The Human Genome Project has been carried out during past 10 years as an international cooperative effort organized as Human Genome Organization (HUGO). Completion of the analysis has just been announced in June, 2000, and more detailed analysis of the functions of the human genes and related DNA sequences will be the next target of the international research race. In particular, single nucleotide polymorphisms, or SNP, would be of great interest in the pharmaceutical business and industry. Bioethical issues are closely related to the human genome analysis, and they have been discussed extensively in the HUGO International Ethics Committee, of which the author of this article is co-chairperson. Common international principles of the ethical issues are indispensable, but we should understand that there may be unique ethical standards in different areas of the world, particularly in Asian countries.

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[in Japanese]

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About ethical and legal problems on cloning human beings with somatic cell nuclear transfer cloning technology, many articles have been already published. But some bioethicists argue that reproductive cloning should be acceptable for some purposes, though some European states and Japan are going to put a ban on human cloning. The base for their argument is the right of 'reproductive freedom (or autonomy)'. But the right is originally intended to give women the access to abortion and contraception, and to protect women from forced sterilization. I suppose that to support reproductive cloning on such a right is an abuse of the right, because cloning human beings is not 'reproduction' in the strict sense. In reproduction, both sexes have genetic relations to the baby, even if the baby was born with assisted reproductive technologies such as donor insemination, IVF, and a surrogate mother. But a baby born by means of nuclear transfer cloning technology doesn't have genetic relations to both sexes, so giving birth to a baby with this technology is not 'reproduction'. In this way, reproductive cloning cannot be supported on the right of 'reproductive freedom'.

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Nursing Ethics has developed for twenty years, separating from bioethics and medical ethics. The purpose of this paper is to study representative books of Nursing Ethics, in order to find what is a peculiarity of Nursing Ethics, looking about feminism perspectives. We examine this problem from three points of view, that is, 1) a confrontation between technical ethics and Nursing Ethics, 2) nurse's role in health-care system, and 3) care.

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There cannot be complete freedom or autonomy in the decision making of any individual. We are always to a greater or lesser degree influenced by the value systems of both the present society and its traditions. The new study field of value structures is composed of three parts; concept, system (concrete installation of the concept), and decision making. These can be useful in analyzing the complex problems caused by the interactions between new technologies and our societies. Since our view of life is inevitably changed by new technologies, the core of biotechnology is a central concern of bioethcs. We first overview the present guidelines and rules of biological experiment at universities in Japan, where we recognized a discordance between the research itself and the related regulation systems. Animal and genetic engineering experiments are conducted independently at animal and genetic experimentation centers of each university, and their regulations are also established independently. We assert that traditional animal experimentation needs to be revised to incorporate issues raised by the remarkable developments of recent genetic engineering. Since the basic elements of genetics are common to all organisms on earth, such elements work on the same principle and can also be applied to human life. In this sense, molecular biology has much impact on our society. This potential impact of molecular biology on society must be included in a new conceptualization of biological experimentation. As a basic step towards reconstructing concepts of biological experimentation, we propose a new, consolidated idea of the 'advanced bio-science experiment'. The word 'advanced' comprises the meaning of frontier; this has an influence on society which could be beneficial or hazardous. The latter word 'bio-science' indicates that we need to regard organisms not merely as individual substances, but as entities holding genetic information to be respected. In this sense, bioethics must be reorganized as 'molecular ethics'.

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According to the author's (Tsuruwaka) interview research for some chaplains, some hospices and hospitals tackle the spiritual care of terminal cancer patients with enthusiasm. However, it seemed that it is not always developed systematically and effectively for medical teams. In the present, concrete support by medical staffs is expected. It is necessary to examine how spiritual needs are expressed first. In this essay, first, analyzes the formation of the idea of relating to spiritual care from the subjects of The Japanese Association for Clinical Research on Death and Dying. Second it examines papers about spiritual care of "The Japanese Journal of Nursing" by lgakusyoin and "Japanese Journal of Cancer Care" by Nankodo. Third, examines how spiritual needs are expressed and related to physical, social and mental pain through dialogue between the author (a hospice volunteer) and terminal cancer patients.

