Tolerance has its positive form and negative one. John Hick maintains its positive form that a religion must contain a kind of plurality. Negative form we find in Pierre Bayle (1686-87) and John Locke (1689-92) that only one just method to peasuade someone to believe in God is to lead one's mind without any compulsions. This type of tolerance has in itself dichotomy between Inside and outside, spirituality and secularity etc. The most important feature of Islam is to reject the very dichotomy which is in the bottom of Tolerance. Hermeneutic distruction means to interpret the fundamental texts of religions so deeply that there remains only the most internal essence of the religion. So we can compare the real essence of the religions which perhaps may show no incompatibility.

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Recently studies in brain-imaging and brain-machine/computer interface have made rapid developments. That has caused the increasing of numbers of the incidental findings in which non-medical, PhD scientists incidentally find some diseases in brain of subjects during experimental researches. That requires establishing ethical rule and/or guide especially focused on the research carried by non-medical PhD scholars. Moreover, information of brain might directly represent someone's mental activity much more than genome or other physiological information. The public tend to associate the brain closely to consciousness and self. Instead the current condition of neuroscience seems not to clearly respond to such "need" from the public, this gap may make the situation much worse in "pop" neuroscience. Several of them often emphasize scientifically inaccurate information. We need the constructive perspective to re-design the cross-area of science and public. Effective guideline is needed, as well the research organization which can cross boarders among departments of government and academic societies.

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At first, I try to think through the signification of the notion of Bios, one of the conceptual couples that K. Kerenyi had presented in his book Dionysos. In contrast with Zoe, Bios implies a form of life that can be an object of biography, and has an existential individuality. When Bios introspects his activities, the style of his introspection is closer to evaluations than to simple descriptions. The life of Bios is fundamentally evaluative. In this sense, the notion of QOL is extremely important for Bios. When confronted with the outside world as a weak existence, a human being did not endure unpleasant feelings and adopted many techniques to overcome it positively. Bios continues to wear knowledge and technology through the technical process of inventions and discoveries in order to enhance his force as a sort of self-armor. It is true that many kind of enhancement techniques we are witnessing give us rather an impression of eccentricity. However, if we consider the life-burdened function of them, and if we situate them in the context of cultural history as successions of self-armor of Bios, this impression will possibly disappear. I think that this article can be interpreted as an effort to reinforce a political ideology of liberalism with a theory of life, at the same time with recognition of fundamentality of enhancement-like interventions to our environment, including our bodies themselves.

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In this short paper I will consider the transformation of enhancement in modern society which requires each person to be as autonomous, subjective, creative, and self -responsible as possible. In other words, I will consider the way human beings are going to be enhanced by biotechnology in such a society.

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[in Japanese]

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The issue of "War and Terrorism" is one of the most urgent tasks to be tackled by Bioethicists. This paper reflects back on the author's experience in Vietnam during the early 1970s and presents "War and Terrorism" utilizing video images in a narrative approach. The author was shocked to learn from one of his Vietnamese students, the devastating affects of "defoliants" used by the U.S. military resulting in birth defects and still births as well as high rates of miscarriage. This encounter with "genocide" by biological weapons directed the author towards a new area of study with a focus on a supra-interdisciplinary study of Life and Ethics or "Bioethics". The author's study of bioethics is founded on belief that life, nature and its environment should be shielded from evil and hasty development of science and technology particularly from military use. The author's idea of "Supra-interdisciplinary Bioethics" has its basic roots from global human rights movements and the author has worked together with pioneering Bioethics scholars from U.S., Europe and Asia. We should avoid narrowing the concept of Bioethics only to cover "applied ethics" in biomedical clinical settings. The new notion of the supra-interdisciplinary Bioethics will open the new horizon for the future understanding of "Life" in the 21^<St> Century. The first step to acquire the true peace will begin with a sincere study of Bioethics against "War and Terrorism".

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The purpose of this study is to analyze the historical process by which Japanese bioethics commissions developed their policy-making to build consensus regarding bioethical issues. The method used in this study consists of historical research and semi-structured interviews of experts. In addition, the content analysis of deliberation in national commissions resorts to Benjamin's four forms of agreement: complete consensus, overlapping consensus, compromise, and majority rule. The finding is that the Japanese bioethics commissions were transformed from closed, ad-hoc committees into opened, standing committees, which focused on specific issues of advanced technologies rather than general principles of bioethics. The bioethics commissions did not built complete consensus because of the diversity of the committee members, but instead tended to reach majority rule, compromise, and overlapping consensus, depending upon each specific issue.

