Remarkable recent progress in reproductive medicine elicits more complicated "Decision making" for the parents from their pregnancy. At moment, Ethical Committee of JAOG (Japan Society of Obstetrics and Gynecology) has reviewed four applied PGD (pre-implantation genetic diagnosis) projects and has not approved except a case of Duchenne muscular dystrophy. On the other hand, insufficient technological progress in prenatal diagnosis caused parents another anxiety and frustrated informations for medical professions. Along with fast technological advancement in diagnostic methodology, quick and sophisticated ELSI resolutions are strongly expected.

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It is R&D investment executed in market mechanism that enables genetic research and R&D of pharmaceuticals or diagnostic methods. Therefore, without patent system, it would be difficult for something useful to be developed and quality of medical services could not be ensured. On the other hand, sometimes access to medical services could be restricted owing to patents. It is important to consider bioethical aspects of gene patenting in this industrialized society from the two following viewpoints. First, the player of R&D that has given rise to novel fruits should be rewarded properly. Second, conditions of gene patenting and licensing should be set up in order to promote R&D for human health and welfare. In this paper I argue concrete cases in which the problem on "bioethical aspects of gene patenting" is arising and investigate what political solutions are feasible.

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I have worked in six different hospices as chaplain being involved with over 2, 500 patients' life and death. The word chaplain was quite new to the staff, patients and their families and, therefore I had to explain what they should expect. Religion and medicine still in Japan cannot be incorporated, and when a religious person had to work together in the medical world with the doctors and nurses, I felt that there were problems that had to be confronted. I would like to convey the role and manner of a chaplain gained through my daily experience in the hospice. I. Being involved with the patients. 1. Although most patients have their family religion, they seldom have their own religion. When they are suffering and in such state of mind, they pray to God for help. They are slightly concerned about any specific religion. (1) To help them to create an image of consolation. (2) Religion that provides hope. 2. Consideration for those who do not wish to be forced to any religion. 3. To create a mutual trust so that they may share their physical pain. II. Being involved with the team workers. 1. Effort to put oneself positively on the team. 2. Attitude of involvement in spiritual psychological and religious care in general. 3. To be a good advisor to the staff. 4. Consideration for exchanging of information. 5. Correct understanding towards other jobs and the manner towards other occupations. III. Being a chaplain 1. One's own care being in a solitary position as chaplain. 2. Studying the technique of religious care. Understanding one's work as chaplain. 3. Understanding one's work as chaplain.

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Human embryonic stem (ES) cells that has captured the attention of scientists worldwide is an "almighty cell" that differentiates into various types of cells through repeated cell differentiation. A successful attempt to freely control the growth of ES cells means that sufferers of a wide range of diseases could be treated via regenerative medicine. Meanwhile, ethical questions have been raised over the study of ES cells as it uses fertilized eggs that have the potential to create a human being. In Sep. 2001, the Education, Science and Technology Ministry drew up a set of guidelines for ES cell research. The guidelines impose severe restrictions on the producers of ES cells, and also emphasize the importance of considering the rights of donors of fertilized eggs. Moral status of the embryo is one of the major ethical debates aroused by ES cell research. Some views of embryo status are based on religious beliefs. According to the Catholic Church, embryos have a right to life from the moment of conception and therefore all research involving ES cells in immoral. The issue of producing ES cells through the destruction of embryos has not generated major opposition in Japan. In reverse, the brain death has not been accepted at national sentiment in 6 and half years after the registration. The difference between Japan and other countries concerning ES cells could probably be explained from the viewpoint of differences in the cultural backgrounds.

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There should have been it for the purpose of the severe handling opening meatus for done study after "The law concerning regulation relating to human cloning techniques and other similar techniques" paid its attention to medical utility of "specified embryo", and having forbidden transplantation to prenatal. There is a problem and asks a law and consistency with "The guidelines for handling of specified embryo" it and, despite the duration, does not get skill. If an ES cell, tissue stem cell and human clone embryo can cry in subject of study as the Trinity, it is not possible for those availability and evaluation of safety. Study of regenerative medicine does not consist last if does not use a cell having gamete, germ, an embryo and the specific character which said. We attention to utility of regenerative medicine and takes a national strategic part, correspondence supporting development of steady study is demanded. The result is reduced to its elements in the future by society.

