The current global survival strategy appears incompatible with the preservation of global environment. Globalized market economy is not resolving but accelerating the divide between the haves and the have-nots in the world. Global warming is taking place mainly through the two contrasting types of ecological destruction: one, generation of green house gases in the wealthy regions, notably in the United States, and the other, destruction of the eco-system represented by de-forestation and desertification in the poverty stricken regions. Neo-liberal market economy ideally functions in "the open system" where the space is big enough not to be affected by human activities and man has freedom to move to the next new frontier. However, the earth is displaying, with the growth of human activities, ever more clearly the features of "the closed system", e.g. limited space and natural resource. Neo-liberal economy has its origin in the survival strategy and the ethics which have evolved through the survival in the open-system and it prioritizes autonomy and liberty to satisfy individual greed. Since the earth is a typical closed-system unable to absorb the impact of human activities, global warming is expected to escalate beyond control. Solving the environmental problems requires the global preponderance of the closed-system ethics characterized by curbing individual greed.

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Is it legitimate to use medicine to improve human ability and to change human character when they are not pathological? If the answer is yes, what would be its limit? One of the most important examples of the debate over the enhancement use of medical technology is the issue of the SSRI, Selective Serotonin Reuptake Inhibitors, such as Prozac. SSRI was produced in the late 1980s and was proved to be effective for those who suffer depressed mood but who are not to be diagnosed as pathological. Peter Kramer's book Listening to Prozac has been influential for it explains the characteristics of the Prozac lucidly and defending its wide usage persuasively while comparing its function with psychotherapy. The present writer introduces both Kramer's defense and the criticism of the enhancement use of the SSRI by USA's President's Council of Bioethics in order to clarify the concept of values of life concerning the limit of the medical enhancement. The value of autonomy is not sufficient. Rather the importance of realizing the vulnerability and the giftedness of human life would be more important aspect of the values of life for this matter.

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Nursing is the oldest of the arts of caring, but the nursing as profession is relatively young compared to other professions. What expertise does nursing claim?. I believe that the essence of nursing is caring for persons. Caring involves more than just carrying out nursing procedures, nurse should care patients, respecting their individual dignity, values and rights. As technology flourishes, nurses and other medical staffs are inclined to measure their values by their technical skills to handle medical equipments. Consequently, the unique nursing contribution became less evaluated. The reason of this evaluation is probably related to the view on nurses as the assistants of physicians, the view which has been deeply ingrained and pervaded in Japanese society. On the other hand, with the development of nursing as a full profession, nurses increasingly describe themselves as directly accountable to their patients. The nursing accountability implies responsibility for the consequence of actions not only chosen but also not-chosen in particular nursing situations. Nurses act as advocates for patients when their health or safety is affected by the unethical or illegal practice of any person.

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Both Bioethics and non-anthropocentric Environmental Ethics were areas of ethics which were first introduced in the 1970s, mainly in the United States. Although there are crucial theoretical differences between these areas, it is of a great significance to integrate them. For, they overlap in dealing with very important issues, such as ethics in human embryo, fetus, animal experimentation, as well as responsibilities to future generations in the area of genetic engineering, for example. There are serious flaws in applying the concepts of "rights," "the principle of utility," "obligation", or "responsibility" in attempts to merge two areas of ethics. Therefore, I hold a synthesis by the concept of "Care" is the most promising method. However, in order to do so, it is of necessity to explore the core meaning of care. Moreover, because Care has its foundation in human emotions, ways to complement its flaws must be examined. In reply to the former inquiry, I have presented an example from Shinto in the ancient Japan. More specifically, worshipping gods in Shinto, as seen in ancient Japan, is a form of Care. For the latter, I have examined several points, for example, relationships between Care and Rights.

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The system of the safety management was maintained to each medical institution in these several years. In a lot of hospitals, the charge nurse bears the lead in the safety control of the entire hospital organization as a risk manager. This means the expansion of nurse's role and responsibility to defend patient's safety. However, a necessary authority for the advocacy has not been necessarily guaranteed to nurse's position in the hospital organization, and the nurse has held many ethical dilemma and moralistic suffering by the scene of daily nursing practice. Therefore, it is forecast that the existence of the authority gradient in the hospital organization becomes a barrier when nurse's risk manager practices the risk management. Then, a strategic approach that corrects the authority gradient is presented based on the experience of my own risk manager, and nurse's responsibility in the health care risk management is considered.