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Purpose: To discuss the most fundamental Japanese value, Wa (harmony), and its implications for nursing ethics in Japan. Background: Much has been written about the confusion of value orientations among Japanese nurses whose professional socialization is heavily influenced by Western culture and whose personal and clinical life depends on traditional Japanese culture. This literature also urges clarification of the values that constitute the deep structure of Japan's ethnic collective unconscious in order to clarify the differences between Western and Japanese cultures. Methods: The concept Wa was analyzed from a literature review. The authors' research data were then used to explore the Japanese nurses' perceptions of this concept as reflected in their everyday practice. Results & Discussion: The concept Wa, originating from Confucianism, means people working in harmony and politeness in a group, with full appreciation of the uniqueness of its members, to reach the goal: goodness, peace and growth of all the members involved. Confucianism emphasizes not to confuse Wa and Doh (conformity with superficial agreement). Doh means you conform and do not express ideas but just act like everyone else so as not to rock the boat. Some Japanese nurses confused Wa and Doh and replaced Wa with Doh in their work lives. In this meaning the slogan 'workplace harmony' threatened those nurses' professional decision making. Some other nurses used Wa in its original Confucian meaning in discussions with the physician whose order had been perceived by the nurse as harmful for the patient, or with the mother who had refused to tell the truth to her terminally ill daughter. The outcome was the patient's benefit while at the same time keeping peaceful and harmonious relationship among the people involved. Those nurses' characteristics included calmness, modesty, warmth, politeness and assertiveness. Their actions were better explained by the concept Wa rather than the Western notion of nursing advocacy where courage is emphasized as the virtue of the nurse. It is important to have a culturally clear definition of Wa and an understanding of how it can be used for teaching nursing ethics in Japan. The need for further research was suggested to clarify other values residing in the Japanese nurses' conduct.

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In cases of Capgras syndrome, the <I> of a familiar person (or his "haecceity" that is entirely different from his attributes) vanishes in front of the patient. In other words, the patient with Capgras syndrome experiences "pure death." If death means the vanishing of the <I> in essence, can we say whether such a death is good or bad? Otherwise, is it possible to say anything good or bad about death? Analytical philosophy tells us that it is difficult to say something good or bad with regard to absent subjects. This suggests that it is impossible to say anything either good or bad about dead persons who do not exist in this world. Here, we lose the point at which the meaning of death converges, whether it may be the death of ourselves or others. Nonetheless, if we dare to look further for the meaning of death, it comes to be meaningful only when death is taken as a change of the <I>, not as its extinction. However, the change of the <I> is neither noticeable nor relatable to <I>. What is left for the meaning of death is nothingness, i.e., just the deaths of others in the form of the vanishing of the neighboring <I> and the death of oneself in the form of the vanishing of the self <I> in the future.

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This paper presents an analysis about why the Hansen's disease (HD) issue has been paid so little attention in Japanese bioethics. There is methodological "room" in American bioethics to deal with "ethics of communicable diseases" even though it too has paid little attention to HD. American bioethics historically adopted inductive methods of case study which promoted the establishment of an organized and inclusive disciplinarity. However, Japanese bioethics find no counterpart in their methodology. On the other hand, the "typically American" viewpoint of "denying paternalism, advocating patient's rights" is also prevalent in the controversy of the Japanese HD issue, and thought to be an indispensable viewpoint. Moral testing of the Japanese policy of patient segregation can be easily conducted using "respect for autonomy" and "non-maleficence" principles, which are also often ascribed to American bioethics. This reasoning seems to be the framework of the historical judgment of Kumamoto District Court in 2001. My conclusion is that the main reason why Japanese bioethics has been indifferent to the issue can be found in its methodology and social role.

