The adoption of the Universal Declaration of Bioethics and Human Rights at the General Assembly of UNESCO on October 19, 2005 was an epoch-making accomplishment for the development of Bioethics in the 21^<St> Century. The author, an international Bioethicist since the 1970s, recognizes a unique element of this UN document. In its preamble, this document makes references to some international guidelines relating to biomedicine developed by international non-governmental organizations such as Council for International Organizations of Medical Sciences (CIOSMS) and World Medical Association (WMA). It also includes references made by other relevant inter-governmental organizations such as WHO and Council of Europe. It is quite unique to see guidelines made and accumulated during the formative era of Bioethics included as a reference resource in a UN document. The contents of this Declaration and some topics relating to Bioethics principles debated in Tokyo at the International Bioethics Committee meeting in 2005 are also analyzed through Asian cultural perspectives.

View full abstract

Issues rerating to new reproductive technologies have been examined and discussed as a part of the main topics of bioethics. The pace of their development and involvement is so fast that the debates in bioethics have not caught up with the technological innovation. However, the controversies in bioethics regarding new reproductive technologies repeatedly bring up the questions of artificial intervention in life and reproduction, diversification of family, disclosing medical information and informed-consent, and commodification of human body parts or gametes. Therefore, in this paper, I will examine the existing new reproductive technologies and the arguments about them in order to point out some issues which have not been discussed, in the hope of stimulating further discussion.

View full abstract

This article, reporting the Japanese patients' perceptions of The Good Nurse, discusses the implication of a virtue ethics approach in Asian health care. Virtue ethics and principle based ethics are two major approaches in bioethics and nursing ethics. Principle based ethics emphasizes action. Virtue ethics argues about morally valued character traits within the agent who performs actions. As part of an ongoing cross-national collaborative research project conducted in Asian countries, we explored Japanese patients' perceptions of The Good Nurse, an ethical ideal based in virtue ethics theory that nurse educators and clinicians strive to achieve. Van Kaam's controlled explication was used to conduct and analyze semi-structured, audio-taped interviews with 26 cancer patients who knew their diagnosis. According to these Japanese participants, both personal and professional qualities characterized The Good Nurse. The patients valued a person-to-person relationship with nurses. Implication of the study includes: an understanding of the meaning of 'good' as applied to patient care situations, and a contribution to the development of a virtue ethics foundation in Asian health care.

View full abstract

Presently, "selective abortion" is carried out when "hereditary disease and difficulty" are found in a fetus through prenatal diagnosis and is considered legal by applying "the Economic Clauses into the Mother's Body Protection Law". However this broad interpretation is lacking legal validity. There is also criticism saying that a "Provision for Fetus" should be established that admits abortion in cases of Fetal Abnormality. First, we will determine what questions society will ask about the "Provision for Fetus", the establishment of which having been discussed since 1970. Next, we will confirm the importance of the viewpoints facing reproductive medical treatment technology which continues to improve along with genomic research. Lastly, we will over the "autonomy" of parents and appropriate ways of "selective abortion", and make sure that ethical rules, such as support for the right of autonomy and value, are followed by nurses.

View full abstract

This paper discusses certain basic issues concerning patients who have irreversibly lost sentience and consciousness (including brain-dead patients and some PVS patients). Current literature fails to give a satisfactory account of the validity of these patients' advance directives and the basis for justifying their families' proxy decision-making. The purpose of this paper is to demonstrate that, in the context of giving justification for laws and policies, 'interest' needs to be understood as a concept that only denotes the phenomena of one's sentient or conscious experiences (e.g., comfort and pleasure). Therefore, 'laws protect the interest of a person whose cerebrum has irreversibly lost all functionality' should mean merely that 'there are some established legal measures by recourse through which the person could have enjoyed a sense of relief concerning organ donation or life sustaining treatment, prior to the loss of cerebral functioning, knowing that it is promised that his or her wish will be honored.' Such legal measures include the provision that a person's wish expressed in an advance directive will always be honored. I shall argue against the trend of the current literature in which it is almost taken for granted that a brain-dead person or a PVS patient has a legally protectable interest in the fulfillment per se of the wish that the patient had before losing consciousness. My position is that when a patient has lost sentience and consciousness without leaving an advance directive, the family's proxy decision-making cannot be justified on the basis that it protects the patient's interest.

