The time of the big bang (the birth of the universe) has been considered in this report in terms of infor-mation structure theory. Information structure theory shows that all structures in the universe were created by information; the universe has developed through cycles of energy, information and matter. The universe itself was created by information. At least three conditions are necessary to create the universe: the existence of principle(s), fluctuation, and time-space. The authors consider the uncertainty principle of time and energy, Δt・ΔE>ℏ/2, where &ℏ is Plank's constant. If the total energy of the universe, 10^<79> erg, was created by the fluctuation, ΔE, then the time of the big bang is obtained as Δt>5.27 ×10^<-107>sec. This means there was a break down of equilibrium of vacuum space. The non-equilibrium of space must have information and entropy. So, information is the origin of the structure called the universe.
Some years ago, the author investigated the ethical basis of the biological experiments to the medical students. So, author obtained that they had highly the ethical consciousness to animals and plants. Now, author made a plan to clarify the ethical consiousness of the medical students. Author employed the record of student's impressions after the dissection of human body. Author systematized their records as 25 items, namely, mental strain and surprise,thanks to human remains, the spirit of human remains, the dignity of man, the mystery of life, the fine structure of human body and so on. It made more meaning-ful that the medical students had a meeting chance with the obligors of registration to the dissection before the anatomical practice. Author felt indeed that students comprehend the mind of human remains and the family of human remains, through the dissection from their records. Perhaps, students felt as a living person about image of a human remains for her hair-pin and the knife-cut in the operation of remains. Many students think the anatomical practice of human remains to very important task to be the doctor, because, many students are strained, -think the mind of remains, - thank the remains for the public spirited, mind, - get high understanding to the fine structure of human body
Medicine has been fundamentally humanistic and ethical in its nature since its origin. It is not a pure science, as is erroneously held by most modern Japanese medical researchers. It is an applied science endowed with evident objectives, i.e. healing diseases and promoting the health of people. Moreover, "disease" and "health" are both value-laden concepts. Human conduct is judged as good or evil according to some value-laden criteria, so it is impossible to separate medicine from ethics. The word "ethics" is derived from Greek "ethos", which originally meant the custom of the people. Customs are different according to time, race, religion etc.. There is not one single ethic on this earth but there are plural ethics. This pluralism of ethics is fitted to modern democratic societies. In the field of medical ethics, current Japanese press comments are unduely concentrated on the up-to- date problems arising from high technologies (e.g.in vitro fertilization, brain death, organ transplantation etc.) However, these topics cover only partial and extraordinary phenomena in the whole of medical practice. We should rather pursue "daily medical ethics" based on everyday encounters of doctors and patients. Above all, reconsideration of the usual doctor's paternalism and popularization of informed consent throughout the medical world in Japan are urgent issues. The medical humanities have been taught in the University of Occupational and Environmental Health for 1st to 6th year medical students as a required course since the beginning of the university (1978). Some defects of lectures as mere delivery of knowledge were criticized and several new teaching techniques have been introduced. For example, in their "early exposure", freshmen are asked to attend to disabled children for 24 hours, and in "nursing practice", 5th year students are assigned to the nursing teams in the university hospital as apprentices. Through these practices the students learn by their own experiences how to find ethical problems in actual medical practice and promote their sensitivity to sick people. These techniques in the education of medical ethics as applications of behavioral sciences will develop further in Japanese medical education.
'Naikan' means "introspection" in Japanese. The Naikan method is a form of meditation practiced in Japan over the past forty years. This is a fixed method of self-observation and self-reflection. This method is suited for medical staff who hope to interact with patients in a humane fashion. The Naikan client is asked to look at himself in his relationships with other people from the following three perspectives. "Examine your memories on 1) the care and kindness that you have received from a particular person (for example, your mother), 2) what you have one for that person in return, 3) inconveniences you have caused that person." If a medical staff experiences the Naikan meditation, he will find it useful in improving the human relations with his patient.