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Important discussions in Japan were held in 2006 regarding revisions to the law relating to organ transplantation from deceased persons. Currently, prior informed consent of the deceased person as well as family agreement is required. Changes to the law could potentially eliminate prior consent of a deceased person in the case of sudden death. This study investigated the acceptance and understanding of brain death and organ transplantation, as well as attitudes towards death held by nursing students and their parents. Questionnaires were distributed in a Japanese university to nursing students, and posted to students' parents volunteering their address. From a total of 240 pairs of questionnaires distributed, responses were received from 137 pairs or 274 in total (57.1%). Using SPSS, the data was analyzed for correlations between acceptance of transplantation, age, religion, reliance on a health care professional, view of brain death, and death attitude between the total group of students and parents, and matched pairs of parent and child. Results indicated that 93 (67.9%) of the students and 81 (59.1%) of the parents accepted brain death as the death of a human, while a total of 189 (69.0%) participants wished to become a donor themselves. However, only 79 (28.8%) participants would to allow their family member to become a donor. Acceptance of transplantation was significantly related to age, religion, reliance on a health care professional, view of brain death, and death attitude. Nurses need to consider that 70% of the participants did not want their family member to be a donor, even if this person wished to be this donor. These results have strong implications for nursing practice.

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The direction of concern regarding bioethics and the depth of understanding of lecture material among students who took the course "Buddhism and Bioethics" were investigated in the present survey. Data were collected by self-description to enable students to freely express their views and analyzed using the KJ method. A total of 200 "distinct paragraphs" were identified from the descriptive data for 139 subjects. In addition, following inductive analysis, these "distinct paragraphs" were classified into nine categories, including "genetic testing and genetic research", "developments and advances in medicine", and "organ transplantation and organ sale". Descriptions focused mainly on arguments for and against each item, and the results suggested that most students who withheld their views or were "unsure" about or had difficulty making a judgment came to their conclusion following sufficient thought processes, rather than as a result of insufficient thinking. Although 30% of respondents were students from the Buddhist Studies department, descriptions regarding "religion" were rarely mentioned. Descriptions relating to expertise in the major were also uncommon due to the fact that most of the respondents were first-year students. These findings indicate that lower classmen also have their individual perspectives on bioethical issues.

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Case studies are essential to medical ethics classes in medical and healthcare schools. While lectures on general theories of medical ethics including moral principles and some topical overviews encapsulating ethical problems of abortion, genetic manipulation or euthanasia are no less important, case studies which have necessarily pragmatic character and are always concrete and contextual, are suitable for simulated training in preparation for actual encounter with ethical problems in clinical settings. However, case studies have certain methodological constraints and shortcomings. Some authors criticize that case studies will seldom reach into the hearts and minds of the people involved and that such cases are written in such a fashion that one can easily substitute one person for another, provided that they have the same illness. Furthermore it is plausible that case studies stimulate the students' analytic scrutiny, rather than imagination, so that cases are trivialized and reduced to mere abstract stories. To avoid such problems and to enrich case studies, we are developing a 'case-construction method.' This method imposes making up an original fictive case on each small group unit of students. In this paper we show the fundamental character of this method and the actual steps of our trials over two academic years and students' responses. This new method is burdensome but effective for medical students. It is recommended that after a sufficient number of exercises using traditional case studies, our new original case studies would be introduced.

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A comparative study was conducted to investigate autonomy for medical treatment in older adults using a self-report questionnaire. The eligibility of 125 community-dwelIing older adults in Japan and 94 Japanese-Americans in Hawaii was assessed. Both groups showed significant correlations between decision-making and relationship with the primary physician. Additionally, family function correlated positively with decision-making and cohesion or adaptability in Japanese, and negatively to information-seeking in Japanese-Americans. Japanese had higher scores for information-seeking regarding the purpose of laboratory tests and the side effects of their medications compared with Japanese-Americans, and relations between decision-making and end-of-life preferences such as place of care, life-sustaining preferences were observed. In conclusion, autonomy for medical treatment in older adults should be regarded with relationships with their primary physician and family. Providing information about medical matters and understanding their preferences, including end-of-life, enables Japanese older adults in autonomous decisbn-making.

