Advocacy in nursing, is a central concept in terms of protecting the interests and rights of patients as well as establishing and improving the expertise and social status of nurses. In fact, advocacy is a role played not only by nurses, but by all medical professionals. Advocacy is an important concept for nursing with extensive meaning and contents. Consequently, confusion can occur due to the uncertainty advocacy poses for nursing practice. Moreover, advocacy is accompanied by risk and difficulty, and there are no clear guidelines on how to implement it. It is necessary to enhance education and improve the workplace environment to practice advocacy effectively. It is also essential that nurses reconsider their values and how they support patients while collaborating with other medical professionals.

View full abstract

In the recent trend toward patient's rights, a patient-centered approach has replaced paternalism as a professional-patient relationship. Medical staff organize a care construction based on four moral principles, namely respect for autonomy, beneficence, non-malfeasance, and justice. In particular for terminal care, patients who face their own death exhibit philosophical and religious anxiety. In medical care, this feeling is called spiritual pain. It is an existential, holistic issue that occurs in medical care. Existential philosophers claim that death limits human life though fear and anxiety. But the act of facing death can help human's find subjective truth in their lives. Jaspers thought that to find subjective truth we need existential communication in which there is no restriction and restraint. Existential communication that has a human-human relationship can be a construct of spiritual care and an aid in leading life on an individual basis.

View full abstract

After briefly reviewing the philosophical controversy on abortion, I will introduce Don Marquis' "future-like-ours" argument and its various critiques. Marquis insists that (1) it is seriously immoral to kill us because killing deprives us of our valuable futures, and (2) a human fetus has a future like ours, therefore (3) it is seriously immoral to kill a human fetus. His argument is very simple but plausible, and not easy to rebut. Possible objections to his argument are (1) an objection from negligence of the women's viewpoint, (2) a ruductio ad absurdum objection from contraception, (3) an objection from metaethical analysis of "loss" and "deprivation", (4) an objection from personal identity and non-similarity of a fetus and us, and (5) a metaethical objection from relation of value and desire. I argue that objection (5), which relies on the desire account of value, is most powerful, if we are to account for modifications and qualifications of "desire", such that desire should be interpreted as "dispositional desire" and desires should be "rational and well-informed". But these objections also have a significant burden of philosophical justification.

View full abstract

In several areas in the world, including New York State and the State of New Jersey, one can virtually be diagnosed dead based on cardiac death criteria even if brain death occurs. In New York and New Jersey, such exemption from brain death determination is often a consequence of the accommodation of religious and moral objection to neurological death criteria. This paper aims to shed some light on the implications and problems of conscientious objection to the determination of death based on brain death. In the first place, the paper describes the background that led to the enactment of such objections in New York and New Jersey, including the initiative by some religious group. Then, the efficacy of the frequentlymentioned parallelism between conscientious objection to brain death and military service is called into question. After distinguishing between the positive and negative effects of conscientious objection to brain death, the paper argues that conscientious objection to brain death differs from objection to conventional conscription understood as a strong obligation in that the "object" of the objection is not obligation but the default death definition or the alleged singularity of human death, considering that the New York guidelines, for example, prescribe no obligation for patients or their families. In so doing, the paper questions the understanding that the essence of accommodation of conscientious objection to brain death is sincerity in limiting the free choice or self-determination in death declaration. The possible ramifications of the above conscience clause are also discussed.

View full abstract

In this article, I would like to address the problems of the Japanese government's policy on reproductive rights from the viewpoint of development of reproductive control technologies. The problems were rooted in an old and unrefined abortion method spread in this country in spite of the international principle of reproductive health and rights. Reproductive Rights are the series of human rights relating to reproduction and reproductive health, which were explicitly recognized at the United Nations International Conference on Population and Development in 1994. These rights are key to women's dignity and gender equality, and articles of the Convention on the Elimination of All Forms of Discrimination Against Women, adopted in 1979 by the UN General Assembly, serve as a basis for these rights, as well as those of the UN declaration of Human Rights (1948) and several other International covenants for human rights. Reproductive rights were only possible after the development of abortion methods that assuage the tension between the pro-life position and women's rights. However, the Japanese government's continuing opposition to the advice of the UN Committee on the Elimination of Discrimination against Women to legalize abortion came about because of the fixation on the feto-centric and women-exclusive view of abortion. Such a policy should be replaced by a more humane, inclusive view of reproduction in order to improve reproductive healthcare and to eliminate discrimination against women in Japan.

