Fetal tissues and organs are useful for regenerative medicine or other medical research. In Japan, the Ministry of Health, Labor and Welfare formed a committee in 2002 to examine regulations on clinical research using human stem cells. The committee had planned to settle on regulations including for stem cells collected from dead fetuses(for example, fetal neural stem cells) though they were exempt from the regulations in the end. Thus, though fetal tissues and organs are usually used in medical research, it is not clear how dead fetuses are disposed or buried and what is the ethically proper procedure to handle them. In this article, I survey procedures for the handling of dead fetuses and their legal status in Germany to clarify the problems involved in this task. Legal regulations concerning the treatment of dead fetuses have been reformed since the late 1990s in Germany. According to the German Civil Status Act, parents of a stillborn child, that is, a dead fetus weighing more than 500g, may register the child's name in birth records. Though a miscarried child, that is, a dead fetus weighing less than 500g, cannot be registered in any records, a certification is issued in which the child's name is entered in accordance with the parents' request. As for burial, it is governed by the law of each state. Most states require parents to bury a fetus when it exceeds a certain weight, and permit burial of a fetus upon parents' request if the weight is below threshold. These regulations were induced as a result of petitions from parents who had experienced a miscarriage or a stillbirth. Thus, when considering the procedures to treat dead fetuses, both the dignity of the unborn child and the feelings of the bereaved parents must be taken into account.

抄録全体を表示

Withholding medical treatment to neonates born with congenital diseases has been prevailed in many countries since the 1970s. In Japan, several guidelines have been established that classify the cases in which we are permitted to withhold life-prolonging treatment. Nonetheless, no definite social consensus has been reached about whether and how withholding treatment because of disability can be ethically valid. Our aim in this study was to clarify the standards of withholding medical treatment to handicapped neonates that are ethically justifiable. First, we point out that withholding treatment to infants is essentially different from ordinary cases because the infant patients utterly lack autonomy. Then, we argue that "intolerable suffering," "quality of life," and even "the best interest" can never compensate for the lack of autonomy. These principles are inadequate for the standard we seek because objective validity is required for the criterion to justify selective nontreatment of infants with handicaps but aforementioned principles can acquire only subjective and individual validity. Consequently, we examined the justifiability of deciding selective nontreatment, which can be both ethical and feasible, claiming the importance of changing our point of view from an individual to a social level, and of a decision-making system based on a broad consensus, not on personal will. Meanwhile, we propose introducing palliative care for terminally ill neonates in order to provide them with dignified end-of-life phase.

抄録全体を表示

Can brain-death be the criterion of human death? This paper examines critically the main views regarding this issue and proposes a new view. First, I argue that the following three major views are implausible: (1) the President's Commission's view (the whole brain formulation), (2) Shewmon's view(the circulation formulation), and (3) Lizza's view (the higher brain formulation). Second, I propose my view. Distinguishing two questions-"Can brain-death be the criterion of(human) biological death?" and "Can brain-death be the criterion of (human) legal death?", the following points are discussed: (1) With regard to the first question, given that some organs function in harmony together in brain dead patients, their somatic organization is maintained, i.e., brain dead patients are still alive. Therefore, brain-death cannot be the criterion of biological death. (2) With regard to the second question, if four-organ systems are (biologically alive but) legally dead, so are brain dead patients, and thus brain-death can serve as a criterion of legal death. On the other hand, based on the premise that four-organ systems could be considered an intermediate state between being alive and dead, brain-dead patients would also be considered being in the intermediate state; therefore, brain-death cannot serve as the criterion of legal death.

