This paper, on a holistic approach to ensure children's rights, discusses the issues of informed assent (I.A.) in pediatric care in Japan, including the UNCRC (UNITED NATIONS COMMITTEE ON THE RIGHTS OF THE CHILD)'s "GENERAL COMMENT No.7 (2005) on implementing child rights in early childhood". I.A. consists of two concepts: parental permission and patient assent, which are specific to pediatric care. In clinical practice, it is recommended that care for infants be provided based on "parental permission" alone. The principle of I.A., suggested by pediatricians in the United States, includes the statement, "Decision-making involving the health care of young parents should flow from responsibility shared by physicians and parents", which is neither consistent with the rights of child patients or provision of appropriate care, nor subject to any legal responsibility. General Comment No.7 defines infants as social actors, and early childhood as a critical period for the realization of all rights enshrined in the Convention on the Rights of the Child. Evaluating the potential of infants positively, the General Comment questions the restriction of infants' rights due to their lack of interactive ability, strongly advocating the protection of their rights. To introduce the concept of I.A., it is necessary for us to change our view of infants' potential and consider their immaturity as a rationale for ensuring their rights, while taking into account the viewpoint of children's rights and pediatricians' views of infants, including activeness and uniqueness, obtained from their clinical experience and research achievements. It is also necessary to discuss the effects of the rules stipulated by health care professionals.

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Recently, evidence from a large number of studies that evaluated the effects of caring for patients with higher brain dysfunction has accumulated. However, few studies have so far demonstrated the effects of medical caring for patients with disorders of consciousness (DOC), which is characterized by a lack of awareness of self or the environment. Of these disorders, the vegetative state (VS) is considered to be the representative. With this background, we performed for the first time, a meta-analysis of the data from the previous paper which demonstrated a high rate of misdiagnosis of a VS. As a result, these findings indicated the the importance of caring for such patients. Accordingly, new methods to quantify the type of care needed for such patients still needs to be established. To achieve this goal, we then suggest that a preliminary verification method should be established in order to evaluate the effectiveness of a rehabilitation program, not of general medical care itself. Our suggestion that the development of a method which utilizes neural plasticity may allow us to correctly assess the effects of rehabilitation, making it possible to establish effective rehabilitation programs for patients with DOC, while also developing systematic methods of patient care in such programs

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The basic tenet of the present paper is that research in medical ethics has been predominantly committed not so much to contributing to the resolution of conflicts concerning actual medical issues but to the pursuit of objective or universal ethical principles. In fact, this tendency might have caused a gap between the general principles that should be applicable to actual issues and the complexity of the situations that confront decision makers with various moral dilemmas. This essay attempts to overturn such an emphasis on the study of general principles, their interpretation and the introduction of results, by focusing instead on the problem-solving of concrete and complex issues. This new direction is supported by the methodology of consensus building. The present paper concludes that researchers in medical ethics should satisfy the following three conditions: (1) the consideration of the generality of action principles; (2) the consideration of the particularities of the action situation; (3) an awareness of the researcher's position as an interested party.

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In France, by a revision of the laws on bioethics in 2004, the indication of the preimplantation diagnosis was extended. This means that, in order to treat the first child who is suffering from Fanconi anemia, giving birth to a second child who is HLA compatible with the first, with the aid of that diagnosis, is now permitted by law. Considering the philosophical justification of the utilization of others' bodies to treat patients, on the one hand, saving patients is the duty of society in conformity with the principle of solidarity. But on the other hand, the donation of parts of the body for this treatment must be based on voluntary self-sacrifice in conformity with the principle of autonomy. And yet doesn't the request that the second child, who has no will or existence, become the means of treating the first, come from excessive solidarity? Shouldn't the consideration of dignity, integrity or vulnerability of the second child come before that of solidarity?

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Objective: The purpose of this study was to investigate patient disposition on end-of-life care after the decision process was explained by the attending physician the patient is while instable condition. Methods: Patients hospitalized in the recuperation and rehabilitation wards were divided into two groups based on whether they were educated (intervention group, 224 patients) about end-of-life care or not (control group, 114 patients) by the attending physician. We performed a questionnaire survey on these patients after they were discharged from the hospital, and a total of 104 (30.8%) patients responded. Results: No difference was observed between the control and intervention group concerning the decision to use an artificial respirator or tube feeding in the terminal phase. Significantly more patients responded that they would want their families more than themselves to receive life-sustaining interventions regardless of their own conscious state. Despite this, over half of the respondents chose "I don't know" when it came to choosing end-of-life care. Conclusion: While intervention did not promote the decision to withhold life-sustaining interventions, the need to provide information on end-of-life care was apparent given that half of the respondents answered "I don't know" to all questions.

