum." It indicates the condition wherein people suffer from a sense of meaninglessness and emptiness. Logotherapy helps a person to discover the meaning of life and, as a result, the existential vacuum can be overcome. Naikan therapy may also treat the existential vacuum. The introduction of dimensional anthropology to integrative medicine enables us to arrange the types of medicine not according to their principles or methods, but according to the dimension of the person who is using these medicines. Moreover, without dimensional anthropology, integrative medicine may help nihilism prevail in medicine, for the scope of integrative medicine is so broad and it will deal with not only cure but also prevention and health promotion with western, traditional, and complementary and alternative methods. I believe that the introduction of dimensional anthropology is indispensable for integrative medicine, and we must continue to establish a better view of the person in medicine.

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Biomedical technology has realized several kinds of human enhancement. Among them, enhancement of our cognitive performance is remarkable. There are already several supplements, for example, caffeine for staying awake and DHA for better memory. However, the present drugs for enhancing our intelligence, so called smart drugs, are completely different from such supplements. Smart drugs are artificially synthetic chemicals that are used in order to improve cognitive performance. They are developed for medical use, but they similarly affect healthy persons. For example, smart drugs can improve a person's ability to pass university entrance exams. However, strong drugs have strong side-effects, and radical enhancement of intelligence gives rise to many ethical issues. Therefore, to assess the ethical implications of cognitive enhancement, in this paper, we will consider the merits and demerits of cognitive enhancement. Firstly, we will outline the current situation on cognitive enhancement. Secondly, we will consider its merits and demerits. In conclusion, we will examine whether cognitive enhancement by smart drugs is ethically admissible.

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As technology advances, a wider range of applications is being found for human body parts. For ethical reasons, it is urgent that we protect human beings from being harmed by these new technologies. However, in today's liberal society, based on respect for autonomy, one may be permitted to dispose freely of one's own body if one does no harm to others, or make use of human beings who are not autonomous in order to treat other patients. It is: (1) one's own body, (2) parts and products of a human body, (3) an embryo, fetus and dead body, that are protected by human dignity, not by respect for autonomy. In order to protect human beings from being harmed by the new technologies, we need a word equivalent to 'human dignity.' Thus by examining the effectiveness of the principle of human dignity in society, we will clarify the real intention of the French ideas on bioethics, which consider human dignity a fundamental spirit.

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Serious accidents can be caused by inadvertent action. In particular, there are various unexpected but hazardous risks connected with medical treatment. In fact, some medical treatments have resulted in grave consequences. One typical example of this is the HIV crisis that occurred in the Japanese blood supply system. The government, doctors, nurses, other healthcare professionals and especially patients and their families were confronted with difficult decision-making against uncertain risks. The question is how to deal with unexpected and uncertain risks. The "precautionary principle" was introduced to cope with such difficulties. However, the precautionary principle is considered to be imprecise and vague when we try to apply it to real-life cases. Decision-making models are required. Healthcare professionals must work in collaboration with other healthcare professionals in multidisciplinary care teams. They must discuss cases with each other and make cooperative decisions. In the past, the doctor has often been assumed to be the most appropriate person to make the decisions. This is not so widely accepted today. Therefore we need a new model for collaborative decision-making. The aim of this article is to provide multidisciplinary care teams with a practical model for collaborative decision-making against uncertain and unexpected risks. The focus is on the process of decision-making. A paradigm case -HIV case- is presented to show how to apply the model to real-life cases. The question of the case is what kind of decision-making is possible for doctors, nurses, other healthcare professionals and hemophiliacs and their families to avoid HIV infection when the cause of the AIDS is unknown.

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Human papillomavirus (HPV) causes cervical cancer, and efforts to develop vaccines against this virus have been proceeding. In June 2006, the U.S. FDA approved a vaccine that prevents HPV. There is now a political controversy over how to use this HPV vaccine in the clinical setting. Because of the high prevalence of cervical cancer in Japan, this vaccine has been eagerly awaited. This paper examines the experience in the U.S. and discusses how this vaccine might be used in Japan where it has not yet been approved and considers how the cost should be borne as well as the ethical problems involved in selecting individuals to receive preventive vaccination.