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The history of Hansen's disease in Japan has been mainly discussed from the viewpoint of medical policies and doctors. However, it still remains to be examined from the perspective of the nursing profession. Nurses mostly devoted themselves to the care of people suffering Hansen's disease through a sense of duty; nonetheless, they violated the patients' human rights. This historic fact suggests strongly that we should establish an important bioethical obligation to protect the patient's values and autonomy as a central component of our nursing ethical education. There is still some lack of understanding, both educational and practical, that the responsibility for the patient's autonomy also rests upon our nursing professionals. In view of the previous Japanese attitudes towards Hansen's disease patients, we must promptly expand systematic nursing ethical education.

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This article compares structure of norms in the field of human embryo research in Japan and in Germany. Although experimental research with human embryos is controversial in both countries, the ground of restrictions on research is much clearer in Germany than in Japan. In order to explain structure of norms in the field of human embryo research and to deal with a problem in possible future development, we need to look carefully at a number of important differences in the interpretations and discourses of human embryo research in Germany and their consequences for policymaking strategies in Japan.

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The purpose of this study was to clarify the acceptance and outcome of an educational program regarding terminal care in order to resolve ethical issues arising at the terminal stage of illness. The participants consisted of 60 elderly persons who were members of the Senior Citizens Club. A group discussion on life-sustaining treatment preferences and approval of living wills was conducted and assessed before and immediately after as well as 1month after the program. A 10-point Likert scale, on which 1 represents strong dissatisfaction and 10 strong satisfaction, was used to rate the program. A rating of 8.2 was obtained, indicating that the program received considerable acceptance. Life-sustaining treatment preferences changed from "depend on doctor's decision" to "refuse them" and "depend on family decision", and the approval of living wills significantly increased immediately after the program as well as 1month after the program. In addition, the percentage of participants in terminal care discussions almost doubled from 20.4% before the program to 38.9% one month after the program. However, only a small percentage of participants executed living wills as compared with participants in foreign studies, which were conducted by using actual documents. Therefore, further research should focus on education to aim the high completion.

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In Japan, public health insurance system prohibits doctors who work at institutes included in this system to provide experimental medical care. They can provide only regulatory authorized methods and medicinal products for series of treatments for a specific condition of patient, if any part of these treatments is paid by public insurance. In case a patient pays themselves or a doctor pays using research fund, use of unauthorized methods is not prohibited, but public insurance payment should not be included any part of the expenditures for the series of care. Because of this, patients who needs medicines which have not been authorized in Japan but is "best proven method" in other countries has to pay so expensive fee for their treatment. However, such system protects patients from being involved easily in experimental methods, where safety and efficacy have not been assured. In this context, such insurance system in Japan has been discussed for reformation. In this article, the author describes the outlines of these discussions, analyzes the points to consider, and propose solutions from bioethical perspectives.

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How to manage unknown risks? The governments, doctors, nurses, and especially patients and their families were confronted with such problems in face of the HIV crisis in the blood supply system. The Principle of Precaution focuses on such difficulties. The principle consists of four elements: (1) taking preventive action in the face of scientific uncertainty, (2) shifting the burden of proof on to proponents of potentially harmful activities, (3) resignation of zero-risk standard, (4) democratic decision making. But the notion of the precaution is imprecise and vague in the application of it. It needs to be 'interpreted' and specified on a case-by-case basis. Therefore, in this paper, I will apply the Principle to the case of the HIV crisis in French and examine what kind of measures to be possible. And then, I will verify the efficacy of the Principle.

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To examine the present state of clinical ethics consultation (EC) in Japan, an anonymous self-administered questionnaire was mailed to all resident-teaching hospitals (N=640). Questionnaires were returned from 267 hospitals (response rate, 41.7%). A total of 24.7% of hospitals answered "yes" to having a system of EC; 75.3% answered "no." At the majority of hospitals which answered "yes," an ethics committee would deal with ethical problems. Among hospitals that answered "no," 36.8% of institutions would solve ethical problems by "the director's judgment" and 18.4% would solve them by "entrusting the problem to the attending physician." Approximately 90% of hospitals indicated "a need" for EC. Overall, findings suggested that at most hospitals there exists a dire need for a support system to cope with ethical problems.

