The purpose of this paper is to consider ethical basis about sharing of benefit which is brought from human genome information. Firstly, I consider concept of information, and discuss a position of human genome information. I examine a concept of information by Nishigaki which treats a relationship between information and a system of biological processes. In the respect for considering a concept of information in a point of contact between life and information, the concept of information by Nishigaki has an important implication in terms of information. About a position of human genome information, the information is classified according to cognitive ability or disability of us. Secondly, I discuss the fact that human genome information has three aspects, and consider the value of human genome information. Three aspects are property, ownership, and sharing. In addition, I focus on sharing of human genome information. In terms of each of us having human genome information, we could think that everyone has group individuality. Finally, about the norm of sharing of benefit which is brought from human genome information, I consider an ethical basis of the norm in a point of contact between a concept of information and arguments of property. I refer to a feature and meaning of International Declaration on Human Genetic Data (2003), and focus on Article 19 – Sharing of benefits. I limit object to access to drug medicine and supplies of medicines. In addition, I refer to a concept of dignity in human body in arguments of property, and I present three concepts of dignity according to three types of genome information. In conclusion, these concepts of dignity could be ethical bases of patient's right to access to drug medicine and company's duty to make patients get medicines.
The task of this study is to clarify the abnormalities of empathy in autistic patients in keeping with their situation and experience. As for the methods to be used, the situation described in "Variable Stars (Henkousei)" by Naomi Moriguchi, who suffers from autism, will be phenomenologically considered. In the phenomenological method used in this study, the situations and experiences described by autistic individuals or what is known as the "meaning of their living world" will be initially recognized, while refraining from looking at autistic people using specified theories or methods in advance. In order to complement and ensure the process, all kinds of knowledge and methods regarding human beings will be actively used as a measure or perspective to understand autistic individuals.
Moriguchi described that she did not quite understand how to connect with others. Connecting with others is realized through empathy. People relate to others and are involved in their situations through empathy. Empathy is an intuitive experience of others through natural pathos, pain, suffering, emotion and passion.
Empathy is at the base of emotion and intellect, meaning that empathy is a natural ability to become involved in the world. In Moriguchi's case, empathy is a barrier to normal involvement with human beings. In other words, it may be said that Moriguchi, who is not able to establish relationships with her schoolmates, has unnatural empathy and is in a state where involvement in the world is absent or immature.
Advance care planning (ACP) is a process aimed at extending the rights of competent patients to guide their medical care through periods of decisional incapacity. The process involves three steps: (1) thinking through one's values and preferences, (2) talking about one's values and preferences with others, and (3) documenting them. Advance directives usually are the written documents that provide information about the patient's wishes and/or her designated spokesperson. Verbal directives may be ethically valid, but most patients and health care providers prefer written documentation in the form of official forms. Advance directives will not always be the outcome of most advance care planning. At a minimum patient should become familiar with the concept and rationale for advance care planning. Some patients will want to mull things over, others will want to discuss the topic with their close friends or family and health care providers. Fewer will be ready to sign documents and even fewer will be interested in personalizing their advance directives so that they are clear and contain pertinent information with clinical relevance.
In this report, we examine a system about the usage of advance directives as ACP. And also, we consider how to construct the clinical ethics consultation, which support health care providers who face ethical dilemmas in clinical settings.
From the following two viewpoints;
1. Conceptual discussion about advance directives from literatures.
2. Practical discussion that assumed a pilot study about advance directives as ACP, which we perform through the clinical ethics consultation (clinic ethics support) that a reporter practice now in Miyazaki prefecture.
In this paper I try to show a rough outline of the problems of medical ethics. The first step is to analyze the medical practices into six elements: 1 medical professionals, 2 a patient who needs treatment, 3 relationships between medical professionals and a patient, knowledge, technique and method of medicine, 6 ethical norms and laws, 6 medical resources. From a viewpoint of those six elements we can restate Oath of Hippocrates and four principles of biomedical ethics proposed by T. Beauchamp and J.F. Childress. In a similar way, we can grasp an outline of contemporary problems of medical ethics, and furthermore, we can show a very rough sketch of problems of medical ethics that may occur in the future. Finally I refer to the essence of medicine which is now and will be called into question in medical ethics.