View full abstract

According to the policy statements of professional medical societies in the US and UK, as well as prominent American and English bioethicists, there are no morally relevant differences between withdrawing and withholding life-sustaining treatments. Both withdrawing and withholding life-sustaining treatments are permitted in the US and UK and decisions to initiate either procedure are held to the same criteria in both countries. Leading Japanese bioethicists also support this view. However, due to Japan's unique cultural and institutional backgrounds, terminally ill patients, their family, and medical practitioners would suffer from a disproportionate amount of psychological burden if the withdrawal of life-sustaining treatments were held to the same conditions as withholding treatment, as is commonly done in the US. To prevent such undesirable results, even if we were to recognize no morally relevant differences between withdrawing and withholding life-sustaining treatments, we argue that the decision to withdraw or withhold such treatments can be justified on different conditions in Japan.

View full abstract

In this paper, I attempt to clarify the limits of the frame of the discussions on 'the moral status of the human embryo.' Conventional discussions on human embryonic stem cells have taken the axis of debate to be 'the moral status of the human embryo,' but in doing so, they overlook the problem of the burdens that are created on the bodies of women. In particular, in the research on human embryonic stem cells using donated eggs, the burden on the donor women is an essential problem. I will focus on the point that the 'residual embryos' are inevitable products of the aim of relieving the burden on the bodies of women and try to point out the importance of the problem of the burden on women in the ethical issues of human embryonic stem cells. In the frame of the discussions on 'the moral status of human embryos,' the problem of the burden on women is structurally overlooked. We have to allow for the problem of 'the burden on women' independently of the problem of the 'moral status of the human embryo.'

View full abstract

This survey was prepared for doctors, nurses, and social workers working in the hospice and palliative care unit to clarify the meaning and reality of the Living Will in hospice and palliative care situations. The results of this survey showed that the respondents perceived the Living Will, not just as a formal document, but in a broader sense as care. Listening to the Living Will of each patient is an important way of providing hospice/palliative care for the patient. It also showed how important it is to "respect the patient's decision making" and to "share information within the team". Examples of actual cases in which "the patient's and family's ideas differed" or "the patient did not want to be placed in hospice" were given. They indicated the greater need for the Living Will in actual hospice situations. The spirit of the Living Will is embodied in hospice and palliative care. Precisely because of this, thorough discussions of Living Wills will be necessary in different cases.

View full abstract

Points of the discussion on the reorganization of the Human Fertilisation and Embryology Authority (HFEA) in the UK are reviewed. The HFEA, as a regulative authority, has supervised activities using human embryos, such as assisted reproductive technologies or embryo research since 1991. According to the UK's law, the human embryo has been protected in a gradualist manner, and each institute and clinic using human embryos must be reviewed beforehand on the contents of their activities as the case may be, and must comply with rules and conditions set by the HFEA. But now, part of this approach has been criticized by the legislature, as abuse of the HFEA's regulative discretion. Recent discussions on the nature of the regulatory authority in the UK might be instructive, because there is a trend to introduce similar systems to the HFEA in other countries including Japan.

View full abstract

Nietzche uses consistently the words health and illness in his writings; however these are widely different from the general health concept advanced by WHO. While being extremely subjective, his view of health is dynamic and equivocal, but at its foundation stands the problem of the living, condensed around how do we live our lives. Historically, the views of health have been placed in religious categories and in moral values. In Nietzche's view, the sin consciousness itself has is origin in Christian morals and it's morbid to be cajoled into religion by interpreting illness and insanity as being the result of sin. According to him, health and illness are not opposing concepts and it's not too much to say that by treating the subject of illness, he makes a criticism of Christianity. However, we can consider that Nietzche denies not Christianity itself, but the principle of life after death and the pessimistic view of life. Our study intends to demonstrate, by following the terms health and illness, that the love to live and will to live is inherent in Nietzche's destructive and offensive philosophy.