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Neonatal and perinatal medicine are the medical fields to deal with the beginning of the life of human being. Neonates are very feeble biological existence and therefore it has been said that they are still in the hand of god. At the same time neonates are also labeled as the existence close to god because of their unpredictable ability and of their purity. Human being means more than home sapience as merely biological existence, and is the social existence to live together as a member of society to appreciate others and to respect others. God has created human being as the replica of god. But most of human beings have shifted from the position of replica of god to ordinal people while growing up. At least the time of neonates could be close to god. Recent brain research is proving that the neonate has incredible ability of brain much more than we have thought. How to maintain and to nurture the ability of young infants depends on how we care these young infants. Infants are the future of our world and if we care infants with love to maintain their ability close to god, they will create the world of peace with love.

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The purpose of this study was to clarify elderly interest in medical professional's lecture as to terminal care, and related factors. Subjects were 258 Senior Citizens' Club Members, 58.9% were interested. Age was a related factor, that is, younger elderly were more interested. Other factors such as discussion about terminal care with family or medical staff, consulting family physician, family function, and experience in surgery were associated with their interest. On the other hand, more than half rely on doctor or family to do decision-making about life-sustaining treatment, if impossible to recover and only 12.2% understood living wills well. Therefore it is important to educate younger elderly to have discussion about end-of-life issues and advance directives in consideration of the relationship with their relatives.

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Individual freedom for a selective abortion based upon prenatal diagnosis continues to pose serious problems. In this paper I have considered this problem with regard to the allocations of medical and welfare resources. This led to the conclusion that regulations for prenatal testing must be established. Since the reduction in the birth ratio of people suffering from hereditary defects may also decrease the allocation of resources for genetic disease, we can no longer ignore the relationship of this problem on the economy. From this point of view, selective abortion can also be acknowledged as a public economic matter as well as an individual matter. The Pareto principle, a generally adopted criterion for effectiveness and justice of welfare in the field of economics, does not allow for a fluctuation of resources without compensation for the effected individuals. Since certain changes of the conditions contravening this principle may lead to market failures, this alone provides the government with rational grounds for establishing pertinent regulations with regard to prenatal testing. This also implies a contradiction of the double standard-the new eugenics never causes discrimination. In this study I regard the fetus and genes as virtual assets for prospective parents. Taking those hypothetical values into account, parents must decide whether to opt for a selective abortion. The market determines asset values of the fetus and genes without liquidity. This irregular structure can also lead to market failure. In addition, other significant factors for market failure include the asymmetry of information, uncertainty and the existence of public goods. As a tentative conclusion, I believe that taxation might be worthy of consideration as an appropriate regulation in order to prevent any undesirable disorder.

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Paragraph 30 of the Declaration of Helsinki by the World Medical Association (WMA) embodies one important ethical principle, i. e. that at the conclusion of the study, every patient in the study should be assured of access to the best proven prophylactic, diagnostic, and therapeutic methods identified by the study. This sentence was included in the Declaration's 2000 revision as a result of intensive international debate on clinical trials in several developing countries, funded and initiated by various research groups from the industrialized countries. However, a small group in WMA is trying to upset this principle by attempting to revise Paragraph 30 or adding a note of clarification to it. 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 was developed in 2002 and released in July 2003. But in the process, there was not enough discussion on this principle, although the same text was included in the guidelines. Considering the recent Japanese situation, clinical trials initiated by Japanese pharmaceutical industries and conducted in Asian countries have significantly increased because of the low cost in these countries, and that trials in small clinics in Japan have been encouraged by national policy, it is necessary for Japanese researchers and society to catch up such with the world-wide discussion on clinical research.