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Deep Brain Stimulation (DBS) is a surgical medical treatment involving the implantation of a medical artificial device which sends electrical impulses to specific parts of the brain. DBS in the selected brain areas has provided remarkable therapeutic benefits for treatment-resistant diseases, such as Parkinson's disease. DBS can directly change brain activities in a controlled manner, and its effects are reversible. Lately, the clinical trials of DBS have been applied to various psychiatric disorders in EU, USA and Canada, such as obsessive compulsive disorder, Tourette syndrome and severe depression. Nevertheless, DBS therapies for affective disorders are still at the experimental stage and they may contain risks in implanting the device into a person's brain which possibly alters that person's brain function and hence his personal identity. Based on the experiences of Germany and France, this paper will examine the safety of DBS treatment for psychiatric disorders, the patient selection criteria, and etc.. The conditions for proper application of the DBS technique will also be clarified hereby. It will be argued in this paper that for psychiatric diseases, the DBS specialists can never decide alone and psychiatrists always need to be consulted to avoid possible failures resulting from mistakes in applying this technique. In real practice, the medical doctors usually consider that very sick adult patients are competent to give informed consent. Although the formal signature of consent from a family member is not a compulsory requirement family support for patients is considered crucially important. In France, the consent of the patient is the principal requirement for adopting DBS treatment; yet, the situation becomes difficult when the patient is considered unable to make an informed and rational decision. Under such circumstances, the decision could be then made by a legal representative. Previous medical practices of lobotomy have revealed many problems and concerns which need to be resolved. Although lobotomy has certain benefits, it has been over applied to massive cases without any well-defined criteria and its practice was also poorly designed. Therefore, the new techniques of DBS must be considerably better defined in terms of its criteria, procedure and ethical boundaries to avoid possible bioethical mistakes.

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Mysteries of the human body "is an exhibition, which is open to the fee-paying public, comprising specimens of human corpses produced using a technique called 'plastination'. The purpose of this paper is to review the ethical issues of this exhibition. Dignity of the corpse dictates that casual utilization of cadavers is not acceptable; usage should be limited to that with discernable meaning and appropriate intention. Although this exhibition claims to be educational, there are issues with the method of displaying the specimens and questions regarding its educational effectiveness. There are also many uncertainties regarding the origin of the specimens, which are said to have been donated to science in China. Primarily, under existing Japanese law it is not possible to use bodies donated to science as exhibition articles without compensation. Consequently, this exhibition slips through the gap between Chinese and Japanese law. In order to set parameters for the provision of corpses genuinely needed for research and educational purposes, a law stipulating the rigorous confirmation of donor intent and the ethical requirements is vital. Conception of this kind of law necessitates examination of the ethical issues of this exhibition which exploits the gap in existing legislation.

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When nursing a family member, the family plays a major role and especially in most cases, women are expected to take the responsibility for providing nursing care even though nursing care has become socialized and many nursing services are available nowadays. Usually patients have various psychoneurotic symptoms and changes of language, emotions, behavior, and personality although there are many ways for advancement of dementia and its symptoms vary among different individuals. We verified and analyzed a particular suffering of daughters such as their feel of loss and heavy responsibilities and circumstances when they decided to institutionalize their mother prior to occurrence of dementia as well as change of the relationship with their mother because of the illness. In addition, we highlighted the issues of current nursing care in this study and considered measures that we can pass on so that we can lessen their burden and protect the dignity of lives of both mother and daughter. In the result, the particular struggles of daughters and chronological order are seen in the process of using a nursing and personal care facility. The four types of relations are derived from interviews and we found that the each relation has no small effect on the circumstances of nursing care.

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The legal restrictions on adults who can use ART (Assisted Reproductive Technology) are disputed in many foreign countries. Legal management has been employed to ensure a sexual minority's right to family formation in Europe and America, and the rearing of children among sexual minorities using ART is not unusual. Research on parents' sexuality and children's development has shown that there is no problem in sexual minority child-rearing cases. There is the limitation of judging a minority from the majority's sense of values. On the other hand, in view of the situation of sexual minorities and the legal system in Japan, I consider there are five patterns by which a same sex couple could have a child by ART. I assume that the laws regarding a sexual minority's right to family formation in Europe and America are concerned with (1) religious or cultural problems, (2) problems of children's welfare and their healthy development, and (3) problems with international politics in each country. In Japan, it seems that the viewpoint of sexual minorities will be required in legislation of ART.

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In Japan now the main HIV prevention activity at the moment is focussed on ethical issues including respect for human rights of people who are HIV positive. Furthermore, because the main means are "communication interventions", HIV prevention activity is relatively unproblematic from the moral point of view. However, identifying the ethical issues is necessary to put public health programs into execution. The reason is that "communication interventions" are calling each person and the society to realize some specific values. Therefore it is suggested that an ethical analysis and mutual communication between intervention participants and recipients on values included in each intervention be applied to all facets of the public health communication process.

