In this paper, I address myself to the issues at hand. Firstly, I review both the general trends and the essential characteristics of ethical situations in this technological era. Issues are categorized according to "ethical vacuum", "collective, synergistic and cumulative acting", or "fallacy of misplaced abstractness". Secondly, I consider Hans Lenk's theory. He tells us that "mens deficiens humanitatis" emerges in a society where a socio-technological system and market economy dominate; and that co-responsibility is necessary for the survival and progress of humankind in our complex technological world. This means that morality must be concerned with the well-being of other men and creatures. According to Lenk the upshot of this, in terms of moral responsibility, might be formulated as "In dubio pro humanitas concreta". In the third part of the paper, I address the following question: Is it not ethical to allow destruction of a few embryos in order to obtain their stem cells for "therapeutic" cloning research? The issue is complicated by a series of related questions. When does a particular human life begin? In addition, do embryos have human dignity? There appear to be two main approaches to defending conferred moral standing; namely, the NIP-argument (an indirect argument), and Tutiorism, or "Vorsichtsargument" (a meta-argument). Tutiorism holds that, in case of doubt, one is acting with responsibility when the safer course is followed. Based on this argument I conclude: In dubio pro embryone.

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Human Dignity, as the internationally recognized principle of bioethics and the scientific fact of the beginning of human life, inevitably requires the ban of the experiments on the human embryo.

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In this article, I would like to analyze the value 'dignity of human being' with regard to the debates of hES-cells and moral status of human embryos. It is said that by destroying human embryos, human dignity is damaged. However, human dignity is not only the value peculiar to Occidental culture. It is a different kind of value from that protected by the various rights of individuals. It is a normative value based on a natural fact that a human embryo is a potential person. Human dignity is the value which can be replaced with the word 'Humanity'. So we could conclude that we should not destroy human embryos without any relevant reason.

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In Japan, discussion on ethical issues concerning genetic and epidemiological studies on human subjects started only recently around the time when guidelines were established based on an agreement by three government ministries in March 2001. Until then, discussion mainly focused on ethical issues in clinical medicine such as external fertilization and organ transplantation. At the Radiation Effects Research Foundation (RERF), the Human Investigation Committee has been conducting deliberation on ethical issues concerning research since its establishment in 1977. This committee was established because it became an obligation for RERF, a joint US-Japan research organization, to have an internal review board (IRB) after disclosure of the "Tuskegee Study," in which human experiments were conducted on African-American men in the US. At RERF, the Human Investigation Committee has thus far reviewed ethical issues concerning more than 230 research projects. Through the review of various ethical issues including those in the health study of children of A-bomb survivors, the author has come to realize that the basis of ethical issues is how "those who conduct the study" and "those who are studied" understand each other's position and establish a relationship of trust.

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The subject matter of this paper is an examination of the absolutistic and fundamentalistic thoughts. These thoughts are established on the orthodox tradition of the modern rationalism. However, we can not accept them without any qualification under present circumstances. We are demanded to have a more relativistic view-point historically and socially. We need to have tolerant minds particularly.

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Though the term of "human dignity" is very often used, it is ambiguous on the whole. The ambiguousness of human dignity is due to that of the concept of a human being. Nevertheless, it is certain that human dignity is the very German understanding concept supported by historical experience and doesn't need any more grounds for itself. The concept of human dignity is prescribed here in the following manner. First, it has at least a double function of "differentiation" and "leveling" on the basis of a Christian statement that man be created as "imago dei". Secondly, it can have relations not only to "life" but to "death" owing to its context. It is quite different from sanctity of life in this respect. Thirdly, it is formulated as a decree prohibiting instrumentalization, that is, Kant's categorical imperative of humanity. But this principle could not prevent people from making a cloned man for the purpose of bringing him/her up. In such a case, we need to reconstruct an image of man by adding elements of "contingency", "uncertainty", "incompleteness", and "naturalness" etc. and seek "the good of man" over again.