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Despite the decisive declaration in the French laws of bioethics that the law secures the priority of the person, the ambiguity inherent in this statement regarding the idea of "the person" and "the priority" generates contradictory attitudes in actual applications of the golden rule. Careful analysis of problems surrounding this clause reveals that "the priority of the person" must be differentiated by three aspects : 1. in biological level; the priority over the other animals of the person in spcies. 2. in juridical level; the priority over the biological person of legal personality. 3. in sociological level; the priority over the welfares of society of dignity of an individual. However, as long as tensions take place in actual life among these three dimensions, there is no way but to secure the interest of the one at the cost of the other two. The French laws of bioethics are actually dependent on the effort to coordinate and balance the values of these three aspects incorporated in the single concept of "the person." After all, they, in principle, postulate that human embryos and fetus be respected, but, in certain cases, admit chances that they will be eliminated considering the balance of values. In other words, they respect more or less lives of human embryos and fetus case by case. It is this flexible concepion of personality that is found in the French laws of bioethics.

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What is the role of an ethics committee in reviewing a proposal for the first trial in the world of an advanced medical technology? From November 2002 to October 2003, the Ethics Committee of the Kyoto University Graduate School and Faculty of Medicine reviewed a protocol entitled, "Living related pancreas islet transplantation for insulin dependent Diabetic Mellitus patients." This report provides an overview of the review process and then discusses the role and social responsibility of ethics committees in Japan. A hypothesis is presented, which asserts that an appropriately functioning ethics committee is necessary to facilitate the implementation of a given advanced medical technology. The case of pancreas islet transplantation is shown to support this hypothesis.

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While nursing professionals are active in the fields of medicine, health and welfare, there are few studies on nursing professionals' awareness of ethical issues except for those of nurses. The present study examined the differences between clinical nurses and public health nurses in terms of their awareness of ethical issues. The research was conducted using the self-report format based on the previous studies. The results showed that more clinical nurses than public health nurses responded to almost all items of nursing-related ethical issues which they had either faced or worried about. The only item that the public health nurses responded more than the clinical nurses was "the difficulty of intervention with abuse issues." The percentage of the clinical nurses who had a place or opportunity to talk about ethical issues was 45%, whereas that of the public health nurses was only 7%. Furthermore, the percentage of the clinical nurses who indicated that they had an ethics committee at their work place was 30%, whereas that of the public health nurses was 2%. In contrast, the percentage of the clinical nurses who were not facing any ethical issues at the time was 40%, whereas that of the public health nurses was 70%. The results indicated that the public health nurses had fewer ethical issues and places or opportunities to discuss ethical issues than the clinical nurses, implying the influences of the place and contents of their work environment.

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Patients who are Jehovah's Witnesses refuse blood transfusions because of their religious convictions. Therefore, physicians are often confused about providing information and receiving consent when such patients undergo treatment that might require blood transfusion. In this paper, we consider appropriate strategies for the treatment of patients who are Jehovah's Witnesses in the department of oral surgery. The wishes of these patients must be respected in accordance with the principle of informed consent and the right of self-determination. However, some difficult situations involving blood transfusions may arise : the patient is too immature to make decisions; the patient's will cannot be determined during a life-threatening emergency; and the patient is unintentionally injured by someone. Therefore, to avoid problems when treating patients who are Jehovah's Witnesses, comprehensive guidelines should be prepared in advance for difficult situations that might arise

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Assisted Reproductive Technology (ART) treatment has made remarkable progress and is rapidly infiltrating into society as one of the choices for inducing pregnancy. On the other hand, ART technology raises serious issues, such as "multiple pregnancy" and "fetal reduction" due to the use of ovulatory drugs or treatment with IVF-ET. This report discusses the kind of information which will be available to patients when making decisions about ART treatment. Especially, we will describe the quality and the quantity of the information about risks of multiple pregnancies. This information has been collected from papers for informed consent that are considered as one of the most important information sources for patients, in addition to gathering it by themselves with books or internet. In conclusion, we have suggested that patients are not sufficiently informed about the risks of multiple pregnancies and so forth, when they make decisions to select ART treatment.