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In recent years, literary works have been employed for medical professional education in Japan. Mainly they seem to be used as ethical cases in medical/nursing ethics courses. On the other hand, in the United States, literature has been taught as part of medical/nursing ethics courses as well as to nurture clinical competence which is fundamental for medical or nursing professionals in terms of literary methods and skills. In this paper, I will describe a brief history, the objectives, and some methodological approaches of literature studies in US medical and nursing education. Then I will show how literary works have been used as educational materials not only for ethical case studies but also for other aspects of professional education. Learning from US literature education for medical and nursing professionals, I suggest that Japanese medical and nursing educators should take note of the usefulness of literature studies, a liberal arts discipline, in clinical education.

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There is no national health insurance in the United States. The health insurance system consists mostly of private insurance, especially employer-provided insurance. As a consequence, over 46 million people in the United States are now without health insurance. In addition, the number of uninsured people has increased rapidly in recent years because of premium increases and the loss of employer-based insurance coverage. The lack of health insurance is a great barrier to health care. The uninsured find it difficult to access and to pay for the health care services they need to improve their health. The increase of the uninsured has negative effects on individuals and the society as well. For example, the uninsured tend to have more health problems because they lack access to affordable health care and coverage. In addition, communities are at risk of losing health services because increased numbers of uninsured are unable to pay, resulting in hospitals reducing their services and health providers moving out of the community. However, only incremental reforms have been implemented until now because the conservatives have dominated the Republican Party while the liberals have lost their power in the Democratic Party. Comprehensive reform like President Clinton's health care reform failed because conservative Republicans opposed it and the Democratic Party was divided into liberals and moderates. The lack of health insurance in the United States is problematic because it leads to fundamental questions like "Is basic health care a right?" or "Should individuals or governments be responsible for health care?" Given the seriousness of the uninsured problem in the United States, health care reform is needed to guarantee a safety net for all people to receive a reasonable level of medical care.

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Nowadays we discuss 'death with dignity' in order to claim death back from the hospitals for ourselves and recognize our right to freedom of choice. At the same time, we are apprehensive about the current trend which menaces the handicapped and the aged. We are obsessed with the thought that one must contribute to the society, which may in turn cause our apprehension. In this paper, I will clarify how 'modern thought' provokes the current state of our consciousness in a society, where everyone admires the power of the human will to increase productivity endlessly, and which tends to view health as a good. People in good health will realize an affluent society, which however may in fact be a cruel society for people in poor health, even if a portion of the abundance is provided to them. We must learn about 'death' in order to be freed from this cruel society, restrain our boundless desires, and hold a common awareness that we are allowed to live our lives in the real world.

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Compared with the legal concept of Informed Consent (IC), IC as an ethical concept has not yet been scrutinized sufficiently. The IC concept based upon an unrealistic assumption of the "Liberal Individual" as a rationalistic life-planner is criticized not only from the communitarian or care-ethics point of view, but also from the multicultural point of view. Some critiqued points, for instance, detachment from cultural context and lack of virtue ethics, should be drawn out also from East Asian Confucian values. It is necessary to turn back from the Rights-based discussion to a virtue-based discussion to find a more universally acceptable IC model. I propose a Communicative Consent model that lays stress on the interpersonal communication between doctors and patients.

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Research misconduct, such as falsification and fabrication of data, is a big issue in many countries. In Japan, however, activities to deal with research misconduct have just started, so it is doubtful whether there is ample procedural due process in the inquiry and investigation. In the United States, DHHS has an independent office named ORI, whose responsibility is to inquire and investigate research misconduct. This scheme has a twenty year experience and some legal issues have been discussed and judged in Departmental Appeals Board and in courts. US experience is helpful for Japan in establishing a formal system to handle research misconduct.

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'The dead donor rule' (hereafter DDR) is 'the ethical and legal rule that requires that donors not be killed in order to obtain their organs'. Although this rule was coined in 1988 by John Robertson, it had been one of the most important ethical rules of organ transplantation since it became medically feasible. According to the rule, vital organs such as hearts and lungs cannot be removed from living donors even if they have voluntarily agreed to donate the organs. In this article, I first present a review of Anglo-American literature on the controversy surrounding DDR. Roughly speaking, there are three approaches to this topic: (1) DDR should allow some exceptions; (2) DDR should have no exceptions, but the definition of death can be changed so as to meet the demands for more transplantable organs; (3) DDR should have no exceptions, nor should the definition of death be changed in any way. Secondly, I suggest that the first approach is relevantly similar to one strand of argument in Japan which states that taking organs from brain-dead donors is illegal but justified and that this may deserve more attention than so far received, given that the first approach is considered as a viable option in the DDR debate.