In this paper the meaning of "dignity" – Japanese "songen", German "Würde" – is discussed. These words have changed in their meaning with the passing of the years. Japanese "songen" is equivalent of dignity. The meaning of this Japanese word is ambiguous. Originally this word had the meaning of "what is precious, majestic, and inviolable". These adjectives were mainly used for the quality of noble people or royal persons. Likewise the Latin word "dignitas" had the meanings of "greatness, majesty, dignity, etc." in the classical usage. In fact, in this sense of dignity we can hardly understand the meaning of "death with dignity". But in after years the meaning of "dignity", or the German word "Würde", has changed under the influence of Kantian ethics. In this context "dignity" means the absolute value that any person has. Kant asserted that we must treat human being as an end in itself rather than merely as a means to other ends. There is Christian ethics behind this Kantian absolute value of a person. The doctrine of neighborly love is the precept that we should love our neighbors without reason of loving. One of the reasons people accepted the absolute value of a person of Kantian ethics is that they had already accepted the doctrine of neighborly love. But in the rise of Bioethics Kantian word "dignity" has been secularized. In Bioethics the sanctity of life is negatively dealt with, and human dignity is expelled from medical ethics. Therefore today dignity has had another meaning. Namely it is also used in the sense of "self-respect"
Though the academic study of nursing has only about a 100-year-long history thus far, nursing has been exhaustively discussed in order to clarify specialties such as 'care' or 'advocacy." These two concepts have in common the way in which they are both difficult to define because they both are polysemic. Even though these discussions have given new depth to the specialties in nursing, the discourse has not yet come to an end. Recently, it has been suggested that the roles of caring and advocacy in medical practice are not exclusive to nurses. What then, are the specialties of nursing? This question has been raised again.
In this article, I introduce 'nurses' ethics' from “Medical Philosophy" written by Hisayuki Omodaka, the father of Japanese medical philosophy, 70 years ago. He gave validity to the special roles of nurses, and also perceived the importance and expertise of nurses' roles which advance patients' natural healing power. This must have been quite a novel argument at that doctor-centered time.
Mr. Omodaka mentions that when nurses perform their two roles concurrently, their specialties are truly implemented. The two roles are: 1. To assist doctors with medical treatment. 2. To attend to patients by observing them carefully, knowing them properly, and watching over them with gentle tenderness. Through these special roles, if the essence of nursing exists in respecting an individual's dignity and inducing patients' natural healing power, I believe that the core meaning of nursing advocacy exists in nurses' daily diligent care to their patients.
The purpose of this study is to consider the significance of reading "literatures written by patients" in the medical faculty. This study is divided into two parts. The first part deals with the philosophical question: "Can we understand patients as other minds at all?" The second part deals with the concrete methods and results of understanding patients by reading literatures written by patients. In this paper I deal with the first part.
In the first, (1) I attempt to make clear the difficulty of understanding patients. It does not mainly concern the physiological pains, nor the qualia of sensations, but the mental sufferings that a patient's pains cause in his whole life. (2) Then, I try to solve a philosophical problem, namely, 'other minds problem'. I examine several philosophical standings, namely the analogy theory, the behaviorism, Schelling, Scheler, and Wittgenstein's arguments. From these examinations I draw the conclusion that understanding other minds is possible only in 'the second-person's view', not in 'the third-person's view'. In the third-person's view, we see another person as the unrecognizable object X. But in the second-person's view, we see another person as 'you'. I draw this conclusion from 'the tautological statement concerning self's pains' in Wittgenstein's argument and 'the negation of metaphysics' in the Scheler's argument. (3) Further, I consider the difficulty of understanding patient's sufferings in particular. Its difficulty does not consist in 'the spatial-physical irreplaceability', but in 'the temporal-historical irreplaceability between patients and other people. (4) Finally I consider the meaning of 'expression (text)'. I explain 'reading texts' as the condition to establish the concretesecond-person's relationship.
To sum up, we can understand patents' sufferings in the second-person's relationship by reading the texts as their expressions.
On June 26th, 2010, the Japan Society of Obstetrics and Gynecology(JSOG) changed its way of thinking about the application of preimplantation genetic diagnosis of embryos (PGD). As a result, the application of PGD extended to not only such serious genetic disorders as 'Duchenne muscular dystrophy(DMD)', but also to habitual abortion due to 'structural abnormalities of chromosomes' including 'chromosomal translocation'’. This means that PGD application will be able to include habitual abortion resulting from 'inversion', 'deletion', and 'duplication of chromosomes' , as well as 'chromosomal translocation' which is subdivided into 'reciprocal translocation' and 'Robertsonian translocation'. The new views of JSOG are expected to result in the following four cases.
(A) The application of PGD for patients suffering from serious genetic diseases other than DMD, muscular dystrophy, adrenoleukodystrophy, Leigh encephalopathy and ornithine transcarbamylase to which JSOG has already approved PGD application.
(B) The application of PGD for patients suffering from habitual abortion resulting from 'inversion’, 'deletion', and 'duplication of chromosomes' as well as 'chromosomal translocation' which is subdivided into 'reciprocal translocation' and 'Robertsonian translocation'.
(C) The application of PGD for patients suffering from 'numerical abnormalities of chromosomes', as well as the already approved 'structural abnormalities of chromosomes'.
(D) The likely establishment of an official management and administration institution for the handling of information related to PGD as well as the continued pursuit of safety in PGD.
The new views on PGD published by JSOG on June 26th, 2010 ask for JSOG to deal with the above four cases as soon as possible.