In this study, we first state that, although the majority of patients access complementary and alternative medicine (CAM) for the purpose of medical treatment or therapy, most conventional medical professionals（especially physicians） believe“ Evidence-Based Medicine (EBM)” to be the only legitimate principle and tend to hold CAM in contempt. Furthermore, we point out that the deficiency of legal regulations for CAM causes a serious problem that a vast number of patients depend on ineffective or even unsafe CAM. Stemming from this, we stress the importance of introducing particular regulatory frameworks for CAM as“ medicine.”
Then, we argue for the significant benefits produced by regarding CAM as a part of the field of medicine and enumerate the conditions necessary to utilize CAM effectively within the current medical system, considering the advantages as well as the limitations of EBM. In conclusion, we emphasize the necessity of“ Medical Pluralism” to ensure the safe and effective use of CAM to properly respond to the health needs of patients. Conventional medicine based on EBM is reliable but still limited in many ways. Therefore, a lot of patients are dissatisfied with current medical care in Japan. As far as we accept these facts, we must recognize that“ Medical Pluralism” can be the essential idea which enables the integration of CAM and EBM into the holistic medical care system truly required by patients.
In the 1940s in Japan, professionally trained midwives, not doctors, assisted most births by pregnant women. Also, midwives sometimes arranged for the formal or informal adoptions of infants whose parents could not raise them. In 1948, a midwife was arrested for letting an estimated 103 infants left for adoption die at the Kotobuki Maternity Home in Tokyo since 1944. The infanticides were seen as a result of strict anti-abortion regulations in wartime; the incident was used to promote the passage of the Eugenic Protection Law in 1948 to legalize abortion. Most researchers have mentioned infanticides by midwives in the context of women’s reproductive freedom and the decline of midwifery since the 1950s in Japan. This paper uses the perspective of protecting infants’ lives to examine how the infanticide incident affected the situations of women with unintended pregnancies and infants relinquished by their parents. The paper deals with historical materials from mainly the 1930s and 1940s, including newspapers, governmental documents and specialist journals for midwives. From the 1930s to right after the end of World War II, midwives were in charge of giving infant health care counseling and sheltering infants for adoption arrangements. However, after the Kotobuki Maternity Home incident, midwives were prohibited from sheltering infants or arranging adoptions. The Eugenic Protection Law was enacted in 1948 to allow women to undergo abortions; also, infants’ homes and children’s welfare centers, which had been established by the Child Welfare Law of 1947, were given the responsibility of sheltering infants and arranging child adoptions. Furthermore, midwives’ responsibility for infant health care was taken over by public community nurses. The child welfare systems constructed in the postwar era treated pregnant women and infants separately, ending midwives’ more holistic protection of infants’ lives through their interconnected responsibilities of assisting pregnant women and caring for infants.
In recent years, in discussing informed consent obtained between a doctor and a patient, we normally endorse the so-called“ conversation model” over the“ information disclosure model” ― for good reason. The advantages of the“ conversation model,” which integrates two-way communication between a doctor and a patient, are that it pays much more respect to a patient’s autonomy and that the doctor can correct the patient’s misunderstanding during the process; they mark a distinction from the“ information disclosure model” which is based on simple one-way communication. Close examinations of the“ conversation model” reveal a hidden, essentially asymmetric relationship between a doctor and a patient, however. Furthermore, we can see that the model’s assumption that a patient is a“ reasonable person” who is always capable of making rational or reasonable judgments is not convincing at all, when we discuss patients who are rarely in a position in which they can give any reasonable thinking. It turns out that the model has several practical problems as well. Given the essential doctor-patient asymmetric relation, what do we need to apply the model in a more practical fashion? This paper attempts to give an answer to that question by examining Howard Brody’s“ transparency standard.” The standard makes the model meet practical and legal purposes required for actual medical practices, but appear to lead us to what I call“ moderate or liberal paternalism.”
Regulation for use of tissue of aborted human fetuses for research is enforced in countries and international organizations such as World Medical Association and the Council of Europe. For these parties, the use of fetal tissue is permissible when conditions prescribed by the guidelines are met. Common requirements for permissible use are ① approval by the Ethics Committee; ② determination of provision of fetal tissue after the decision of abortion; and ③ consent of the provider. Some guidelines require that the man is not rejecting, but there is also one guideline that accepts only the consent of the woman. In any guidance, the consent by woman is essential. From the perspective of systems of providing information, this paper presents a literature survey of the use of fetal tissue. It was found that ① daily, open exchange of views about provision of fetal tissue is not possible for women; ② women hope and want to know the intended use of the fetal tissue and the overall description of the research; ③ although information needed to grasp the overall idea of the research is sorely lacking, women may make decisions under pressure. On the basis of the results, people who are requested to provide information later are required to provide information that is satisfactory for decision making, instead of unsatisfactory information such as those labeled as“ being offered to know/not being offered to know”. For this reason, the current“ sufficient” explanation should be re-examined as to whether it is truly a satisfactory explanation.