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In March 2001, "Ethics Guidelines for Human Genome/Gene Analysis Research" was issued as jointly prepared ethics guidelines by three Ministries (the Ministry of Education, Sport, Science and Technology, the Ministry of Health, Labour and Welfare, and the Ministry of Economy, Trade and Industry). This was followed, in June 2002, by the issue of "Ethics Guidelines for Epidemiological Studies" also jointly presented by the Ministry of Education, Sports, Sciences and Technology, and the Ministry of Health, Labour and Welfare. According to these ethics guidelines, every research institute and hospital, which intended to conduct biomedical researches involving human subjects, was required to establish an ethics review committee for reviewing and monitoring the appropriateness of conducting a research protocol from ethical and scientific viewpoints. When these ethics guidelines were issued, it was implicitly premised on condition that research institutes and hospitals had set up their own ethics review committees and these ethics committees could fulfill their rolls properly. However, there is presently no full account of information concerning the state of Japanese ethics review committees. Our project conducted a nationwide survey on the ethics committees supported by the Health Research Grant of the Ministry of Health, Labor and Welfare. This paper reported the current situation of Japanese ethics committees, presenting some results of the survey. Then the present author suggested pivotal points to deal with overwhelming discrepancy between medical research ethics and medical care ethics.

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In order to answer the question raised in the title of this paper, the concept of clone in sciences was shortly reviewed. The clone is nothing but an organized entity derived from a post-fertilization cell, which shares the same genetic composition. The historical use of the word "human dignity" was also reviewed, and it was made clear that there was no definite and unchangeable meaning for the word. It was often used to silence opposing opinions without persening solid reasons. The technology of human cloning is within the acceptable safety range of reproductive medicine. If someone has no other means to have a child, and if it does not harm other person's interests directly, we have to approve that his last resort may be the human cloning. The essence of freedom is not to force one's preference on others.

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Various ethical guidelines based on ethical theories and existing legal regulations are very useful and important in order to resolve moral problems encountered in clinical settings. On occasion, however, we face ethical dilemmas that are incapable of being overcome by use of an ethical guideline or a law. In this paper, we discuss the role of virtue held by the involved in ethical decision-making pertaining to dilemmas related to patient care. Virtues considered relate to the ideals of medicine, the goal of healing one's patient and the moral happiness attained as a one involved in patient care decision-making. In our opinion, virtue defined in the context of ethical decision-making lies not in making normative conclusions, but rather in providing guidance throughout the process of decision-making. We surmise that this virtue held by those engaged in decision-making regarding patient care may ultimately be able to raise the level of medical care. When the most suitable course of action is unknown, virtue in the context of patient care decision-making and such subsequent action aimed at doing good is needed.

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The purpose of this paper is to investigate the ethics which control collective actions that raise huge and knotty environmental problems. Usually environmental ethicists have tried to insert injured nature into our moral community. Nature itself, however, never behaves morally. Therefore, we shall try to reconstruct the moral idea of the agents on the collective actions. Garrett Hardin, supposingthatthe agents maximize their self-interest, advocates abandoning of any attempt to construct morality in collective actions. But this means the very justification of taking a heavy toll on human lives to prevent from the environmental destruction. Although Hardin says his theory derives from the deep concern for the survival of humanity, that intention is contradicted by his theory. Hans Jonas advocates "future ethics". Its imperative is expressed as "Act so that the effects of your action are compatible with the permanence of genuine human life." "Future ethics" makes our duty toward the existence and the condition of future generations and aims to get the authority which excludes human survival from the object of a trade-off to prevent nature from destruction. Moreover, the imperative makes it our obligation not to ruin the idea of man which has always continued to be constructed in our unlimited heterogenic process. Jonas advances a theory of the agent responsible for his duty. The most important concept of the agent is that its existence cannot be maintained in itself. It always depends on others, the world. When the world's existence is threatened, the agent is responsible for it. Following to Jonas's theory, this paper proposes that the most important problem of environmental ethics is the distribution of responsibility according to the ability to fulfill it. We have thus gained the ground as 'common but differentiated responsibilities' (The Rio Declaration on Environment and Development, Principle 7).