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Because use of cloning techniques in domestic animal production has not been evaluated from ethical points of view, consumers are increasingly conscious of ethical questions on the technology. This paper explores the potential benefits of cloning techniques in domestic animal production and discusses the ethical issues and public acceptability. Although there are the economic potential benefits of cloning techniques, it was indicated that integrity of an animal might be damaged by cloning and the techniques would lead to loss of genetic variation of the animal population. This paper concluded that the problem is one of reconciliation between economic utility on one hand and ethical and acceptance issues on the other, and judgments of the cloning techniques depend on their technical levels and costs and the degree of openness of the information and public acceptability.

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The concept of life includes something more than biological elements. What is this "something"? To think of this problem, this study points out at first that both bioehtics that high-developed medical technology is inextricably bound up with, and the arguments that are critical of "life commercialization" do not give a clear definition of the whole concept of life. "Life" is indicated only as the negative "blank" which is the opposite of that what is being justified or criticised. Secondly, from a historical point of view, it is clear that the statement that the background of modern medicine constitutes of Cartesianism, is only partly true. Modern medicine rather has its own characteristic view of life-a view of life, that bioethics seem to ignore, while creating the conditions for the realization of a new concept of life. Thirdly, this study argues that the new concept of life is based on "an exchange of death for life", which stands for the acquisition of "life" in return for a death. The medium required for this exchange could be the concept of life. (179 words)

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In Japan, the first birth as a result of artificial insemination with donor sperm (abbreviated below as AID) was in August 1949. There have been numerous developments in the half century since. Despite the rapid change in the field of human reproduction as the result of medical progress, legal change has been slow. There is still no legislation in Japan regarding this topic other than the official medical guidelines for Assisted Reproduction (AR) as laid out by the Japan Society of Obstetrics and Gynecology (JSOG). It took half a century (until 1997) for JSOG Guidelines to approve AID. More than 10,000 AID children were born before any guidelines existed. JSOG approved in vitro fertilization and embryo transfer (IVF-ET) in 1983, because only married couples' gametes can be used. The first symposium by the Society of Private Law took place in 1956 and included a debate on the question of parentage, but no agreement was reached. Conferences held by the committee of the Science and Technology Agency involving research associations have failed to provide opportunities for drafting legalisation, although the necessity to do so has been pointed out. A working group of the Research Project of the Department of Education published its recommendations for legalisation in 1994. In the light of this stuation, in 1997 the Department of Health set up the Committee for Advanced Medical Technology Assessment, and established ad hoc committees on Assisted Reproductive Technology (ART) and on Preimplantation Genetic Diagnosis in 1998. These working groups are gathering opinions by analysing the feedback from postal and email questionnaires. The report covers the current legal situation on ART in Japan and the UK, where certain conflicts are arising between the requirements of UK and EU law.

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The right to die means that the terminally ill person has the right to refuse further treatment. The duty to die means that the terminally ill person feels that he has no choice and must refuse treatment because of social factors such as the family situation or financial cost to society. This paper describes the perceptions from a sample of 121 Japanese nurses, physicians and others interested in bioethics problems, and 64 Western counterparts. The right to die received support from all of the Western and a majority of the Japanese sample; whereas the duty to die received weaker support from the West and rather strong disagreement from Japan. Themes emerged in the two groups from a content analysis of their reactions to the major concepts of right to die and duty to die, and these included autonomy, meaning of life, justice, and patient-family connectedness and love. Differences and similarities in the meaning of these themes were explored.

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Although organ transplant from brain-dead patients became legal in Japan after the Organ Transplant Law came into force in October 1997, there is still no public discussion as to how the donated organs should be distributed to those in need. For instance, non-profit organization Japan Organ Transplant Network's policy is to distribute/transplant organs to those named at the top of the waiting list first in the case of heart, kidney and lung transplant, if medical condition level of recipents is equal. The "first come, first served basis" system might seem fair and just-at least superficially- but elderly patients with chronic organ problems might be often treated before young people suffering from organ disorders. In case of liver transplant they adapted the scoring system calculating the kind of disease, emergency level and blood type, but alcoholic patients might be treated before non-alcoholic patient suffering from damaged liver. A data analysis of the United Network for Organ Sharing (UNOS) revealed that 40%-70% of the donors were young patients aged between 11 and 34, while the recipients were 50 to 64 years old. The study aimed to identify the "ideal recipients" to whom the younger generation (the single largest potential donor group) wished to donate their organs if they were diagnosed brain-dead. The findings revealed that they would be more frustrated if the recipient turned out to be alcoholic, old, male(more than female) and convict. If Japanese government ignores the young people's view, the number of donating organs might decrease.

