Recently in Japan, it is no rare matter telling the name of disease to advanced cancer patients. But on the other hand many health care providers do not feel they have sufficient knowledge of a patients course of disease to accurately predict a prognosis. How do we reply when a patient asks about his/her prognosis? We are afraid of making them hopeless, so we may be unclear in our explanations or tend to modify the truth. But they have a right to know the truth. In addition, it is important knowing prognosis for that they can arrange good death by themselves. They can prepare for it by knowing prognosis. An indicator we can use for prognosis is the survival curve. The survival curve is made from the data of lung cancer patients diagnosed in our hospital for the last ten years. It is classified by tissue type and stage. By using the ten-year survival curve, we can give patients a rough outlook of their prognosis. We knew a patient who arranged good death by himself after he knew his prognosis by this way. We think the use of the survival curve to tell a patient his/her prognosis is of significant value to consider.

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The attitudes toward the brain death and the organ transplantation in Japan has been an unusual case against other advanced and medicalized countries. In order to become clear the roots and the value structure of our attitude, I have analyzed the Net debate for the right and wrong of it by KJ method. As a result, the core value of the proponents is autonomy and self-determination based a view point of person, and they has a viewpoint of an observer. The other skeptical people has criticized that a viewpoint of body, person, science, and so on, based dualism has ethically a lot of problem. They has claimed that the discussion should be necessary from a donor's and donor-family's viewpoint and the control system on the high-medical society should be necessary by the non-specialist or non-profession. I think that the value structure on brain death and organ transplantation in Japan has gone with the current of the values besed modernization called "post-modernity" or "high-modernity". So I consider that our conflict for the brain death and organ transplantation in Japan will give a massage to any other modern societies as a pioneer.

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Questionnaire surveys of university students were carried out to know their views of death/life and their understanding of most advanced science technology. The results suggested that these young students were affected strongly by the Japanese traditional view about death/life, ie : the worship of ancestors and/or the spirit of the dead, the sanctity of graves which must be given priority in values; the strong aversion to damage any part of the dead bodies as it is believed that one should enter the world of the dead with an intact body, the faith in the existence of the soul and the fear of curses, etc. The interesting point here is that most of the students answered they were not affiliated with any specific religion and did not consider themselves to be religious people. According to this data, it appears that despite being born into a highly information-orientated society, the students were still affected by traditional Japanese folk beliefs. Such traditional views might affect their ethical view about advanced science technologies, for example, organ transplantation, cloning, et. al.. On the other hand, the data showed that they had interests in the ethical problems caused by the development of advanced science technology. But at the same time, they misunderstood some biological facts relating to these technologies and their judgment on the ethical issues of applying the technologies to humans are based on criteria of image rather than scientific knowledge. When the medical value was emphasized, they recognized cloning of humans as good, however when the medical value was not illustrated, they answered that the application of cloning technique toward humans was wrong. The opinions toward ethical problems seemed to change based on how the technologies were described to them. These data show the importance of education for them in school. Not only the concept of bioethics, but also the basic science should be taught to all young people to understand advanced technology.

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Ethical problems on the movement to routinize the mandatory HIV testing in prenatal care are critically discussed. Recent advances in clinical technology had achieved a remarkable reduction in mother-to-child-transmission rate of HIV. Some medical experts have recommended the mandatory, universal testing for all pregnant women. Unfortunately, there are not sufficient treatment institutions at this time in Japan. To be routinely offered is, not testing, but informed consent, pre- and post-testing counseling and enough information on support resources in terms of rights. Some address a duty to know own HIV status resting on the harm-to-others principle. It is dubious that it is justified as an absolute obligation.

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Androcentrism is based on the preservation of women's reproductive ability. It has been maintained by controlling their sexuality for a long time. However, as our way of existence has been changing these days, it is possible to consider androcentrism, which holds the belief that women's reproductive ability is important, as losing its effects. Sexual intercourse is a phenomenon to give and take physical friction between two persons, the condition necessary to realize this action and sensations that are generated while the action is carrying out effect the their "self". In a woman, this effect on "self" is interpreted in the context of androcentrism, and it is used to keep the system of an androcentric society. On the other hand, this process is always concealed because of the excuse that it is unavoidable in human life. As a consequence of this condition, women's human rights are infringed upon. This situation means that sex is a clever means to maintain androcentrism.

