Medical ethics should be considered from the point of view of the helpless patient. N. Hartmann once defined the human being in relation to four phases: 1. inorganic (unorganisch) 2. organic (organisch) 3. psychic (seelisch) 4. spiritual (geistig). All human beings are composed of these four phases, and he describes the dominant roles in each phase. If we try to apply these concepts to medical practice, we find patients tend to see themselves in terms of the psychic and organic phases, while doctors should act in terms of the spiritual phase. So patients generally tend to desire hedonistic satisfaction, while doctors tend to pursue normative goals. These are the fundamental ethical differences between doctors and patients in the field of medical practice. Medical practice should be founded on the modern social values of respect for human dignity and happiness. Japanese medical practice in particular must try to respect these humanistic values while maintaining its traditional cultural and ethical standards. In other words our medical activity should be based not only on the American medical concept of "quality of life" , but also on the Japanese traditional attitude of caution in medical matters.

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I want to clarify the relation between paternalism and the rights of self-determination by using medical disorder models. I have used one case to clarify the question of paternalism and the right of self-determination, using the case of real psychiatric patients: one in a self-reliant situation, one depending on others, and one chaotic situation. Paternalism and its limitations are examined for each situation. I conclude that ordinary people who are around psychiatric patients should take responsibility to help such persons.

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A survey on terminal care was conducted in St. Marianna University School of Medicine in 1988. The results show: a) ST. Marianna staff members have a strong interest in terminal care; b) few of them consider religious support necessary for terminal patients; c) St. Marianna staff members recognize it's time to discuss hospice and hospice care earnestly. In our country, religious indifference is really quite persistent in this generation. Nevertheless, many terminal patients want religious support as well as psychochiatric support. With considerable experience of clinical pastoral care for terminal patients in the hospital, we are convinced that they need religious support.

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Today's marvellous medical advances confront us with a verysevere problem, namely the criteria for establishing death, such as brain death. Technical advances in medicine now permit maintenance of cardiac and respiratory functions in human beings for a few days after massive or total destruction of the brain. This fact has presented us with delicate and difficult problems, especially in relation to organ transplantation. Namely, when a human being's brain functions are lost irreversibly and yet his cardiac and respiratory functions are maintained by an artificial life-support system, does he live or not? Up to now the signs of life have been seen as vital signs (body temperature, pulse, respiratory rate and blood pressure etc.). But if these signs are maintained by artificial methods, are they truly vital signs? Physicians say that even if a life-support system works, cardiac function will stop in a few days or a few weeks. But this short term is quite important for organ transplantation. At that time each organ except the brain is maintained through artificial circulation of blood. Therefore physicians who agree to organ transplantation stress that brain death is the true death of human beings, for the purpose of legal removal of organs. But many ordinary people have complex feelings about it. They don't easily admit a family member's brain death because of their warm pink bodies. Here we have a severe problem. In this article I have focussed on these problems and have tried to think of the redefinition of death in modern society from different perspectives, that is, philosophically, psychologically, medically, culturally and legally. And finally in conclusion my thoughts are presented.

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Schelling's philosophy of nature has two sources, one is Kantian and Fichtian transcendental philosophy, the other is the contemporary natural science of his time. In this essay, I discuss Schelling's life-concept against the background of the medical dispute of Brown's "lrritabilitat (Erregbarkeit)-Lehre" in Germany at the turn of the 19th century. Schelling's central interest in life-organisation is the individual mediating his environment. In this context, he accepts Brown's "lrritabilitat-Lehre" through Roschlaub's revision of it and A. v. Haller's concept of "Sensibilitat". So he criticizes its "Ungegrundetsein" and develops it into his triad of Erregbarkeit-Sensibilitat-Bild- ungstrieb. He then inserts this triad into his theory of nature.

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From the late 1960s, arguments concerning ethical problems in clinical applications and experiments of life sciences and biomedical sciences began in the United States. They caused the birth of a new discipline, bioethics. This situation influenced American medical education and showed various difficulties in the traditional ways of training physicians in professional ethics. American medical schools had to make new educational programs, that is, medical humanities, whereby students would have special courses in human values. The purpose of this paper is to consider historically the connection between the bioethics movement and the development of humanistic medical education in the United States and to make clear the influence of bioethical ideas in medical humanities. The author concludes that the medical humanities program is based on the ideas of bioethics. One of these is that a patient's autonomy has to be respected in medicine. Another is that we must participate in interdisciplinary discussions in order to make correct decisions in ethical problems of life sciences and medicine. The necessity of humanistic medical education in Japanese medical schools is also discussed.

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I live in the same world as others. And it is the seemingly same natural fact that each of us is born in the world and is destined to die. The present situation we are involved in, however, seems gradually to make this natural fact unnatural due to the great change directly or indirectly caused by the development of science and technology. For example, such developments make it possible for a patient, who would have died in accordance with the traditional techniques of medicine hitherto, now to continue to be alive by means of the respirator, or something like it in the I.C.U.. This situation raises a series of questions interwoven in medical, ethical, philosophical, and legal areas, as we can easily understand by remembering the "Karen Quinlan" case. Indeed, I know these are very difficult questions to answer. I merely aim here to find a possible way to answer them in the light of "nature" as a human identity, a naturalistic, but not a natural law approach.

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