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The Coordinate of Social Workers defines its own Code of Ethics as an indicator to systematize the autonomous controls, over and above the existing legal regulations. Since the reformation of the social welfare system gives a strong influence on the contents of the Code of Ethics of Social Workers in Japan, it is necessary to search for the ethics, to be consistent with the principle of the system reformation. The four concepts, "History", "Universality", "Function and Structure" and "Idea and Value", which are requisite to systematize the ethics of social workers, are discussed comprehensively. The function and structure of social works in the community are verified, in particular, through the case study of the practice of a certified social workers office. The current studies and movements, including the communitarianism, are also examined critically as efforts to establish a new paradaigm for the ethics thought of the social work. In conclusion, the idea that the communitarianism could provide a sound basis for the ethics thought of the social work is suggested.

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Corneal transplantation using eyes obtained from cadavers resulting from unnatural deaths has been legal in Japan since 1997. To determine how the donor cornea can be used, blood from the cadaver must be examined. We examined the ethical and legal problems of drawing blood during ocular extraction from such cadavers. In cases of unnatural death, the medical examiners or forensic pathologists must collect the donor's blood with the consent of the donor's family before forensic autopsy is completed. To avoid problems during corneal transplantation, medical examiners or forensic pathologists must work with ophthalmologists to collect the donor's blood, especially in cases of unnatural death.

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In 2002 the Kawasaki "euthanasia" case made headlines all over Japan. In 1998, a physician in charge allegedly removed a tracheal tube from a comatose asthmatic with respiratory failure and subsequently injected large quantities of a tranquilizer and muscle relaxant, and the patient died as a result. In this paper we discuss what was lacking in the physician's decision-making process and what ought to have been done to take proper care of the patient. We also deliberate upon what kind of action is ethically acceptable in a clinical setting and can justify such an act by comparing it with the case of Ms. B in the UK, which has been recognized as setting a judicial precedent for dealing with "death with dignity." Furthermore, we list several proposals to help health care professionals make ethically sound decisions on behalf of a patient in the case where withdrawal of mechanical ventilation is demanded by the conscious and competent patient with chronic respiratory failure. In conclusion, ethically correct conduct in the clinical setting sometimes demands a legal basis to protect health care professionals from lawsuits and it is therefore essential to establish ethical and legal standards through the cooperative work of health care professionals, judicial specialists, and clinical bioethicists.

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Bioethics covers ethical, legal, and social issues. The polarity of interdisciplinary research has to be broadly recognized by the individual practitioner. However, we tend to deal with medical economic problems individually. The problems regarding distribution of medical resources cannot be separated from those of bioethics, with an increase in the age and consumer intention of the patient. This study reviews problems concerning bioethics, in relation to the medical service market, from an economic viewpoint. We focused on the aspects of medical evaluation and medical quality, and considered economical clinical procedures (the evidence accumulation situation). This was done so as to enable us to consider the characteristics regarding medical efficiency with respect to an action (insurance institution/medical care expense depression) in a governmental medical policy, from a micro viewpoint as compared to a macro viewpoint. We took into account the British medical reform and trends of American formula for medical economics (neoclassical economics). There are a general scene (health care) and an individual scene (clinical spot) for medical treatment. However, it is difficult to determine which of the two should be given priority. A distribution control rule is required in order to build a medical system, which will last and can be developed. In addition, it is important to establish a medical treatment for the health-care system and an economic ethic for medical personnel. The principle of respecting autonomy maintains as well as enhances medical evaluation. The architecture of a frame, which involves reviewing accumulation of knowledge and its use, is indispensable.