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Paragraph 29 of the Declaration of Helsinki by the World Medical Association (WMA) expresses one of the important ethical principles, i.e., that new method should be tested against those of the best current methods. The latter sentence of the same paragraph states that "this does not exclude the use of placebo, or no treatment, in studies where no proven prophylactic, diagnostic or therapeutic method exists". This sentence has provoked international debates on the 2000 revision of the Declaration, resulting in no significant change to the Paragraph's text. The debate, however, continued even after the 2000 revision. Consequently, a "Note of Clarification" on Paragraph 29, which disproves this established principle was approved at the 2002 WMA assembly. In Japan, where there are no legally-binding regulations for medical research involving human subjects at large, a set of administrative guidelines on clinical research will be released in 2003. But in the process of developing the guideline, there was not enough discussion on the debate. Considering the recent national policy that especially promotes medical research, decision-making on the range of permitted placebo controlled researches, based on historical, ethical, and political perspectives, has now become necessary.

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The purpose of this study was to investigate differences in awareness and thinking processes among medical doctors, medical students and ordinary people about the application of genetic medicine. We carried out a survey on ethical awareness and value judgments regarding genetic medicine. Questionnaires were distributed directly to the medical students, and sent by mail to the medical doctors and the members of the public. The number of valid returned questionnaires was: 109 for the medical doctors (54.5%); 365 for the medical students (72.9%); and 121 for the ordinary people (60.5%). The results showed that there were no significant differences in the awareness among medical doctors, medical students and ordinary people. In general, a cautious attitude was observed concerning the application of cloning technology to humans. Many respondents agreed with the practice of the selection of fertilized eggs by genetic diagnosis in cases of families with genetic problems or serious diseases. Answers tended to vary with age and by sex, which suggested that decision-making in respect of genetic medicine may depend on age, sex and/or experience, but not on knowledge.

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This study determines elderly inpatients' preference to end-of-life issues, especially life-sustaining treatment and advance directives. Fifty-two patients (29 men and 23 women) aged 65 years or over (average 72.7), who were hospitalized in the internal medicine ward at a university hospital were interviewed. Study subjects gave their life-sustaining treatment preferences in the terminal stage, 47.1〜54.9% of subjects responded "I do not want to receive life-sustaining treatment," next "I rely on the physician's decision" and "I rely on my family's decision," only 3.9〜9.8% wanted aggressive treatment. Advance directives were supported by 55.8%, mostly women. The reasons were "I help my family make decisions on end-of-life issues (51.7%)," secondly "The importance of my own autonomy (34.5%)." The reason for patients not supporting advance directives was "I will rely on my family or physician to make the decision when the time comes (56.5%)". Few elderly inpatients desired life-sustaining treatments and half supported advance directives for their family or autonomy, which suggests the importance of executing advance directives when younger elderly. Health providers should consider these preferences, and assist elderly people in their decision-making in endof-life issues.

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The issue of what constitutes brain death seems yesterday's controversy. It is true that in the past few decades, brain death has become widely accepted in technologically advanced countries. But behind the consensus, some now argue, is the fact that brain-dead patients make ideal organ donors. The criteria for whole-brain death proposed in the United States in 1968 originally served two purposes-the withdrawal of life-sustaining treatment from those determined to be brain-dead and the procurement of organs for transplantation from such patients. But in the years since the report, the diagnosis of brain death has become less relevant to the former purpose. Now life-support is withdrawn from patients with less severe degrees of neurological dysfunction in the U.S. Opponents of brain death in the U.S. say that very few patients they diagnose as brain-dead actually meet the criteria for brain death-the permanent cessation of functioning of the entire brain. They say that the current science tells that the concept of brain death is incoherent in theory. Proponents of brain death say that brain death may look like an arbitrary line drawn between life and death, but it is practical and useful. A champion of the definition admits that brain death is a kind of social construct. He says that even though it is not a perfect concept, it is still sufficiently coherent to design a workable public policy, in other words, to maintain the organ transplantation enterprise. Now an increasing number of doctors understand that brain death is a social construct maintained for the irresistible utilitarian purpose. Some of them predict that no one will be diagnosed brain dead in the future because there will be no need. Professionals say that lay people know little about the emerging argument. But the public should be informed about it because the organ transplantation system relies on good-will donors.