View full abstract

Five years have passed since the Japanese Long-Term Care Insurance Law was enforced. Since then, many ethical problems have become evident. They include: 1) Social welfare being viewed as a business opportunity; 2) Violation of the autonomy of the elderly, especially those with dementia; How to determine 'competence'? Who should be a surrogate or proxy? What is in the best interests of the elderly?; 3) Issues relating to the care of the dying in nursing homes; the definition of 'terminal'; what constitutes the futility of treatment; issues relating to unnecessary life-prolonging medical treatment (e.g. tube feeding); and 4) Other issues such as those of privacy, the keeping of official secrets, and abuse and risk management. There is a need to cultivate the ethical sensitivity of care-givers, and to explore ways to analyze and resolve these difficult ethical problems so as to respect the dignity of the elderly as human beings until the last moment of their life.

View full abstract

The Act on Organ Transplant places its legislative emphasis on the axis of the "donor family's consent" and "the autonomous decision of the donor." This paper attempts to explore the process of consensus formation necessary for organ transplantation in today's medical world, keeping in mind that such a process is dominated by the consent of the donor's family, often as a sole condition for transplant work. An unavoidable question regarding "consent" is whether the family willingly and unanimously makes a decision, or whether there is an element of coercion or at best, whether compromise is involved. This paper gives special attention to the discussion of bioethics in the United States, where the subject has long been debated, and places focus on the matter of family consent in the organ transplant process. From the perspective of Christian ethics, often involved in discussion of bioethical issues in the United States, it may be helpful for us to return to the Biblical narratives in the New Testament on family and clarify the core characteristic of family as a relationship. What we understand as "family consent" must be interpreted as a relational process. One of the key issues is what is known as "doing the will of God" as understood in first century Palestine. This paper attempts to compare this, enlightened by contemporary Feminist theology, with its understanding of relationships rather than what was often comprehended merely as an experience of self-determination and justification. The writer argues for the understanding of "doing God's will" in a relational context, with "friendship" as a mutually supportive, life-affirming, nurturing and egalitarian relationship. Consensus formation regarding organ transplant needs to have this relational understanding to be publicly and ethically viable.

View full abstract

The purpose of this study was to clarify nurses'knowledge, opinions and attitudes towards regenerative medicine to provide safe and beneficial treatment. The self-reported questionnaire was applied to 442 nurses working at the major hospitals in H city. The result showed 61.9% of them knew about regenerative medicine at the average level of people untrained in medicine, their main resource of knowledge being the mass-media. The depth and contents of their knowledge also depended on whether their work was related to regenerative medicine or not. In response to questions asking whether or not the cells used should be derived from an individual's own body or not, there were many opinions. Some preferred a method using their own Adult Stem Cells rather than one using Embryonic Stem Cells, another person's Adult Stem Cells or fetal cells. The most influencing factor in deciding approval or disapproval was whether the procedure used one's own or another's cells, the expectations of regenerative medicine and fears concerning medical safety and related ethical issues.

View full abstract

In 2003, the Committee on Assisted Reproductive Technology published its "Report on the Development of a Medical System for Assisted Reproductive Medicine Using Donor Sperm, Eggs, and Embryos," which proposed the drafting of legislation for donor conception (DC) in Japan. In its report, the Committee added an item about disclosure of information permitting identification of donors to DC offspring in order to ensure their right to know. We interviewed 5 people born through artificial insemination with donor's semen (AID), and heard about their experiences as DC offspring and their opinions about disclosure of donor information. Then we analyzed their statements and reviewed what kinds of donor information they wish to obtain. Our conclusion is that AID offspring seek to learn not only identifying information about the donor such as name, age, address, academic background, job history and medical history, but also about the donor's personality by meeting him if possible. Finally we suggest the need to consider measures premised on the assumption that DC offspring will meet their donors in the future.