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This study compared thanatology between Japan and Germany by a consciousness survey regarding truth-telling in students at the Department of Law and the general population in Japan (Fukuoka) and Germany (Heidelberg) between December 4, 1999 and December 30, 1999. We investigated ideal care of the patient and patient's family required for terminal care as well as disclosure of medical information. As a result, 71.95% of Japanese subjects and 92.78% of German subjects desired truth-telling to themselves and their family. In both countries, percentages were high. To clarify the tendency of thanatology, 5 factors, right, preparation, family, self-determination, and confidence, were investigated in subjects who desired truth-telling, while 5 factors, not desiring to watch, being watched, after being watched, care, and consideration, were investigated in subjects who did not desire truth-telling. As a result, especially among university students in the two countries, most subjects who desired truth-telling selected their rights to be informed of their physical status as the reason for desiring truth-telling, suggesting that they were strongly conscious of their rights to know their health status. Furthermore, Japanese tended to think that they have to do things that should be finished before death, while Germans valued a confidence relationship with their family or close relationship. The percentages of subjects who did not desire truth-telling to themselves or their family were 5.48% in Japan and 0% in Germany. However, the percentages of subjects who desired truth-telling to themselves but not to their family were 19.51% in Japan and 6.18% in Germany. The following reasons were common between the two countries : their family will be afraid of knowing the truth; and they do not want to see their family being shocked. As the reason for not desiring truth-telling to themselves, many subjects selected an item that they would be afraid of knowing the truth. Furthermore, members of society selected the following items : their weak characters do not want to be seen, and they do not want to give their family surplus trouble. They strongly expected evasion from their psychologic stress to their family. To calmly accept death, which will always come to everyone some time, and to spend the rest time significantly, the patient and patient's family must think about life and death. Furthermore, the medical staff side responsible for truth-telling must respect the patient's or family's will. This study proposes that the importance of thanatology should be generally recognized for each person to live a satisfactory life.

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Because the concept of informed consent gradually prevails in Japan, patient participation in decision-making, especially for elderly people, has become a compelling issue for bioethics discussion. At the core of the discussion are their lowly estimated decision-making capacity and traditional values such as respect for the elderly and the family's expected role for them. To investigate the attitude for CPR (cardio-pulmonary resuscitation) and the decision-making process, 110 middle-aged and elderly healthy people [range of age : 50-90] were interviewed in the precinct of one famous temple in Tokyo from May to June of 1999. A fictitious situation was set where a cancer patient with a prognosis of survival of a few months is about to discuss future implementation of CPR with family and medical staff members. Two scenarios were presented. The first is that the cancer patient is one of the subject's family members, and the second is that the patient is the subject themself. Subjects were asked 1) who should decide whether or not to do CPR; 2) if they prefer to receive CPR; 3) what to do when surrounding people (family and medical staff members) had different but reasonable opinions. They were required to respond to both scenarios and to give reasons for their answers. This interview was performed with detailed explanation of the CPR procedure, which would facilitate the subjects' understanding of CPR and increase the quality of the data. More than 60% of the subjects answered that they would decide by themselves and would prefer not to receive CPR. However, the subjects would not insist upon their own choice when surrounding people have different but reasonable opinions. Moreover, the subjects dramatically changed their opinions between the two scenarios. It has been demonstrated that the concept of patient's self-determination has now been accepted by middle-aged and elderly healthy people in Japan. However, the results also indicate that traditional values implicitly underlie their preference of self-determination. Future studies targeting actual patients are needed. (324 words)

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In the present-day medication the diversified values is complicated. Through the organ transplant that we are faced with hard choice between a life of a donor and a life of a recipient, we are under the necessity of thinking over the sense of values in life. I suppose that any experience with nursing care of the other has influence on our sense of values in life and health. So the shift in consciousness of 203 nursing students concerned brain death and organ transplantation at the before and the end of clinical teaching of nursing was examined during 4 years from 1994 to 1998. The results showed there were decrease of nursing students who approve brain death and organ transplantation at the end of clinical teaching of nursing on the all years. It could not find clearly the links between nursing function-structure and the factor of the shift. From this study, it was indicated that providing the information and learning about the general idea of nursing care based such as a knowledge with experience, and a view of humankind with holism, should open a new way for total judgement on the problems of health and life.