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Ethical questions, especially those involving the relationship between physicians and patients, have taken on new importance in the face of advances in medical technique, increased litigation and healthcare reform. We conducted a survey of the extent of awareness regarding clinical ethical issues among resident physicians to evaluate the need for education in clinical ethics for medical students. The results of the survey, conducted among recruit physicians at a university hospital, indicate a relatively heterogeneous awareness of clinical ethics. Improved instruction in legal and ethical issues in the course of the medical educational process might result in improved doctor-patient relationships in clinical practice. We suggest that legal and ethical pedagogy should play an important role in both graduate and postgraduate medical education.

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This paper aims to suggest an approach which should be expected of men of religion by examining the argument by a Buddhist against the brain death and organ transplantation. Buddhist Yamaori's arguments against brain death and organ transplantation are very interesting, but do not seem to hold as an objection from Buddhism for the following reasons. 1) He says that there are in principle no manners of death in brain death and organ transplantation, but this is not necessarily true. 2) His negation of organ donation by referring to the development of the shashinshiko (捨身飼虎) story is a negation based on historical criticism, but not on Buddhism mind. 3) He says that he is so eager to fast that he won't donate his organs, but it is deduced from a mistaken premise. His arguments have the following characteristics or limitations. 1) He disapproves brain death and organ transplantation based on only one story or dogma. 2) He assumes from the beginning a situation where his ideal manners of death and dying of fast can be carried out, so he dismisses the problem of brain death and organ transplantation as unsuitable to the situation. 3) Consequently, the people involved in organ transplantation such as donors, recipients and their family are not taken into account. From the above consideration, men of religion are expected to feel sympathy for dying people, and they should keep in mind the following points. 1) When they make remarks about the problems on contemporary medicine, they should explain or argue not from individual dogmas but from fundamental principles of their religion. 2) Since they are regarded as specialists on matters concerning death, they should make their best effort to know about present-day medicine, particularly emergency medicine, when they make use of their expertise or experiences.

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The Purpose of this study is to analyze the reality and the characteristics of the "Life worth Living" (Ikigai) of the elderly of Japan in perspectives of the narratives on the basis of the research on it in Japan. The subjects consist of 105 aged people of 5 groups; those dwelling a nursing home, living in the retirement residence, going to rehabilitation in a clinic (day care), the Society of the New Elder Citizens (Shinrojinno-kai), hospitalized in hospice. The findings included 5 patterns as what the elderly feel the "Life Worth Living" (Ikigai). They are (1) a sense of relationship, (2) a sense of satisfaction, (3) a sense of self-fulfillment, (4) a sense of usefulness, and (5) a sense of value. Particularly, it was emphasized that the relationship with their family and the satisfaction of daily life or in the past is significant. The "Life worth Living" (Ikigai) of the elderly related to the passage of the time, particularly the past and the affirmation of life and self. Narrative approach is necessary and useful for the research in clinical settings from bioethical point of view.

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This article will analyze a few recent medical neglect cases (cases where parents refuse to consent to their children's medical treatment) in the U.S. These are the State Supreme Court cases of HIV-positive children and children with pediatric cancer (Custody of a Minor, Newmark v. Williams, In re Nikolas E.). These cases are especially difficult with which to deal as the diseases are not immediately life-threatening, yet the children would surely die without medical treatment. Furthermore, the medical treatment of these diseases is uncertain to bring about a cure. In resolving this difficult issue, the courts needed to balance the interests of the parents, the child, and the state. This article will analyze these interests and make it clear that "the best interests of the child" are the controlling factor in these cases. And in determining "the best interests of the child", many things must be considered such as (1) the effectiveness of the treatment, (2) the nature of the treatment, including the side-effects, danger and aggressiveness of the treatment, and (3) the emotional effect to the child while being away from his/her parents for medical treatment.

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In the United States, Katskee v. Blue Cross/Blue Shield of Nebraska was a case in which the concepts of disease and illness became a point of issue, concerning whether insurance should cover the cost of a preventative-internal-organ excision for a plaintiff diagnosed with ovarian cancer syndrome. The court held that the surgery performed to correct the state by reducing the risk was legitimate, since the plaintiff's condition constituted illness. This paper explains that the increase in genetic knowledge has the potential to expand the current concept of disease and illness, or to give a negative value to the concept of disease, whether viewed as non-normativism or normativism. Finally, a tentative assumption was made in which classifying the medical intervention into a genetic condition revealed three types of conditions; a presymptomatic condition, a susceptibility condition and gene polymorphism. As long as the state is assumed to be a disease or illness, it can be concluded that the medical intervention into the genetic condition is given the status of treatment (cure).