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The results of patient interview and questionnaires given at the time of dental examinations indicate the type of information a patient places emphasis on when making decisions concerning dental treatment. It is not uncommon for patients to have misconceptions about the presence or absence of dental caries. Therefore, it is important to adequately explain that the presence or absence of pain is not necessarily related to the presence of dental caries, nor that it is a sufficient criterion upon which to accept or reject treatment. In addition, whenever it is necessary to remove healthy dentin, the reason for doing so must be explained in easy to understand language. When recommending extraction of the wisdom tooth, it is also extremely important to inform the patient of the need for the extraction as well as the risks involved in clear, easy to understand words. With implant dentures, the lack of impartial explanations concerning the drawbacks has been a problem. With regard to the recurrence of dental caries, it is important that the dentist foster the kind of doctor-patient relationship in which patients find it easy to express their grievances and complains. In dental treatment, it is imperative that patients be educated in oral hygiene so that their decisions can be heeded as much as possible.

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About Narrative in bioethics, our discussion is not limited to "Narrative Ethics" in a narrow sense (Narratology), but it analyzes methodological and practical meanings of Narrative, emphasizing the role of Narrative in a sense of the Social Constructionism. "Giving concrete solutions to concrete conflicts". If we consider it as one of essential tasks of bioethics (or applied ethics), Narrative approach has only a very limited meaning at the methodological level in bioethics. It is because narratives do not give us a concrete ethical determination, although they also have an important meaning, theoretically and practically, to grasp clinical situations as what was built by various narratives. However, on the clinical level, attentively considering narratives (listening carefully to a patient's petition; also including its context) has decisive importance in a practical meaning. Rather than the theme in a narrow range as the methodology of bioethics, the concern of Narrative should be connected to a concrete request as an improvement of the medical locus.

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Recently the term, "informed consent" is widely heard in our society. If informed consent is truly practiced, we can expect as a result; medical treatment to be heightened, the incidents of medical malpractice reduced, and improved relations between doctors and patients. A Supreme Court decision rendered in 2000 is expected to be a driving force in having informed consent practiced in our medical field. This article explains the liability of doctors regarding informed consent, while considering the main points and significance of this decision and the legal extent of its influence. Since the patient at issue was one of Jehovah's Witnesses, the article mainly analyzes the legal issue of the refusal of blood transfusions and the matter of informed consent.

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The purpose of this paper is to get insight into the problem of experimental nature of clinical medicine from Jay Katz's treatise on human experimentation. The ongoing practice of clinical research often afflicts physical as well as psychological harm on patient-subjects. According to Katz, the non-distinction between therapy and research together with inadequate practice of informed consent are possible causes of harm. Patients invited to participate in a clinical research expecting to get therapeutic benefits on their problem are unknowingly subjected to placebo-controlled randomized clinical trials. Katz's proposals of the requirement of disclosing necessary information on the research protocol may decrease the number of participants but can be expected to prevent unnecessary harm. Although a glimpse of discussion on the issue in a recent medical journal cannot allow us to be optimistic, we want to say that once everything necessary is disclosed, then people may voluntarily participate in a scientifically meaningful experimentation.

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Recently, the practice of "spiritual care" has been caught attention in the field of terminal care. There are some discussions that how to introduce the idea of "spiritual care" in Japanese culture or tradiion in the context of terminal care and how to make a scale on Japanese "spirituality" to grasp patients' spiritual needs objectively, etc. At first, however, in order to develop our detail discussions I think that it is necessary to examine how the idea of "spirituality" in Western hospice care has been understood, developed, and how the researches on spiritual care have been carried out. The purpose of this essay is to review the trends of Western literatures on spiritual care. I'll be expecting that this review of literatures will be a positive contribution to researches on spiritual care in Japan.

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When a medical choice has to be made, it is vital to place oneself in the position of the patient. There may be, however, a conflict of interest between the patient's right to self-determination and the doctor's ethics or beliefs in regards to the medical treatment. Can such a conflict in values be prevented? To what extent should doctors respect the patient's rights? Questions regarding a conflict in values, as well as the extent of informed consent (IC) are frequently raised at medical conferences and classes at universities. In order to obtain the answers, in addition to medical knowledge, the matter of ethics holds an important key. Jehovah's Witnesses have been addressing this issue by offering accurate information about their views to medical personnel and lawyers. As one approach, they have accepted invitations to classes of medical students at universities and participated in the discussion. The view of Jehovah's Witnesses was explained from three aspects, 1) ethics, 2) legal matters, and 3) medical choice. This has resulted in a better understanding of Jehovah's Witnesses, which in turn has helped avoid confrontations. Consideration was also given to cases involving minors. As a case study in bioethics and IC, the basic beliefs of Jehovah's Witnesses are explained.