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Although legally human embryonic cells can be used for medical purposes, I don't think we have yet thoroughiy explored philosophical arguments regarding this. Even when such argument are made, the views are shallow, and there are few which consider the humanistic question of when human life begins. In Buddist Yuishiki thought of the construction of human consciousnes, that which has the fundamental ability to establish an ego is called the Alayashiki consciousnes. I want to consider whethr or not human calls are independent humans from this point of view. In particular, the cells of the first moments of life carry the information for the entire body, but have not yet been seperated into different functions. Moreover, the independent human comas into being though various important environments and conditions, auch as those of the mother's womb. If thesc conditions have not yet been established, we can't call it an independent life. I want to prove the importance of distinguishing between life that can become a human and lief that can become a humanand life that is divided into seperateparts.

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Gilligan insisted that an ethic of care and an ethic of justice should converge in a mature person. Although an ethic of care and an ethic of justice seem to have mutually exclusive nature, she did not lecture what kind of form a convergence takes concretely. If such a convergence is possible, it must be explained. So this paper gropes for possibility of an integration of an ethic of care and an ethic of justice through the examination of what kind of acts these two ethics lead when we faced to moral dilemmas. An ethic of justice is too abstract, and advocators of an ethic of care criticize an ethic of justice that we cannot cope with moral dilemmas under the complicated situation that we meet with in reality. However, an ethic of care does not give a coherent vision about what acts we should take for moral dilemmas. On the other hand, a theory revised by Kohlberg shows an answer to a certain extent in moral dilemmas. Kohlberg's new theory is the thing which let an element of an ethic of care and an element of an ethic of justice fuse, but it is difficult to consider it an integration of justice and care. I divide relation of ethics to moral dilemmas into two parts. One is relation to be concerned with before choice, and the other is to be concerned with after choice. An integration of two ethics is given in conclusion by investigating a characteristic and the function that each morality reveals to have. The ethics of care takes an active part after we dealt with moral dilemmas whereas the ethics of justice only works before we deal with moral dilemmas. In this way an ethic of justice and an ethic of care affect moral dilemmas together.

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Recent developments in rapid HIV testing kits has led to their increased popularity in the United States. Individuals can easily purchase an HIV Home Testing Kit over the Internet. Using the kit makes it possible to confirm one's own HIV status with no risk to one's anonymity. Opinions on the popularization of the kits are conflicting. Most negative opinions are pessimistic about the possible misuse of the kits. Few studies have focused solely on the ethical issues involved. In this paper our concerns are with the matter : Is it a right to undergo HIV testing at home in order to confirm one's HIV status without intervention or services from medical professionals? At the heart of these negative opinions, we sense a desire of the government to closely regulate people with HIV/AIDS. However, we also feel that individuals have a right to confirm certain physical information such as body temperature, blood pressure, body weight, and so on. Likewise, it also seems that they have a right to be aware of their own HIV status. In conclusion, we believe that the use of home HIV testing kits as a valuable tool for individuals, apart from visiting hospitals or taking medicine, should be permitted, although there may be certain difficulties or risks involved in their use.

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Disclosure (or explanation), understanding, and consent (or choice) are essential elements for Informed Consent (IC). But in fact, there are many obstacles on the way to patients' understanding. In this paper, examine what is the suitable way for explanation to promote understanding which can be adequate to be precondition of consent. There have been many discussions about the 'standard' of disclosure up to now, but they can not give an adequate answer to this above-mentioned problem. It is often pointed out that there are two major methods to solve this problem, i.e. avoiding excessive amount of information and promoting suitable interpretation of information. I maintain that, as one of the several ways of explaining to realize the latter, analogical explanation of information is effective. But significance of this way has not been fully pointed out yet. 'Analogy' in this context consists of two factors which doctors select, that is, target and base. The target is a series of information of which doctors intend to inform patients. It is usually medically-specified information, so it is often very difficult for patients to understand. The base is a thing by which doctors intend to explain the target and to make them interpret it properly. The base must be an ordinary and well-known thing for patients, and at the same time it must hold some relation or correspondence to the target. By using such analogy in addition to other ways, doctors' explanation can be helpful to patients' understanding. Moreover, if improper use of analogy is avoided and each patient's autonomy is held, analogy can be used in order that doctors guide patients to choosing the option which they judge to be the most desirable for his or her patient.

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