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The purpose of this paper is to analyze the socio-structural factors of eugenic policy from the mid-1960s to eprly-1970s in Japan through analyzing "The movement for preventing birth of disabled children" of local governments which was intended to prevent births of disabled children. The main point is that this social policy was a turning point in the process of transforming eugenic policy in Japan. I also clarify this process by analyzing the social context in which this eugenic policy was "needed" to prevent "disabled children" from being born the socio-structural factors to make it possible.

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Interpretations of 'withholding' and 'withdrawing' in life-sustaining treatments becomes different depending on how we conceptualize the human body: whether we recognize it as an assembly of parts or as one holistic gestalt rather than a mere assembly of parts. Given that we focus on the relationship between the patient's intention and the condition he is in, if the patient accepts the condition, there can be withholding which means to follow the causal process; withdrawing is not intended in this case. If the patient does not accept his condition, there can be withholding and withdrawal used as a means to stop life-sustaining treatments. There is a clear difference in meaning between withholding conducted with the patient's acceptance of the condition and withholding as well as withdrawing conducted without the patient's acceptance of the condition.

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In Germany, "pregnancy conflict counseling" is legally obligatory for all women at least three days before undergoing an abortion, unless it is medically or criminologically indicated. The law has been heavily debated in Germany because counseling, which should be a voluntary conversation, in this case is legally obligated ("Beratung als Zwang"). This paper studies the problem of the German abortion law and investigates the reality at the scene of the counseling by analyzing reports written by the counselors on the job. According to the law, "the counseling serves to protect unborn life", but is to be performed "regardless of the result (ergebnisoffen)". These paradoxical regulations bring, as the counselors say, problems into the practice. Nevertheless, most of the clients who receive counseling are ready to talk about themselves and the pregnancy when the counselors show an attitude of respect and listen to what they have to say. According to the counselors, their attitude of "openness (Offenheit)" when talking with each other is crucial for the success of the counseling. It is not easy to answer the question, whether the German counseling serves directly to protect unborn life or not. From the counselors' reports, however, we can at least conclude that the counseling helps the pregnant women to better understand their own situation and wishes. In some cases it will also, for example, help them in solving conflicts with their partner or family. The counselors' intention with the counseling is mainly to lighten the psychological or material burden imposed on the pregnant women, in order to avoid possible "post-abortion-syndromes" and any further "unwanted pregnancies". This paper interprets these practices philosophically as "dialectic process" (Hegel) and examines its meaning, directly for the pregnant women and indirectly for the unborn human life. This approach allows us to understand the "pregnancy conflict counseling" practice as a long-term effort of the German people to reduce the number of abortions and improve "reproductive health".

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Since the 1980', many homosexual people in some western countries, both lesbian and gay, have used artificial insemination by donor (AID) or adopt children. Recently similar cases are seen among Japanese lesbians by, too. The purpose of this research is examine Japanese lesbian parenting situation by interviewing two couples and bringing into the open issues some caused by, the popularization of reproductive technology. Both couples interviewed had tried AID but only one of the couples succeeded in a partner becoming pregnant and delivering a baby. The American partner of the other couple decided to adopt a foreigner child. Although parenting by these women are supported by their relatives and the local community, they regard these women as exceptions. This situation is brought by the fact that lesbian are not visible in Japan yet. This result suggests that it is crucial to clarify how we apply our concept of reproduction as well as discuss relationships between reproduction and an individual's sexuality.

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The use of genetic information is expanding increasingly as genetics develops. So far, in bioethical research about genetic information, the validity of genetic exceptionalism such as "Is genetic information so unique that we should separate generic from non-genetic information?" has been discussed. However it is often pointed out that in Japan, establishing rules for dealing with the development of genetics is lagging. Therefore, I think that in Japanese biomedical studies, we should look at the influence of genetic information on our society and shift the focus to more public political discussion to solve the problem practically. In this paper, I introduce the thesis of Mark A. Rothstein which offers valuable insight for public political discussion about genetic information. Finally I survey national regulations on dealing with medical information and point out problems.

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