In Japan, the guideline, which Japan Society of Obstetrics and Gynecology established, has worked like a regulation of preimplantation genetic diagnosis (PGD). PGD's development, however, offers us many possible options for using it other than those utilizations recommended by Japan Society of Obstetrics and Gynecology. The guideline prohibits the use of PGD such as sex selection, HLA matching and non-medical enhancement. On the other hand, borderless global society in these days makes it possible to use it for these undesired purposes in another country where there are no such regulations. What is more, some Japanese insist that PGD for those purposes must be available in Japan as well. Therefore the authors conduct a literature review and a critical analysis in order to take a closer look at ethical principles and norms to examine the use of PGD. The authors especially focus on "Principle of Procreative Beneficence", which Julian Savulescu, a philosopher/bioethicist, proposed first in 2001. According to the principle, parents who want their babies have a duty to bear the best child possible. This principle sparks active debates over the pros and cons in Western bioethical community. As a result of the review of preceding studies, the authors point out that they argue the pros and cons of the principle because it leaves its interpretation open; For instance they argue whether the principle requires an absolute duty or a prima facie duty like W. D. Ross proposed. In order to settle this conflict, the authors ask what a "good reason" is on the principle and point out that if the principle is based on utilitarianism, as it tends to be understood, it has some limitations. The authors conclude that a virtue ethical perspective proposed in this paper can complement the principle.

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This paper examines "grief work" and "mourning rituals." The former is the individual, psychological effort to overcome grief caused by bereavement, and the latter is the public (religious, folk) representation of grief. Under the traditional (modernist) model, the aim of grief work has been to help the bereaved sever their connection with the deceased and attain autonomy. In recent years, however, a new model has become more popular-it stresses that the bereaved continue symbolic bonds with the deceased for their adaptation after bereavement. Under this new model, Japanese ancestor worship has been appreciated as an expression of such "continuing bonds." However, traditional rituals in Japan are declining as the population ages, the number of children diminishes, and individualism prevails. Japanese people begin to request "freedom" (self-determination) even in funeral-related practices. However, unregulated marketization and commodification (disparity caused by liberalization) cannot be curbed by the principle of "freedom" alone. Therefore, hereafter, "mourning rituals" should be founded on "human dignity (the dignity of the deceased)" rather than on "freedom." To treat the deceased with dignity is to talk about their lives and pass their memory on to succeeding generations.

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In Japan, the difference between research ethics and clinical ethics is ambiguous. Therefore, the two roles of the ethical review of medical research (the role of the institutional review board) and the support of medical-staff with clinical ethical problems (the role of hospital ethics committee) are commonly assigned to a single ethics committee. As a result, resource-poor ethics committees cannot fulfill their role; especially they fail to perform the latter HEC role, because it is less regulated by public rules than the former IRB role. However, clinical ethics guidelines laid down by the health, labor and welfare ministry and medical academic associations encourage medical-staffs at bedside to utilize ethics committees when they cannot resolve issues independently and show the public that ethics committees function well. The main reason why hospital ethics committees are not common and do not support medical-staffs at bedside sufficiently is that the understanding of hospital ethics committees is limited in Japan. It is the role of bioethicists to consider and reveal the ethical and legal significance of utilizing adequate hospital ethics committees and their requirements.

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Judgment was declared recently that hospitals are required, as standard medical practice, to perform examinations and medical treatment of patients with serious hepatic cirrhosis on the premise that living donor transplantation is available. We will consider the issue of living donor transplantation with organs harvested from healthy donors in terms of the ethical standards of physicians. The judgment announced that the safety and efficacy of living donor transplantation has been recognized. It took into account the large number of surgeries that have been performed in many institutions with a high cumulative survival rate. It also pointed out the importance of obtaining informed consent from the patients and the contents of said consent. However, this judgment applied the standards of "safety and efficacy" and informed consent for the transplant recipients to the healthy donors, to whom these standards should not be applied. No medical reasons exist to justify such surgical operations on healthy donors, who have the inviolable right to sustain their health. Therefore, discussion on the appropriateness of healthy living donor transplantation should be undertaken not only among physicians who advocate the procedure but also all physicians including community clinicians, as this is related to the ethical standards of physicians in general.