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Recently much attention has been given to the social problems associated with Japan's declining birth rate, while rapid advances have also been made in the area of reproductive technology. The Japanese national and local governments accordingly tend to encourage infertile women to give birth in order to increase the birth rate. The danger of this approach is that it creates a situation in which infertile women may face social pressure to have treatment. From the point of view of demographic analysis, it makes sense to argue that encouraging infertility treatment will contribute to an increased birth rate. The present article, however, takes a different perspective, reviewing the present state of infertility treatments and discussing its potential for increasing the birth rate with reference to the provision of the "Anti-Declining Birth Rate Countermeasures Basic Law."(A multi-party consortium of Diet members submitted a bill in late 1999 to establish this law, but this effort was abandoned when the House of representatives was dissolved in June, 2000.) It concludes that current policies are problematic in terms of individual reproductive rights, cost of treatment, and the limited availability of information and counseling for infertility. To the contrary, promotion of infertility treatment is likely to cause even more problems and negative effects than currently exist in the area of reproductive medicine.

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The body is a substantial container of the subject, and medical intervention to the body is of significant interest to the subject. Clinical medicine is thougt to be shifting toward a patient-oriented contract, and in this model, a patient's right to autonomy expressed by the term, "Informed Decision, " and a physician's right to discretion are two main ideas. The patient's right is defined as "The right of the patient, who is the subject of clinical medicine and the client of medical services, to decide about his or her own body, based upon the well understanding of the physician's explanation, and within the limits of social admission." The physician's right is defined as "The right of the physician to extend the life, with his proffesional knowledge, and within the limits of social admission, in the case that three steps of autonomy (i.e., explanation, understanding, and decision) are not fulfilled, and that the patient's autonomy is not acceptable, and that there are some unavoidable circumstances." In the future, a patient's autonomy will become more popular on one side, though the number of old patients whose intention is unclear will increase on the other side. We should distinguish these two rights clearly and apply them correctly.

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The questionnaire was undertaken with students who were about to be engaged in biological experiment at Research Center for Experimental Biology of Tokyo Institute of Technology. The aim of this research was to obtain information concerning their knowledge and awareness of ethical and social issues involved in animal experimentation. The results may be summarized as follows : 1) Eighty six percent of the students feel some uneasiness or conflict, although they recognize the usefulness of the experimentation. 2) While they did not tend to concern themselves with possible pollution to the environment due to the materials they use, they did think that they needed to consider objections to their animal experimentation. 3) Over 70% of the students did not have much knowledge of any guidelines or rules for the animal experimentation. The following 3 points were assessed to be requirements for easing these problems : 1) A program for bioethics and its teaching system needs to be established for undergraduate students. Through gaining basic knowledge and ideas about human values surrounding science and technology, they will start to settle their conflicts. 2) The course must allow for the students to actually recognize and implement existing rules. In addition, the teaching system needs to contain historical background regarding guidelines and rules that are recognized as valid in the international context. 3) More contemporary rules deduced from new bioethics should be implemented.

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In this paper, we will discuss fundamental ethical norms required in epidemiological research. First, we will argue that the common argument that when no satisfactory informed consent can be obtained from individuals for epidemiological studies involving them consent from a community to which such individuals belong or permission from an ethical committee is acceptable, is not ethically plausible. Individual informed consent cannot be replaced by such alternatives. Second, it will be argued that automatic exemption of the need for informed consent in epidemiological research where anonymity of data or samples is guaranteed is also unacceptable. Even research which uses and stores data or samples without identifiers can harm individuals and even in situations where no harm is anticipated, ethically sound research is essential to avoid doing individuals wrong. Third, we will show that the common assumption that researchers can access patients' medical charts with permission provided by the patients' physicians or authorities at hospitals are not ethically defensible either. While it is essential to consider the ownership of medical information, it is clear that such information does not belong to medical professionals or researchers. Finally, we will argue that the institutional review boards and researchers should establish protocols and research procedures that cannot cause any moral harms or wrongs to individuals even if the research is conducted by a less than virtuous researcher. In conclusion, it is claimed that, taking into consideration the balance between the importance of medical and epidemiological research and respect for personal privacy, we have to set limits to the conduct of such research if we wish to create a morally superior societies. Informed consent from individuals for research involving them is essential even if obtaining it is costly and time-consuming.