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Patients who are Jehovah's Witnesses refuse blood transfusions because of their religions. Physicians are often confused with their beliefs, especially, in case of immature patients. In this paper, we describe appropriate measures for immature patients whose mothers are Jehovah's Witnesses. We treated three patients under the age eighteen whose mothers were Jehovah's Witnesses at the Department of Oral and Maxillofacial Surgery. Two of them, the age of fifteen and seventeen have accepted blood transfusions at their own volition. For a nine-year-old patient, we performed bloodless treatment under his refusal of blood transfusion because we had considered he could make a decision at his own risk. Decision-making by minors is usually affected by their parents' determination. However, even to the minors, we should respect the patients' intention if he has sufficient ability of self-determination. Therefore, physicians should respect the parents' own informed choice in spite of their age, based on the sufficient communication with the patients and their family. Furthermore, when his judgment ability is inadequate for a decision-making, we should consider the blood transfusions or bloodless treatment by the judgment of an ethical committee in consideration of their parents' opinion.

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It is likely that midwives face ethical issues and find dilemmas as they work professionally assisting to deliver babies. In this study, a questionnaire survey was conducted with midwives regarding their awareness of ethical issues, their response to problematic situations and actual problems they face. The results showed the following: (1) The ethical issues which the subjects found most problematic, included "following directions of doctors" they did not find the most competent and "disagreement of needs among clients." This result seems to be related to midwives' expertise and independence. (2) The midwives' awareness varied according to their age, implying that career and experience influence their awareness level. (3) When handling ethical issues, more than 70% of the midwives sought consultation with parties involved and a third party, while some older midwives resorted to ethical committees. In conclusion, it was implied that midwives held awareness of ethical issues related to professional ethics, values and their own competence, indicating that their awareness and handling of ethical issues were influenced by their expertise and experience as professional midwives.

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In the west, Christian Chaplains usually take a significant role of meeting the spiritual needs of terminally ill patients and their families. However, it is not common for the Buddhist priests to play such a role in Japan. The purpose of this study is to assess the current state and prospect of Buddhist priests' participation in terminal care. The subjects were Buddhist priests in Chugoku district of Japan, who belonged to Shingonshu Sect. Of 29 surveys distributed, 23 (79.3%) were responded. Stated that two-thirds of the Buddhist priests had experienced in participating terminal care in some forms without realizing that their works were related to the field of medical care involving the terminal periods. Concerning the thought of "death", we found that majority of Buddhist priests gave advice to the clients using acceptable words and multiple forms matching to the current society, rather than preaching Shingonshu doctrine. As to the future activities, Buddhist priests are hoping to develop a closer relationship with their parishioners in daily life in order to meet the needs on crises. they would work most effectively for "grief work" of families cooperating with palliative care team in community. In order to facilitate this, our results suggest that it is necessary for all of us, the society as a whole should be more receptive in this matter, along with Buddhist priests' continuing study and training in the field of terminal care.

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In recent years the curriculum to train health care workers has included a thorough understanding of bioethics. But the method of instruction mainly centered on reviewing case studies about the type of medical care given. This purpose was achieved through a format of discussion and debate. However, to make known the fuller meaning of bioethics in health care education more than that must be done. To begin with, the purpose of debating and discussing specific problems concerning human life should be seen as a way to help students to get more in touch with his/her personal set of values about their view of life. This study explored the meaning and the purpose of studying bioethics in the case of the education curriculum for future health care workers by focusing on the opinions expressed by nursing students during a class at Tenshi College in the Nursing Department following introduction of examples to the class.