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"Medical tourism", aimed at treatment received in over-seas countries, was generally practiced as a means for people who are unable to receive adequate medical treatment under the medical standards of their own home countries and needed to seek necessary medical care in advanced countries. In recent years, however, a growing number of cases of medical tourism involve not simply the dissolution of disparity in treatment opportunity. They also take advantage of disparities in the economic and regulatory framework to receive medical treatment that is otherwise either difficult or impossible to access. They do this by traveling to nations with advanced medical technologies. In particular, medical tourism that makes use of the human body as a medical resource, such as third-party reproductive medicine and organ transplantation, presents numerous points of debate. It reflects the many issues related to the quality of medical technology, as well as the use of regulatory and economic disparities to one's advantage, thus giving food for thought regarding the direction of regulation of medical tourism in general. This paper proposes a direction for the regulation of third party reproductive tourism. The proposed direction is based on a comparison between travel for transplantation and transplant tourism, which are gradually moving toward regulation.

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This paper examines the problems of liberal eugenics, namely, parents aiming to enhance a particular trait in their future children by inserting some relevant genes into their embryo, and explores whether this is compatible with the principle of liberalism whereby individuals have the rights to choose their own way of life. According to liberal eugenics, when changes to children's genes and changes to children's environment have the same effects, we should evaluate them similarly. The paper, however, argues that there is an important difference between them: parents change their children's environment by taking the wishes of their children into account while they change their embryos' genes without considering any feedback, positive or negative, from their future children. The paper therefore argues that parents have the procreative freedom to decide whether or not, with whom, when, and how often they reproduce, but they do not have liberty to change the genes of their embryos merely to enhance the traits of their future children, since this type of genetic intervention may violate the children's rights to choose their own way of life. The paper also points out that the conservative, liberal, and communitarian criticisms of liberal eugenics, as offered by Kass, Habermas, and Sandel, place very strong emphasis on the influence of genetic modification on human character, and concludes that we can point out the non-liberal characteristic of liberal eugenics even if we acknowledge both genetic and environmental influences on the development of human character traits.

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This report is based on interviews with six women who have been able to get back into society after the national leprosy -segregation (and discrimination) policy was ended. I focus on the particular suffering of those women who have left the segregated institutions. I found that most of these women think that they should not have babies even after being back in society, because they are still influenced by prior wrong medical policy. Such women's temptations to envy women who have given birth even after leaving the institutions of segregation disturb the former group. Beyond this, the women (whose relationships with their families have been disrupted) report that they cannot recover warm relations even with their own mothers. They are also bothered by problematic relationships with other persons around them. Furthermore, such women feel conflicts since they, on the one hand, had had a sort of financially-secure and stable life-style at national expense and, on the other hand, have suffered hardships such as forced abortions and even infanticides at the hands of the discriminating authorities. Also, now still both in and out of the segregated institutions, the women are caught up in a feud of something like mutual surveillance of each other. Those who have been bullied may also bully others. In contrast, many of the exited women report that they have equal relationships with their husbands with respect to gender difference and responsibilities, for their husbands are comrades who have together experienced the same segregation. Similar situations are reported to apply to the males, and this is how particularly women's sufferings have been masked and not revealed.

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In the Yomiuri Shimbun published on July 11th, 2012, Dr. Tetsuo Otani clarified that he had implemented the initial clinical application of the currently JSOG non-endorsed new type of preimplantation genetic diagnosis (PGD) as a precautionary measure against miscarriage thought to be caused by numerical chromosomal disorders. The above article brought about a statetement of JSOG's opposition to the clinical application of the new type of PGD, in which the JSOG said that they would never endorse the clinical application of the new type of PGD of Dr. Tetsuo Otani. In this paper, we will ethically examine the conditions brought about by Dr. Otani's new and effective cure for miscarriage thought to be caused by numerical chromosomal disorders as well as a bioethical bottleneck accompanied by the new type of PGD with my ethical views on that bottleneck. Based on the research presented in this paper, it is clear that the JSOG's stance on PGD lacks logical coherence.