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We usually recognize instinctively that it is unreasonable to be blamed for something beyond our control or expectations, and that we should be morally evaluated in terms of motives or intensions, which are insusceptible to luck. On the other hand, however, we admit in many cases that luck exerts some influence on agents' moral evaluations. This inconsistency has long been discussed as the problem of 'moral luck'. This paper shows that the same inconsistency can be found in our attitude toward medical malpractice, and considers how to deal with it. According to D. Dickenson, who introduced the concept of moral luck into discussions of medical ethics, bad luck in medical accidents means doctors' misfortune of being blamed for inevitable accidents that occur beyond their control. Medical malpractice, which is caused by negligence and therefore can be prevented, is thus excluded from her consideration. Contrary to this, this paper argues that even regarding cases of negligence, if there are structural, technical factors that can induce such negligence, anybody could make medical errors, and it is in this sense that there exists moral luck in the cases of malpractice. This consideration leads us to the following conclusions; (1) even in the cases of negligence, it may be unreasonable to inflict criminal punishment on doctors, for we cannot clearly distinguish according to criminal law between cases of vicious negligence and those of mere moral luck; (2) a criminal suit is not a proper means to investigate what really occurs in medical malpractice.

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The Donor Conception Review Committee of the Science Council of Japan concluded in March 2008, that surrogacy both with and without compensation should be prohibited in principle in Japan, albeit with possible exceptions for research purposes. However, it is unlikely that problems related to payments to surrogates can be eliminated simply by prohibiting commercial donor conception. If surrogacy for research purposes is permitted on a merely exceptional basis in Japan, issues regarding payments will undoubtedly remain. In this paper, I first give an overview of the current status of surrogacy in Japan and other countries and then go on to describe the details of a specific surrogacy case in California and the content of the 2008 Declaration of Istanbul on Organ Trafficking and Transplant Tourism. Finally, I discuss issues relating to the payment of reasonable expenses and reimbursement for surrogacy. Based on this discussion, I find that in the absence of a clear definition of "reasonable expenses," there is little difference between payments for commercial surrogacy, as in the U.S., and those for non-commercial surrogacy, as in the U.K. The Declaration of Istanbul explicitly discriminates between comprehensive reimbursements of the actual costs of live organ donation, as opposed to payments for an organ. It might be useful to apply a similar distinction to surrogacy by discriminating between the cost of surrogacy and the actual sale of women's or infants' bodies. In conclusion, we need to clearly specify the nature of "reasonable expenses" in order to prevent money-related disputes regarding surrogacy.

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In this article, I examine why disagreements of diagnosis are likely to occur in psychiatric diagnosis. This problem (which I call the "reliability problem") raises the question of whether psychiatry might have real objectivity. If psychiatric doctors (specialists) give different diagnoses to the same patient, the patient would justly doubt the objectivity of the diagnoses. In addition, our expectation that psychiatry and its classification system relates to the objective world would be undermined, since the standard of classification seems to be liberally interpreted by each diagnostician. This problem has been addressed by the employment of so-called "operational diagnostic criteria." However, the following problems remain: (a) there are different operational criteria systems; (b) if several different operational criteria systems are at once applied to the same patients group, the proportions of patients with a disease vary depending on the criteria systems; and (c) because it is not shown that a particular criteria system has an advantage and validity over other criteria systems, there is no rationale for regimenting a particular criteria system. In other words, only one operational criteria system must be used uniformly by all diagnosticians before the reliability problem can be truly resolved, but this is not realistic at present. Since each diagnostician can choose any criteria system according to their preference, the reliability problem reoccurs regardless of the introduction of operational criteria. We need to continue to inquire into the reliability problem and the objectivity of psychiatry.

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In Japan, 4 children were born by posthumous reproduction from 2001 to 2004 (1 in Shikoku, 1 in Tokyo, 1 in Osaka, and 1 in Nagano). In the case in Shikoku, the Supreme Court denied the legal child-parent relationship between the child whom the wife bore using her dead husband's frozen sperm and the deceased husband. Japan does not have a law that specifies posthumous reproduction, and the Supreme Court used this lack of existing legislation to deny the child-parent relationship. I am opposed to the judgment of the Supreme Court. Posthumous reproduction should be admitted under certain conditions. Firstly, before the man dies, he has to agree to posthumous reproduction. Secondly, the man has to freeze his sperm based on his own free will. The example of Shikoku fulfills the two conditions. About 60% of the general public approve of posthumous reproduction in Japan. However, there are many dissenting opinions among obstetricians such as the Japan Society of Obstetrics and Gynecology. Japanese society has strong views about the family, which may relate to its general approval of posthumous reproduction. It may become the pressure which has it forced that a woman bears a child. I am opposed to the pressure. However, if the pressure on a woman bearing a child is refused and she wishes to perform posthumous reproduction based on her own free will, I will respect her decision.

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