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Managing diabetes successfully depends largely on a patients' self-management, causing the health care provider to take on a paternalistic role in the diabetic's care. In order to evaluate features of paternalistic intervention in diabetes care, we asked 822 patients with diabetes about their self care. The questionnaire consisted of four questions : 1) the influence of self-management on life style, 2) the justification of paternalistic intervention, 3) respect for autonomy in diabetes care and 4) costs. About 38% of the patients with diabetes think that diabetes self-management interferes with their life-style. They justify paternalistic intervention because of their trust in health care providers and concern for the prevention of diabetes-related complications. Approximately 61% of the patients think that autonomy should be respected in diabetes care. The majority of patients are interested in the economic aspect of diabetes care. In conclusion, a health care provider should be aware of the paternalistic nature of diabetes self-management.

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On April 15th 1999, the Improvement Review Committee of the Ministry of Public Welfare, after considering the needs of State medical examinations, presented its final report. According to the report, it emphasized the need for medical students to respect the moral values and human rights of the patient. We feel that there is a need to educate medical students in regards to ethics, so that they may become doctors who fully understand the matter of informed consent from the standpoint of the patient in treating them. In fact, several universities are providing education on the matter of ethics for their medical students. One example is that of the Osaka Medical College, where there was a small group learning session, concerning the case study of the refusal of blood transfusions on religious grounds by Jehovah's Witnesses. We make report about contents of the lectures which consist of : 1. [Who Jehovah's Witnesses are.], 2. [Ethical standpoint of Jehovah's witnesses toward medicine], 3. [The court case because of transfusing blood to a Witness patient without admittance], 4. [Why it became court case.], 5. [It should be discussed even how we should view life and medical ethics], 6. [To establish real informed consent], 7. [Guidance by Ministry of Public Welfare], 8. [Conclusion]. Additionally, at some medical universities representatives of Jehovah's Witnesses have taught the matter of ethics education. We will introduce the results of using the refusal of blood transfusion on religious grounds as part of education in ethics for medical students.

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This essay will treat the "principlism debate", based on Mark Kuczewski's recent study : Fragmentation and Consensus (1997). His discussion starting on the analysis about communitarianism and casuistry, try to integrate these perceptions. We will discuss his perception critically and pay attention to "narrative" in his discussion. Insisting on the importance of "narrative", we will analyze it's possibility in bioethics.

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This paper uses findings from studies that the authors conducted in Japan regarding ethical issues in terminal care and attempts to raise the debate beyond the descriptive level about issues of information disclosure to terminally ill patients. Essentially, these remarks take the next logical step and present four possible frameworks for information disclosure to families and patients within an ethics of relationships. Since information disclosure, or the lack of it, stands as a pivotal point in decisions about terminal care and what does or does not follow thereafter, the focus here limits the discussion to this topic. Findings from the studies are briefly mentioned and based on these data, the four possible frameworks for information disclosure are developed. These four frameworks might be used in differing situations where decisions need to be made. The basic ideas and questions central to the development of these frameworks are described.

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Amongst other specific professions, the health profession is highly specialized because it deals with medicine. Therefore, the responsibility assured by health professionals is very great. We studied the codes of ethics of Japanese health professions. By analyzing and comparing them, we found each code consisted of the following five categories; 1. introduction (preface); 2. ethics pertaining to patients (individuals); 3. commom ethics to be practiced; 4. special ethics for each health profession; 5. ethics specific to the country. On the basis of the study, we further examined the codes of ethics of the three international health professions; The World Medical Association, Inc., The International Pharmaceutical Federation, and The International Council of Nurses, by means of comparison and analysis. The examination shows that in categories 2 and 3, we think it's both possible and desirable for health professionals to have common basic principles. Consequently, we have drafted the Common Code of Ethics for Health Professionals. Our idea is that if all health profession worldwide can have a code of ethics with a common basic concept and written in the same organized manner, they will be able to maintain the same high standards of ethical behavior, and work together for the benefit of patients (individuals) and society.

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