View full abstract

Clinical ethics is enterprises to elucidate what may or may not be done in concrete clinical settings. It differs from normative or prescriptive medical ethics, as one of sub-divisions of applied ethics, which tries to establish and underpin the supreme but abstract principles applicable to medical cases. Whereas normative medical ethics chiefly concerns principles, clinical ethics does this or that particular case, if real or fictitious. Case study is the lifeblood of clinical ethics. The simpler the case at hand is, the easier we can apply any given principle to the case. A good thick case, however, is not as simple as so-called principlists might hope. To enrich clinical ethics, and to avoid reducing clinical ethics to normative medical ethics which often deals with thin cases just as exemplification of mechanical application of authorized principles, we should inquire into the fundamental features of clinical ethics and the nature of thick cases. As long as we pay attention to the fact that describing and reading a case inevitably require imagination and interpretation, each clinical ethics case is identified with a literary text. Actually what has focused on how we can legitimate our interpretation on a text is hermeneutics. A philosopher referred to a tradition or a culture as a horizon which makes it possible to interpret and understand a cultural work. But we should recognize that what to be read in clinical ethics are individual texts embedded within certain peculiar contexts rather than monumental works in capital letters. Then this article argues that the disciplinary model of clinical ethics is not ethics in general but literature.

View full abstract

This paper analyzes how discourse ethics and narrative ethics contribute to resolve ethical questions in the context of clinical ethics. Jonsen et al. present a practical approach to ethics case analysis in medicine. Their approach has universal value, but at the same time has some defaults: culture-specific aspect to USA, lacking perspectives of time/process, prospective guide, and communicational aspects. Habermas' discourse ethics supplies some of the deficiencies, but will hardly handle cases in which (A) the patient is lacking competence to participate in the discourse, and, (B) the patient has the ability to participate in the discourse, but at an insufficient level to perform fully rational discussion. Narrative ethics, on the other hand will sophisticate clinical ethics by supplying norms such as "Take into account the process of formation of individual's values and that of norms in a group of people," and "Compare cases and stories." It will enable clinical ethics to handle the case of patients lacking the ability to make rational discussion. Although incompetent patients cannot be handled with that meta-ethical sophistication, the question can be reset as follows: "Can we determine the story of an incompetent agent via discourse in which the agent does not participate?" By resetting this way, narrative ethics may open new horizons to consider this sort of question in the light of normative argument.

View full abstract

Although modern bioethics, as a scientific discipline, was originally seen as secular rather than religious, some aspects of bioethics have developed a religious propensity over the past few years. Yasunori Ando, a Japanese religious philosopher and Masaru Ikezawa, a Japanese religious scientist, in analyzing the relationship between bioethics and religion concluded that the two are actually closely connected. Within bioethics, there is one approach that aims to generate consensus about bioethical issues when inquiring into the fundamental nature or essence of matters. The latter sometimes overlaps with religious thinking and concepts. Even though religious rights should always be defended in the public arena, religious reasons or reasoning alone cannot guarantee the validity of any assertion. Thus the dialogical bioethical aspect has an important role to play here as the interface between the two approaches can lead to fresh, new development.

View full abstract

In this paper, I aim to clarify three views of the body from three characteristic nursing theories on the holistic paradigm. They are C. Roy's adaptation nursing model, which depends on behavioral science, P. Benner's nursing theory, which depends on phenomenology and J. Watson's nursing theory, which depends on transpersonal theory. 1. "A body as a behavioral system" by C. Roy: This type of body is treated as an object operated by another. The body of the nurse does not interchange with the patient's body directly so it will miss something in sharing with the patient. 2. "A lived body" by P. Benner: This type of body is lived with the other person. The body of the nurse is called by the patient's body and encounters it there. 3. "A transpersonal body" by J. Watson: This type of body is an energy field, and appears in multi-dimensions; body, mind and spirit. The body of the nurse resonances with the patient's deep energy field without words. We can find these "bodies" working together in practice scenarios. The nurses need to be careful to recognize their own view of the body.

View full abstract

The purpose of this research was to examine whether the bioethics of medical students changed after receiving medical science lectures. The same questionnaire survey was conducted in the 1st year, 4th year and 6th year for new medical students in 2002-2003, and their replies were analyzed. As a result, the same trends were seen in all 3 surveys as regards "progress in medicine," "progress in genetic research," and "the use of genetic diagnostic tools for intractable nervous diseases with no cure." On the other hand, as to the question "would you willingly donate a sample to genetic research if asked?" the number who gave a positive response increased with increasing years of study (P < 0.001). This suggests that although students' perception of their own problems did change, their perception of problems related to society as a whole stayed the same from the time of their admission as new students right up to sixth grader.

View full abstract