View full abstract

In this paper, the posthumous reproduction of using frozen sperm stored and then used after a husband has died is discussed in relation to the legal system recognizing the legitimacy of a child after the genetic father's death and to bioethics. This paper argues that first, posthumous reproduction should not be allowed, since it lacks the most important prerequisite for assisted reproduction, that being that medically assisted reproduction in Japan may be used to help legally married couples and offspring produced are considered legitimate. Second, in this type of procreation there is a lack of competent consent from the husband because he is dead, even if he gave his consent before his death. Just giving sperm and consent is not enough to get a woman pregnant as the continuing existence of the parent should be necessary for the child's interests and rights. Third, if this reproductive technology were allowed to be used, it would be very difficult to put any periodical time limits or legal conditions regarding frozen sperm used from a deceased man. From these points of view, this paper argues that the posthumous reproductive technology using frozen sperm after the husband's death is unacceptable, and the children born through this process should not be legalized or recognized as legitimate from the genetic father who is already dead, because of the reasons outlined above.

View full abstract

Because the principle behind the law of Informed Consent (hereafter referred to as IC) assures a patient's autonomy and right to decide, doctors have been required not to persuade, but to offer their patients explanations which are unbiased and objective. However, when considering speech acts and social constructionism, "explanation" and "persuasion" are inseparable in actual medical treatment conditions. Looking at it in this way, there is an inconsistency between the patient-doctor relationship as defined by law and actual medical practice and as a consequence, requirements prescribed by IC law cannot be applied uniformly. Therefore, determining how a doctor should deal with case variations not accounted for in IC law remains an urgent problem even today. This paper thus proposes an "educational model" of IC. Here, IC is thought of as a model in which a doctor consciously reflects upon his or her understanding of the patient and that patient's individual viewpoint through a written transcript of patient interactions. In addition, by not thinking of patients as merely subjects for treatment but as individuals with a particular outlook on life and his or her unique sense of values, the training of doctors to exercise discerning judgment even in the most severe IC scenarios is explored.

View full abstract

When the statute respects a patient's right to refuse every medical treatment, although that refusal will ultimately result in the person's death, can a patient refuse treatment on the grounds of his religious belief, or can a doctor carry out medical treatment against a patient's will? In France, this issue remained unsettled until recently. On March 4, 2002 the Patients' Rights Act was enacted and a medical treatment veto as a patient's right was put forward in a new form. On August 16, 2002, however, the Conseil d' Etat has ruled that a doctor did not infringe on a patient's personal autonomy, if transfusion action had satisfied some requirements. By this judgment, a patient's personal autonomy became the "decreasing fundamental freedoms (liberte fundamentale en demi-teinte)". In relation to the Medical Profession Ethics Code (Code de deontologie medicale), doctors still sit in a sensitive position, and this Act was able to override the judicial precedents of the Conseil d' Etat. This paper will argue that this judgment should not be extended to other cases of treatment refusal in consideration of the recent development of patient's rights which the French medical law has treated so far.

View full abstract

Recently the Health Promotion Law, which prescribes that all people have a duty to administrate their own health, has been enforced in Japan. This paper is intended as a critical investigation of widespread discourses on the obligation to achieve good health for the people's own sake. In the beginning, we review the evolution of classical public health to the new public health movement. While classical public health addressed the improvement of the environment such as installing sewerage systems for infection prevention, the new public health movement since the mid 1970s has largely been concerned with our lifestyles. With some epidemiological surveys, both researchers and policy makers reached agreement on the tenet that reforming 'unhealthy' lifestyles is more effective and economical than curative health care practices. Thus, they insist that people have an obligation to promote their own health and prevent disease by self-discipline, and that medical intervention in people's lifestyle is justified. Here we outline the essential features of today's discourse on the duty to promote health as follows: healthism, a quasi-religious and moral characteristic of modern medicine, giving extraordinary meaning to diseases and illnesses by metaphors, the medicalization of our everyday life, and an excessive emphasis on personal responsibility for disease or illness as rhetoric to justify cutbacks in required health and social programs. As will be seen, we examine these claims of preventive medicine in detail. In conclusion, we cannot accept the idea of the obligation to promote health for people. On the contrary, it rather seems that the government is obliged to preserve the environment, to assure daily commodities' safety such as food, water, housing and so forth, and to improve health care services without paternalistic coercion.

View full abstract