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The 2012 Nobel Prize in Economics was awarded to American economists for the theory of stable allocations and the practice of market design. The algorithms and practical reforms by them have contributed, among other things, to the organ-matching systems. For example, many individuals in need of a kidney transplant have had loving family and friends generously step forward in hopes of becoming living donors. Unfortunately, some of these potential donors discover they are unsuitable because of blood type or tissue mismatch. With paired kidney exchange (also called kidney paired donation or paired kidney donation), however, an incompatible donor-recipient pair can trade kidneys with another mutually incompatible pair. The earliest paired exchanges were simple two-way swaps. Over time, they have become more complex. For instance, it has been recently demonstrated that a chain started by someone who wants to give a kidney but does not designate a particular recipient can go on indefinitely. The transplants do not have to be done in the same place or at the same time, because no one seems to be in danger of giving a kidney without having a loved one receive an organ in return. It has been demonstrated that this practice greatly increases the number of compatible kidneys available to patients. Since many societies find the buying and selling of kidneys repugnant and prohibit it, the idea of paired kidney exchange might be a significant development. However, implementation of a strategy based solely on economic considerations raises some bioethical concerns. A certain degree of increase in the number of transplants is reasonable, but should be justified by simultaneously limiting negative effects on the other organ donation systems. This article discusses the various matching algorithms on paired kidney exchange and the ethical hurdles associated with this new approach to living kidney donation.

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Research ethics consultation services have been increasingly recognized as a potential valuable mechanism for ethical review of clinical research. In addition, public interest in research ethics has increased. However, the approach and method of research ethics consultation varies with institution, and there are many unresolved issues that need to be addressed, including what the purpose and concept of such services should be and whether core competencies for consultants can and should be defined. When faced with the dilemma of how to implement clinical research while minimizing the risk for subjects, consultants find it difficult to determine whether the clinical research is being reviewed for acceptable and implementation of the research. In dealing with difficult tasks, consultants need to recognize that ethics in research is a public issue, which should be resolved through the public system. Consultants should thus remain independent of other entities and should have a code of professional ethics, for example, maintaining confidentiality, being loyal to the duty, and declaring conflict of interests. This paper sheds light on the issues related to research ethics consultation by considering professional ethics in the field.

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In this study, we analyzed how Living Donor Liver Transplantation (LDLT) have expanded and increased in Japan, while also elucidating the surgical conditions and challenges associated with such transplantations in order to clarify the future challenges and issues that still need to be investigated. The adaptive diseases for liver transplantation have changed significantly in comparison to the beginning, with viral cirrhosis / hepatoma being the major adaptive disease at present, and relapse following transplantation in hepatitis C, adaptation criteria for transplantation in hepatoma, etc., also becoming a problem. Though they have been entrusted to the doctor, we obtained findings indicating that discussions from a broad perspective with sufficient consideration of the QOL for recipients following transplantation are required regarding the adaption of LDLT who are family members.

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To understand and enhance nursing ethics in practice, a questionnaire survey among clinical nurses was conducted, and the factors associated with ethical sensibility were identified. Six yes-no questions were associated with high scores in ethical sensibility. These questions involved experiences with nursing case analysis, interest in nursing ethics, the necessity of ethics education, awareness of ethics programs, experiences with ethical problems, and suffering from ethical problems. Among four composite variables constructed from 16 questions, "knowledge of nursing ethics" and "attitude toward nursing ethics" were identified as factors associated with ethical sensibility. In addition, age and length of work experience together were found to influence ethical sensibility. These findings could be helpful in developing programs and systems to improve nursing ethics in clinical practice.