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The purpose of this study is to clarify the characteristics of ethical problems experienced by ward nurses in nursing practice, their experiences and responses to these problems, and associated underlying factors. In this study, a self-administered questionnaire survey was issued to 1,746 ward nurses in October and November 2007 in Japan. Responses were obtained from 1,144 ward nurses (recovery rate: 65.5%). The results show that they often experienced ethical problems one to three times a month. The average resolution rate of the ethical problems reported by them was low at 40%. The most frequent problems they experienced were "Use / nonuse of physical / chemical restraints", "Staffing patterns that limit patient access to nursing care", and "Conflict in nurse / doctor relationships (or other professional relationships)", but most of the problems were not solved. Variables such as the nurses' sex, size of institutions, wards the nurses worked on, and chances for the nurses to study ethical problems were indicated as the associated underlying factors which affect both experiences of ethical problems and the resolution rate of ethical problems. The occurrence rate of experiencing problems was correlated with moral sensitivity to the associated underlying factors. This study suggests that it is necessary for nurses to have opportunities to study ethics for nursing in order to develop greater ability to solve the ethical problems and improve organizational systems in the hospitals.

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An important purpose of hospital ethics committees is to judge, according to relevant laws or guidelines, what is difficult for medical staffs to make decisions on. These judgments usually involve the case by case application of laws or guidelines to clinical settings, and resolution of conflicts between legal and ethical principles. What is presupposed here is the contemporary version of 'trust in reason', i.e. the well considered arguments by those full of knowledge and experience will lead to the appropriate conclusion. For ethics committees to have a manual for discussion is very useful, but too much dependence on it will make their judgments stiff. Ethics committees are required to have a kind of virtue, that is, they have to make appropriate judgments based on the particular and concrete situation. Therefore they have to improve constantly their ability to make judgments. Because the nature of ethical consideration is dynamic and not confined to current norms, ethics committees may bring the validity of laws or guidelines themselves into question, while obeying those norms. As virtuous people who live according to the laws can revise them through government, ethics committees can play a part in amending the laws or guidelines by influencing the network of ethics committees.

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This study examined nurses' awareness of guidelines in the decision-making process for terminal care, and knowledge and clinical practice about hospice and palliative care for older adults in long-term care settings. A cross-sectional survey was conducted using a questionnaire. A convenience sample of 127 nurses belonging in two hospitals with long-term care wards participated in this study. Survey items included demographics, knowledge and clinical practice about hospice and palliative care, and nurses' attitudes towards death and dying. The mean age was 39.4±9.6 years, 118 (92.9%) female, and 15.2±9.2 years of nursing experience. Awareness of the guideline was that 70 (55.1%) knew it, although 57 (44.9) did not know it at all. Factors associated with awareness were knowledge and clinical practice regarding hospice and palliative care. On the other hand, demographics and attitudes towards death and dying were not significantly related. Knowledge of hospice and palliative care was higher for symptom management and teamwork compared to pain management and providing information about long-term care insurance for discharge. Additionally, lower point of practice regarding hospice and palliative care than knowledge was observed. These results suggest that palliative care skills and good teamwork were indispensable in the decision-making process for terminal care.

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We, in terms of narratology, examine how the structure and mode of cases as such affect the manner of conducting discussions and the quality of arguments in medical ethics case studies. To do so in the concrete, we consider similar three cases from well-written textbooks and compare their narrative characteristics. This shows that some of these cases are prepared according to the style followed in the writing of clinical case reports. The descriptive style of case reports in general medicine is likely to be diegetic (Platon), monologic (Bakhtin) and too brief, and reflects little information about the patient's personality, way of life and life history. For medical ethics case study should deal with values and all aspects of each patient's life as such, every case description should convey more detailed relevant information about the patient's personal matters and that of her/his family members. Psychiatrists, as we all know, used to pay great attention to the aforementioned aspects in the process of diagnosis and treatments before the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association prevailed among psychiatric practices in the early 1980s. In this respect, the previous style of drawing case reports in psychiatry apparently seems to have implications for medical ethics case study. Nevertheless we should admit that psychiatry differs from medical ethics in that while the former has a standardized system of both nosologic and diagnostic judgments, the latter does not have such a system to date, as is accepted by most medical or clinical ethicists. The nature of medical ethics case study cannot be merely deductive. Then it is plausible that we should explore specific rhetoric or poetics for describing cases so that case study is really practical and goes far beyond exemplification of how to apply moral principles to individual cases. A case to be used in medical ethics case studies should be messy and be constructed, like a literary work, with much nuanced taste (Barthes) or ambiguity, polyphonic voices (Bakhtin), and drama.

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The aim of this paper is to show the transformation of American bioethics. New technologies in the medical health-care field, such as organ transplantation, withholding and withdrawing life-prolonging treatments, reproductive technologies, and prenatal testing, have provoked various serious problems in the United States since the 1980's. Bioethics has attempted to solve these problems, insisting on people's autonomy in decision-making. Nowadays, people have started to pay attention to health disparities as an urgent social issue in the US. For example, over 47 million people do not have health insurance. Moreover, it has been proved that an individual's health condition is significantly different depending on one's race, ethnicity, and socio-economic status. To deal with those issues, the target of bioethics seems to be broadening from the individual level of life and death to the general public health level. In this paper, a review of a brief history of bioethics is presented. Then, arguments which critique the bioethics that focuses on the individualistic approach to health care are examined. Finally, the recent trend of ethics which centers on public health issues is discussed.

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