抄録全体を表示

We are afraid that our non-existence continues forever after our death. Lucretius spoke on this fear, stating, "Because no one fears the eternal nonentity which is in front of our birth, it isn't also necessary to fear the eternal nonentity in our after death," as a way to convince people to be rid of this fear. This statement is called Lucretius' "symmetry argument". Yet despite this, almost all modern debaters have insisted that the relation between pre-birth non-existence and post-mortem non-existence is asymmetrical. The main purpose of this article concerns the following two points about this statement of asymmetry; namely, that this statement is premised on a specific view of metaphysics and that the meaning of the claim of asymmetry must be examined from a viewpoint of metaphysics as it relates to time and the world. In this study, I first pointed out that the opinion of debaters included the assumption that we ourselves could identify non-existence. Next, I pointed out that the disputants would actually be insisting that the dead continue to exist in some form. Third, I examined which specific theories on time from twentieth-century analytic philosophy suited the disputants' opinion, and found that no ideas on time were entirely consistent with their view. Lastly, I examined non-existence before birth and non-existence post-mortem from a viewpoint of the possible worlds semantics of analytic philosophy. From this, both non-existences are located in their own possible worlds, and in addition to this, there is the real world in which the subject is alive. My examination concluded that there is a difference in existence qualification between a possible world and the real world, but that there was no such difference between two possible worlds. This suggests that the relationship between pre-birth non-existence and post-mortem non-existence is neither symmetrical nor asymmetrical.

抄録全体を表示

The objective of this paper is to discuss the reasons that some individuals in the United States refuse to be vaccinated, focusing on those reasons usually described as "conscientious." This paper discusses current compulsory vaccination practices and the most common categories of reasons objectors in the United States give for refusing vaccinations (on medical, religious, or philosophical grounds, the latter two of which are often described as conscientious reasons). Possible ways to handle refusals are examined from the perspectives of the three categories of refusals mentioned above, the particularities of vaccination within biomedical ethics, and public health ethics discussions. Although refusals based on divergent perceptions of risk are commonly classified as refusals for philosophical (personal) reasons, objectors in this category are trying to present medical reasons, which do not convince experts. Even if experts try to persuade the public by presenting scientific evidence, there remain fundamental difficulties in convincing objectors. Refusals for religious reasons are to a certain extent established historically, but few major religious groups nowadays explicitly refuse vaccinations per se. Refusals in this category are not necessarily plainly "religious." Certain refusals on religious grounds, including those based on repugnance for the use of components derived from aborted fetuses, can be avoided by technological advances in the medical field. Refusals based on philosophical reasons should be handled in more sensitive, individualized ways than they are now. The inquiry ventured in this paper is important for Japanese society in that it deals with general questions surrounding the contradictions between the autonomy principle, which is paramount in biomedical ethics, and the compulsory schema of public health policy, and asks whether and how the different qualities or characters of decisions regarding health care and public health should be translated into practice.

抄録全体を表示

Recently, a modern medical strategy has been proposed in Japan. It is called "Preemptive Medicine." This paper described the main features of "Preemptive Medicine" and its theoretical framework from the medical philosophy viewpoint. First, I examined a definition and concept of "Preemptive Medicine." This medical strategy presents a preemptive intervention for persons at risk to become ill in the near future. Risk prediction depends on presymptomatic tests like genetic testing that could reveal hereditary characteristics and other possible biomarkers. This predictive medical intervention prior to onset might be a new fashion in preventive medicine. Second, I reviewed the definition and characteristics of existing preventive medicine in comparison with those of "Preemptive Medicine." I then noted that "Preemptive Medicine" was the primary type of preventive medicine, so-called primary prevention. Third, I surveyed a typical single book on "Preemptive Medicine" in Japan edited by Hiroo Imura. It depicted the present state of and some problems for realization of the new approach. Fourth, I considered the meaning of intervention for "potential patients" or persons without illness at present but with some risk of becoming ill. They could be distressed over their predicted future disease. Furthermore, the efficacy of the prevention is not sufficiently proven from the viewpoint of Evidence Based Medicine. Finally, I concluded that the characteristics of "Preemptive Medicine" are, as follows: (1) "Preemptive Medicine" is a new form of preventive medicine; (2) its goal is personalized primary prevention; (3) it might have some psychological and social implications for harm to "potential patients"; and (4) it needs to show validity in early predictive intervention.

抄録全体を表示