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Questionnaire surveys were carried out to investigate the influencing factors on students to make a decision on possession of donor cards. The results showed that the possession rate of donor cards was 23.0%. There was a high possession rate of students who approve brain death, wish to have an operation with organ transplantation and talk about brain death and organ transplantation with their family and friends. But, there was no relation between possession of donor cards and interest on science and technology and social consciousness. From this study, it was indicated that providing sufficient information and training in order to total judgement should be required to make a decision on possession of donor cards.

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Pre-implantation genetic diagnosis (PGD) is a new technique which makes it possible to investigate hereditary diseases and chromosomal defects of an embryo produced by in vitro fertilization (IVF) prior to its implantation into a woman's uterus. This technique is already available as a service worldwide for couples at high risk for having children with genetic disorders. By 1999, over 100 babies were born following the use of this technique, predominantly in Belgium, the Netherlands, the U. K, the USA, and other countries. This new technique creates a number of ethical and social problems. In Germany PGD is implicitly prohibited by the Embryo Protection Act (1990). However, on the other hand, abortion some weeks later is allowed when the conditions for a medical indication are fulfilled. So, on February 24, 2000, the German Medical Association (GMA) asked the public whether and how they think PGD should be used to help these couples. There are four ethical aspects in the German arguments against PGD. They are expressed in terms of arguments about "human dignity", "human rights", "eugenics" and "discrimination against handicapped people". It is the aspect of human dignity that the arguments in Japan lack. In this report I will show what this argument is and try to clear up what it means, with following the German ethical discussion regarding PGD.

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On 6 October 2000, the High Court Family Division in the U.K. ruled that it was in the best interests of two women that artificial feeding and hydration stop, based on the Human Rights Act 1998, which came into effect on 2 October 2000. In the U.K., there is no right to die, but principles, which have been established on the basis of the accumulated judicial precedents, based on self-determined withdrawal from or withholding of medical treatment, even if this shortens life as a result. However, a consensus on the questions of treating mentally incapacitated adults is still being sought. On 27 October 1999, the Lord Chancellor's Department reported "Making Decisions", after analysing 4000 responses to the Consultation Paper in December 1997. They have decided to legislate, when Parliamentary time allows, to provide a range of key principles to give clear guidelines to those making decisions about the care and welfare of the incapacitated. I will report on the views of the judiciary and government, and look into the question of legalising therapy abatement for mentally incapacitated patients.

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Bioethics is a completely new field of study which goes beyond the notions of traditional academic discipline. I propose that bioethics be defined as a supra-interdisciplinary study focusing on value judgements relating to all spheres of "life" issues in the context of social and natural environments. My own view of bioethics has its origin in Saigon, Vietnam, in the 1970's, when I encountered the misuse of scientific and technological achievement for military purposes such as in the case of "Defoliant Operation". In Vietnam today we can still see the result of this military operation. There continues to be births of deformed babies, up to 100,000 according to the survey by the Red-Cross in Vietnam. Could we have envisioned such an outcome 25 years ago? A new vision for future civilization can be established through a forward looking bioethics in public policy. This must be supported by grass-roots civic actions and advocate groups focusing not only on biomedical value issues but on all aspects of "life" issues. Bioethicists need to have a sense of justice including the respect of the human rights of vulnerable people. The New Nuremberg Code of Ethics and The Universal Declaration of Human Rights of Future Generations are two important starting points for moving towards a global consensus for "Future Civilization."

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These days, the right of self-determination and self-ownership are loudly advocated, though the ideas of these words are traced back to the natural law theory in 17th and 18th centuries. Why have those ideas come to the fore again and been discussed so much? I think they were called back by the newly occurred problems such as brain death, the possibility of organ transplantation and artificial reproduction, etc. People who want to push ahead with these remarkable results in the medical world put use the word right as a whole. But what is right? What is ownership? Here I will elucidate them on the basis of a realistic point of view. In the last analysis a human being is not a particular existence equipped with universal human rights. A human being is a kind of creature living on the earth, having inherited its genes from unknown ancestors who occurred on the earth 4,400,000 years ago. The earth is a closed system, so, our various wants must be under control in order to keep harmony with the order of nature on the earth.

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