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In the first half of 2012, two research papers on the transmission of influenza H5N1 virus among ferrets were published in Nature and Science. Prior to their publication, the U.S. Department of Health and Human Services recommended deletion of the methodological details of the experiments from the papers, and this led to heated debate. While the papers were eventually fully published, it is noted that during the publication debate, the publication meaning and value of the life science research result were not discussed. This paper first looked back on the debate and made clear about the problems included, then it expands on the observation that "freedom of scientific research", "freedom of expression", "responsibility of scientists" and "meaning of life science research" are inherent in the publication of life science research results. The paper concludes that restriction of publication on life science research results can only be permitted when the need of restriction overwhelm the meaning and value of the publication.

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This paper explains the clinical practice of terminal discharge and how it has led to the enactment and subsequent revisions of the Hospice and Palliative Care Act in Taiwan. In this paper I divide my argument into three parts. First, I investigate the actual situation of terminal discharge by examining the regulations in the Medical Care Act and related reports from healthcare providers. The practice of terminal discharge is the discharge of a terminal patient at his or her wish so that the patient can spend the last few hours or days with his or her family at home. In my research, it is shown that the practices of discontinuing life-support-treatment after arriving at home and of family members acting as the patient's medical proxies have been tacitly accepted by clinical practitioners. Second, I focus on the relation between the practice of terminal discharge and a movement from 1995 by terminal care practitioners that advocated for the legalization of "natural death." The activists argued that terminal patients who have signed an advance directive to refuse life-support-treatment and those who have expressed their wish to be discharged from the hospital at their end-of-life have shown their will for a "natural death." Through the movement's efforts, it became clear that there had already been a public consensus for the practice of terminal discharge; as a result, a law governing terminal patients' right to self-determination, the Hospice and Palliative Care Act, was enacted in Taiwan in 2000. Third, I examine the revision of the Hospice and Palliative Care Act and identify the process of granting family members the right to act as medical proxies regarding the discontinuation of the life-support treatment. The law as enacted in 2000 only allowed family members acting as medical proxies to refuse life-support-treatment; later revisions allowed medical proxies to both refuse and discontinue life-support-treatment.

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The Chinese policy on healthy childbirth and childcare is prescribed in the Maternal and Infant Health Care Law of China (MIHCL), along with its subordinate regulations and administrative regulations, and municipal/local regulations, an example of the latter is the Maternal and Infant Health Care Ordinance of Heilongjiang Province. The MIHCL and its subordinate regulations impose the following duties on doctors (who belong to medical institutions recognized under this same law) and on couples who plan to marry. First, couples who plan to marry must, before marriage, undergo a "premarital medical examination" and submit a "certificate of premarital medical examination" to the marriage registration office before marriage. Moreover, based on the MIHCL and its subordinate regulations, under certain circumstances, doctors must advise the couple to postpone marriage, withhold issuance of a "certificate of to premarital medical examination," advise the couple to use birth control for an extended period or undergo a sterilization procedure, perform prenatal diagnosis on pregnant women, and, based on the result of the prenatal diagnosis, advise them to have an abortion. In addition to stipulating duties, the MIHCL and its subordinate regulations prescribe perinatal care services and care for newborns (Article 14 of the MIHCL and Article 26 of the Measures for Implementation of the Law of the People' s Republic of China on Maternal and Infant Care), reflecting the Chinese policy on better childcare.

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In France, bioethics laws amended in 2004 and 2011 regulate assisted reproduction. In the amended version 2011-814 of July 7, 2011, the sentence, "Assisted reproduction is intended to respond to the wishes of the couple to become parents" has been removed from an article of the Public Health Code on the purposes of assisted reproduction. Since then, couples have recourse to assisted reproduction only if the treatment for medical infertility is required to achieve pregnancy or if the risk of transmitting particularly grave diseases to children or partners is to be avoided. Why did the French Parliament amend this article? A survey of parliamentary reports and legislative debate show that citizens' opinions published after the Consensus Conference on Bioethics in 2009 were a significant influence. This amendment was made so as to deny the existence of any right to have a child using medical technology and to regard assisted reproduction as merely a treatment for medical infertility. This amendment seems to be a political decision to deny some the "desire to have a child" according to their sexual orientation.