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A woman (Theresa Schiavo, hereinafter "Terri") had been PVS for about 10 years at the start of this series of litigations. Her husband, as a guardian, insisted that artificial feeding and hydration be stopped. Though her parents opposed, Florida state court granted this claim and ordered the removal of PEG (Percutaneous Endoscopic Gastrostomy) tube. This meant Terri's death in 10-14 days. Strong public opinion went to the governor, Jeb Bush, and members of Florida legislature. They enacted a statute which authorizes governor to issue a one-time stay to prevent the court-ordered withholding of nutrition and hydration. Terri's husband filed a motion that this statute was unconstitutional, courts admitted this claim and ordered withdrawal of tube-feeding again. This time federal legislature enacted a statute to carry this case within the jurisdiction of federal court, but, against this intent, federal courts rejected claim from Terri's parents. In this paper I introduce this case and try to make some discussion (1) on the relationship between the right to refuse medical treatment as privacy and wishes of others (family members and general public), especially whether the latter may overrule the former, and (2) which governmental branch is most suitable for deal with withdrawal of medical procedure.

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"From anthropocentrism to biocentrism" has been used as a slogan in fields of environmental thoughts and ethics such as animal rights, biospherical equality, and eco-centrism. However, must we now truly abandon the positive idea of "humanity as the center"? Isn't it really important to be human? This paper is going to confirm the idea of "the importance of being human" in order to rehabilitate the original concept of anthropocentrism. First, the issues of philosophical anthropology will be introduced. Anthropologists of the early 20th century were confronted with the new natural scientific knowledge of that time, which would result in the deterioration of the traditional view of humanity. Therefore they had to re-position humanity because of this new crisis. Their philosophical situation is very similar to the present situation in which the status of humanity has been challenged because of the serious environmental problems brought about by modern technology. Next, the argument of R. Nozick will be identified as a key to the possibility of the rehabilitation of anthropocentrism. Because his argument is based on the easy-to-understand concepts of "belonging" and "prominence", his suggestions will give powerful support to my purpose.

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The asymmetry of information in health care has been pointed out since 1960s. Medical professionals are now attempting to overcome this problem by risk management and through the activities of those experienced in the doctrine of informed consent. By pointing out the need for and incorporating initiatives to be undertaken by pertinent groups in general that includes the perspective of the patient, further development in asymmetric buffering of information can be expected. Our research looks at ways to deal with this problem in socioeconomic activities where asymmetry of information exists and the relationship with medicine, which is considered to require special knowledge. For our research, we selected reverse selection, moral hazard and agency relationship. We contrasted the authoritarian and liberal aspects of medicine and have pointed out the shortcomings in both aspects. This paper points out asymmetry of information with excessive emphasis on knowledge and oblivion of living in a society of scarce resources, and describes the importance of having members of society taking a leading role and devising such a system.

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What does a woman think of, when her husband died (suddenly) and his sperms or their fertilized eggs (embryos) have been left at hospital? This is the common problem in the country where the artificial reproductive technology develops. In France, it has been discussed for 20 years. There are cases concerning artificial insemination postmortem (after death) since 1984, and those of in vitro fertilization in the 1990s. In 1994 the so-called law of bioethics was enacted, which has been amended in 2004. In the process of legislation, this problem was taken into account, and the law provides against it. But the ethical committee supports transfer post-mortem. It would be important to compare the situations with Japan, where the problem of the recognition of a child borne by insemination post-mortem has been just presented in cases these days. I suppose what is necessary to consider at the time of legislation about medically artificial procreation in Japan. We must make distinction of these cases, according to that the artificial insemination comes into question or the in vitro fertilization does, that is, which are left sperms or fertilized eggs (embryos). Moreover, the elements are to be considered, that a child has been born or not yet, the death of a partner was anticipated or not, who had a cause of infertility, and which does the concept of "gestation" mean "fertilization" or "nidation". Importantly, we can point out the meanings of "public policy", the role and the variety of this concept, which is "respect for death", "not destruction of embryos" and "child welfare". When a child has been born, although the marriage is dissolved because of death, the legitimaicy of the child is admitted in France, and the recognition post-mortem in Japan.