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Analysis of the contents of dental consultations can elucidate the ethical problems associated with dental treatment. Although the oral cavity is highly sensitive, self-diagnosis of dental diseases is often incorrect, and correction of erroneous self-diagnoses is therefore important. Many dental diseases cause irreversible changes in the body, and dental treatments cannot restore the body to its pre-disease condition, but patients are often unaware of the risks of not seeking treatment for dental diseases. If treatments are necessary for the maintenance or recovery of oral functions, explanation of the necessity for such treatments and continued collection of scientific data dealing with the indications for dental treatments are important. However, if dental treatments are performed for esthetic reasons, the decisions of patients must be respected. In order for patients to independently make rational decisions, improved awareness of oral hygiene on the part of patients and ethical issues on the part of dentists is required. How people view their teeth is in many ways a reflection of their perspectives on life and death.

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The development of ART (Assisted Reproductive Technology) has led to the emergence of diverse types of newly defined "mothers" who are currently called by different names, including "surrogate mothers", "host mothers", "donors" and providers of the "borrowed womb" or "leased womb". At the same time, there are some who are still left in obscurity or ignored in the worst case without being referred to by any specific term that clearly identifies their existence. This is a dangerous social trend that may lead to the rejection to recognize not only the presence of these new types of mothers but also the new "mother and child" relationship itself. These new type of mothers present a totally new phenomenon that cannot be explained by the conventional anthropological concept of "mother". In The main body of this thesis, I first of all intend to introduce and clarify the diverse types of "fathers" and "mothers" produced through the implementation of ART by conceptualizing the new form of parenthood they represent. Next, based on this new concept, I would like to point out the reality of the situation and issues of these diverse types of "Mothers" and "Parent and Child". And lastly it is not the issue of how these diverse types of "Mothers" can be publicly recognized in the society. The principle of this issue is the "Fertility treatment" itself.

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Recently much attention has been given to the social problems associated with Japan's rapid aging of the population resulting from the falling birthrate. Among the solutions proposed by the Ministry of Health Labour and Welfare has been assistance for infertility treatments, and insurance coverage for such treatments is now actively being discussed. Under the current system in Japan, artificial insemination, IVF・ET and ICSI are not covered by insurance. Such treatments therefore represent a substantial economic burden to those who undertake them, and many such individuals are in favor of broadening insurance coverage to include infertility treatments. However the main goal of government policy is to restore the birthrate; providing assistance, economic or otherwise, to individuals suffering from infertility is at best a secondary goal. Warwick's guidelines for family planning programs make reference to the following ethical principles: freedom, justice, welfare, truth-telling, and security/survival. By these standards, it is possible that efforts to broaden insurance coverage as a means of increasing the birthrate may focus on that target without paying sufficient attention to the need to respect the rights and decisions of the individuals concerned. From the perspective of bioethics, the question of insurance coverage must be addressed not just as a matter of government policy vis-a-vis the declining birthrate but as part of a broader debate regarding the quality of life and reproductive rights of individuals suffering from infertility.

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Informed consent (henceforth IC) has been so far discussed with a special reference to such an issue as each patient's self-decision making. In the United States, however, we find these days an idea beginning to be formed to try to define IC by taking note of not only patients but various relations between those concerned including patients. There seem two points of view of the concept of IC: One is that importance should be attached to the relation between patients and their families when patients make their self-decision in IC; The other is that importance should be given to the relation between doctors and patients, the significance of which is to try to define the concept of IC by emphasizing the relation between doctors and patient in IC. In this paper, therefore, the present writer thinks that the concept of IC should include: first, patients stand in a mutual relation between doctors and their families; second, in the relation between patients and persons concerned, the former will before anything else should be respected in their medical- ecision making. In conclusion, to realize what has been mentioned above, the writer proposes that IC should be divided into two processes: one is to think of medical treatment and the other is for patients to decide their medical treatment.

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