Opinions concerning the essence of medical ethics, their significance and their educational methods differ fundamentally according to one's religious and philosophical orientation. Many questions of medical ethics have to do with the most difficult, eternal, and probably insoluble questions concerning what we know about the essence of human beings and the meaning of truth, love, values, happiness, etc. Problems which reappear in the course of history must be considered from many viewpoints. From the Meiji Restoration in the middle of the nineteenth century until the present, Japan has imported Western science, particularly medicine, at an extremely rapid rate, with the result that traditional methods of Oriental medicine have come to be looked down upon. Unfortunately, these cultural changes have caused a lot of turmoil in the area of medical ethics in Japan and this is due to overestimation of the value of European technology and natural sciences. As a result, it would not be too much to say that an indifference to ethical considerations and a related high degree of selfishness and greed are present in many sectors related to health care in Japan today. However, it is comforting to note that there is some movement for the improvement of this situation. Against this background, it is the purpose of this report to examine certain considerations related to these movements as follows: 1) the history of European medical ethics; 2) the history of European philosophy and religion; 3) the humanism of Nicholas of Cusa; 4) the educational thought of Maria Montessori.
When we want to discuss medical ethics in education, we have to consider the roll and the activity of the law, especially in malpractice cases, as well as philosophical viewpoints. Since World War H, the number of malpractice cases and suits has been increasing at an unprecedented rate in Japan. This increase has brought law and medicine into closer relationship, but also has created tention between the two. Today,the lack of moral foundations among physicians, the secretiveness of the medical profession and the resulting uneasy relationship between physicians and patients is often pointed out. Since Japanese law has traditionally respected the autonomy of physicians, until recently, the question whether certain medical practices violated medical ethics has seldom been brought to trial. But soon, as the result of court decisions, we can expect to see the enactment of improved civil and medical laws. So medical students should focus on building character, and need to take a stronger interest in such laws, to develop their discipline and bring it into line with other sciences and humanities.
As a senior medical teacher, I should like to analyze what teaching medical students means to me. There seems to be three fundamental principles in teaching medical students: The first principle is to teach students from the teacher's own knowledge and experiences what is deemed necessary for students, as future medical doctors, to know and understand as basic medical knowledge and techniques, and also to acquire the professional common sense that is needed when dealing with a number of patients and their families in a morally and ethically acceptable manner as future physicians and surgeons. The second teaching principle is to improve up to professionally acceptable levels the incomplete or immature knowledge that students have already obtained during their previous schooling or daily life. At the same time, a teacher has to guide students to acquire the ability to self-learn. However, the principle involved in teaching medical ethics and bioethics to medical students appears to be different from these two teaching principles. This is because ethical analysis of a medical problem provides no single answer due to the different ways that the values involved both in the medical problem and also in the quality of life of a patient may be treated by different people having different viewpoints. It is important to note that no teacher must force students to accept the teacher's personal opinions or viewpoints concerning his own ethical judgements related to any medical problems. A teacher and his / her students should freely exchange their opinions and viewpoints to analyze various aspects involved in a medical problem and learn together to reach some reasonable solutions. This collaborative learning process is vitally important in teaching medical ethics and bioethics to students. It is the third principle in teaching medical students.
Once people said that medicine was the art of ethics. However, it is now impossible for a practitioner to treat a patient in such a manner. Revolutionary advances in medicine have placed the problem of ethical attitude in the field of practice. Considering these points, it has been asked why the statements about the right to the choice of treatments have been proposed. Of course, it is true even now that patients can not be satisfied without the devotion of medical teams. However, it is really in the field of the most advanced medical technique that ethical problem should be resolved. Here we have discussed the subject of organ transplantation in relation to the brain-dead and persistently vegetative patients, with whom we neurosurgeons are so familiar. In fact, organ transplantation as a medical practice must be one of the major subjects of philosophy, not only as an ethical problem, but also since it involves the existence of human being in the 21th century. Since human life is so transitory, we should search for harmony by identifying ourselves with the universe. Brain-dead and persistently vegetative patients should not be recognized as dead, but respected as among the poorest human beings. Now it is essential, in order to establish the harmony of the universe, that we create a God who is more appropriate in the modern age.