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The Constitutional Chamber of the Supreme Court of Costa Rica deemed in March 2000 that in-vitro fertilization is a technology that infringes on the rights of human life, and has passed judgment to reject the "Regulations for Assisted Reproductive Technology" bill, indicating that it is unconstitutional. This paper has examined the awareness of in-vitro fertilization in Costa Rican newspapers and through discussions at Bible Sharing on the topic of the ruling. It has been made clear that the Costa Rican Government's stance on invitro fertilization is that the human embryo is a person from the moment of conception and is therefore inviolable. In-vitro fertilization can be seen as a labor of love stemming from the bond between a mother and child, but when perceived from the relationship between God and oneself, it can also be seen as an act of surrendering to an evil temptation. The idea of in-vitro fertilization is caught in between these two ideals and has caused a moral crisis for humans. American NGO and Inter-American human rights commission have been pushing for a globalization of bioethics in Costa Rica since the unconstitutional ruling, however this is proving difficult and the issue must be approached cautiously.

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Due to the progress in science and to the change in social climate, the situation of decision making in contemporary medicine has became diversified. However, it should be particularly noted that the range of stakeholders of decision making became incredibly wider. The purpose of this paper is that in such a context contemporary medicine requires to discuss the best method of decision which is based on stakeholders' various opinions. This method must contain consensus building process leading to the best decisions in each case. It is important for consensus building process to acknowledge that there are two different types of consensus buildings. One is for each individual medical action and the other is for system development which supports each individual medical action. These two are mutually interrelated. The second is that two qualifications are necessary so that one could realize a consensus building process as a facilitator. One is to find out participants' interests and the other is to form the best solution based on the interest of stakeholders.

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There are some documents in England which mention to fetal tissue. These documents do not obviously argue why mothers can give her consent to the use of the fetus or fetal material for research or transplantation, or why they can give consent before they have actually undergone the abortion. However, Polkinghorne report, one of these documents, states that the living fetus is not to be treated instrumentally as a mere object available for investigation or use, and this respect carries over in a modified fashion to the dead fetus, in a way analogous to the respect we afford to a human cadaver on the basis of its having been the body of a human person. In this article I intend to clarify how the status of the fetus has been identified and how the fetus become to be used at present in England, by considering changes of the tone of an argument in the documents about the fetal tissue.

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The principle of self-determination is an important concept that modern medicine has acquired through the cruel anti-humanistic experiences based on the past eugenic thought. At the same time, as this concept premises on autonomy of human beings it has a risk to exclude heteronomous individuals again. It isn't either allowed to be used by doctors to justify their negligence or to function as extreme individualism. M. Buber emphasizes human being as an existence living in relationship. This paper also proposes, from a patient's view point, that how self-determination supported by autonomy in relationship can be understood more clearly and positioned properly on a clinical field.

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The dispute over the value of life, which is often compared to confrontation between deontology and utilitarianism, has been largely divided into a position of sanctity of life (SOL ), and a position of quality of life (QOL). First of all, I will maintain that SOL ought not to be based on deontology, and that QOL ought not to be based on utilitarianism. Then, I will try to show that the dispute between SOL and QOL cannot be reduced to the dispute between deontology and utilitarianism. Next, I will criticize Peter Singer who justifies killing "life without personhood" from the viewpoint of preference utilitarianism. However, reviewing Amartya Sen's criticism of utilitarianism, I would like to suggest the possibility of reinterpretating and making use of utilitarianism as for justifying needs for survival. Then, I contend the necessity of securing the need of goods for survival for life as a right to live and survive, and defending the social distribution which allocates costs based upon the need of goods for survival for life. In this way, the argument of cost does not necessarily lead to the argument of burden for sorting out a life.

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The Japanese ethics guideline on human genome/gene analysis research gives advice on how the individual donors should, and should not, be informed of their genetic analysis results. Current genetic cohort study, in general, tends to withhold genetic analysis results to the individual donors. However, the nature of genetic cohort study demands that the researchers of genetic cohort study should report the results to the individual donors if the donors want to know their results. On the other hand, the current Japanese ethics guideline is problematic because it is likely to infringe the autonomy or 'right not to know' of the individual donors who do not want to know their genetic analysis results. In conducting genetic cohort study, researchers are therefore required to prepare, and to follow, an ethical procedure for obtaining the informed consent, and especially for confirming the donors' will to be, and not to be, informed of their genetic analysis results in order to respect the autonomy of the individual donors.

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