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In recent years, with the introduction to the clinical scene of computerized systems such as the electronic medical record, the whole array of items acquired by examinations and clinical tests has come to be registered as "medical information". This medical information is expected not only to be utilized by medical professionals but also to be understood by patients as material for making decisions. Through patients' own narratives based on such conditions, the ethical issues which are inherent in medical information are clarified through accounts by patients with breast cancer, who have particularly frequent opportunities to encounter information concerning their illness. Patients searched for medical information from sometime past, and they could get it. Yet, patients, while being bewildered by the differences between their own physical sensations and the data of medical information, report having no option but to rely on the medical professionals to interpret the data. It is considered that there is a possibility that information, which is intended to be for thinking about one's own life, is actually hindering the self-knowledge of patients and is ending up transforming their consciousness towards passivity and reliance on professionals. In the future, it is desirable that the medical information will be presented to patients in a form such as can be used effectively and to support the patients' autonomous, informed decision-making.

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The purpose of this paper is to analyse how the post-mortem procreation was discussed in France when the law of bioethics was revised in 2011, and to mention the points to be considered in the legislation regarding assisted reproductive technology in Japan. As a method, I confirm the debates at several institutions (I) and the legal trends (II), and mention the points to be considered in Japan (III). In the discussions at the institutions except Council of State (Conseil d' Etat) and at the French National Assembly (Assemblee nationale), post-mortem embryo transfer met with the approval. But because of opposition from Senate (Senat), the law of bioethics in 2011 denied the post-mortem procreation. Persons in opposition to the post-mortem procreation argue that they cannot be responsible for unborn child. There is the theory that since it has become possible to cryopreserve oocyte (freeze egg), it should be avoided to fertilise and conserve in-vitro fertilised egg or embryo more than necessary. In Japan, on the occasion of drafting a bill regarding assisted reproductive technology, we must examine, in distinction from the post-mortem insemination to the post-mortem embryo transfer, destruction of embryo, utilisation for research or donation for another couple and so on, if we reject the post-mortem embryo transfer.

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A big controversy broke out over whether the results of the studies, which altered H5N1 avian flu viruses and made them infectible to ferrets, should be published or not. In this thesis, based on the examination of its circumstances, I considered the necessity to assess such research by risk/benefit and the necessity to establish the appropriate measures from the standpoints of safety, security and research ethics. Especially, in association with such research, pandemic might break out by various causes such as mutations of viruses in nature, leakage of ones in accidents and willful spread of ones by terrorists. It is necessary to fit a wide variety of measures together to cope with it.

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In the U.S. a litigation was filed to invalidate the patents of Myriad Genetics, Inc. on BRCA1 and BRCA2, which were linked with human breast and ovarian cancers. The U.S. Court of Appeals for the Federal Circuit (CAFC) reviewed the case after it was remanded by the Supreme Court, and CAFC judged that such patents were eligible again. The Supreme Court will begin examination upon the judgment hereafter. In this thesis I reviewed the circumstances of the trial and considered its influences on the related people and sectors. I also considered the way to harmonize gene patents with society, industry and research.

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This paper addresses the possibility and value of externalism in bioethical debates. First, it discusses President Council on Bioethics (PCBE)'s public reports, especially much-debated notion of "human dignity," and Ruth Macklin's refutation of this particular notion. Macklin regards "human dignity" as reducible to respect for autonomy, the first of the four principles of biomedical ethics, arguing that dignity is "a useless concept in medical ethics and can be eliminated without any loss of content." The Council counters Macklin's refutation with their report on Human Dignity and Bioethics in 2008. Both views are discussed in some detail. Second, this paper critically examines Macklin's view, situating it in a few specific contexts (ethics of suicides Tooley's so-called "person" theory, and the brain death controversy). By doing so, the paper shows how both Macklin and the Council share their basic assumption of internalism. Finally, interrogating the bioethics based on the notion of autonomy, the paper discusses the significance of the idea of externalism in various socio-bioethical problems.

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