The term "quality of life" (QOL) is currently used to describe one of the most basic goals of medicine. However, the meaning of QOL seems to differ across various medical fields. In some instances, QOL is regarded as a subjective concept, while in others, it is taken to be an objective one. Consequently, the aim of this paper is to provide a more accurate understanding of QOL. First, the paper analyzes the meaning of the words "subjective" and "objective" as used in discussions of QOL, and shows the following: both of the words incorporate two meanings; moreover, in parallel with these different implicit meanings, there are two controversies with regard to understandings of QOL. The first concerns the question of who evaluates the QOL of an individual, while the second is the question of whether it is possible to establish general standards for effective QOL evaluation. Next, by examining debates concerning the notion of a "good life" in bioethics and normative ethics, the paper examines aforementioned questions in attempting to clarify the meaning of this widely used term. Based on the findings, the following two conclusions can be made. First, QOL can be accurately evaluated through communications between patients and medical professionals (and thus, in this sense, it is an objective concept); however, the relative importance of each QOL factor depends on the individual patient's manner of thinking (and consequently, in this sense, it is a subjective concept). Second, it is possible to establish general standards for QOL evaluation based on shared value judgments of what constitutes a good life (in this sense, it is an objective concept); however, an effective evaluation will still depend on each patient's individual condition (in this sense, it is a subjective concept).

View full abstract

The "placebo response" has a long history in medicine. From ancient times to the 19th century, medicine and the placebo response were inseparably related, and successful medical treatments were usually the result of the latter. In current medical science or "evidence-based medicine"; however, the placebo response is considered an unnecessary or even an injurious factor that undermines the quality and the reliability of medical treatment. In this study we reconsider the true value of the placebo response and point out that it is not a perceptual illusion or subjective prejudice, but a real and objective consequence, which is caused by the strong interaction between the human mind and body. Referring to the latest knowledge of psychoneuroimmunology, we explain the reason why the placebo response should be regarded as a "meaning response" (Moerman) and elucidate how it can remedy the limitations of modern medicine. Furthermore, we argue that the appropriate use of the placebo response makes medical practice much more beneficial for both doctors and patients; we also enumerate the conditions necessary to utilize its power within the medical care system of Japan. As is evident, modern science is highly advanced but still limited in many ways. For example, it studies the human body as if it were a machine but knows only a little about human beings as an integration of mind and body. Thus, medical science has revealed almost nothing about the placebo response because all the questions about it arise precisely from the mutual relationship of our minds and bodies. Therefore, it is important to examine the potential of the placebo response, not only from a medical or scientific perspective, but also an ethical or philosophical one.

View full abstract

This paper aims to clarify when a person's wishes, expressed in advance directives, can be revoked. In order to achieve this aim, the paper pays particular attention to the concept of "authenticity of wish," when "authenticity" is defined as "being true to oneself" (especially in contrast to "sincerity" being defined as "being true to others"). The paper understands "being true to oneself" as "being subjected to adequate critical reflection." In advance directives, adequate critical reflection should take place, through communication, in advance-care planning. Consequently, this standard of authenticity can be used to clarify when wishes expressed in advance directives can be revoked. The argument distinguishes between the following three cases, (i), (ii-1), und (ii-2): (i) When a wish to revoke an advance directive is formed through a satisfactory level of communication, it should be permitted, (ii-1) When a patient tries to revoke their wish to start or continue medical treatment without a satisfactory level of communication, their revocation should not be permitted in principle. This is because any misunderstanding cannot be corrected, should the revocation not be their authentic or sincere wish, (ii-2) When a patient tries to revoke their wish to withhold or withdraw medical treatment without a satisfactory level of communication, their revocation should be permitted in principle. This is because any misunderstanding can be corrected later, even if the revocation is not their authentic or sincere wish.

View full abstract

Since the Uniform Determination of Death Act was enacted in 1981, the "whole brain" standard has been legally adopted and widely used in U.S. medical institutions. This standard is a criterion in which an individual is deemed to be dead as a result of the irreversible cessation of all functions of the entire brain, including the brain stem. Neurologists and philosophers, however, continue to discuss the conceptual issue of brain death. Questions concerning its form and meaning ("What is brain death?" and "Does whole brain death really mean the death of a human being?") frequently arise in journal articles, symposiums, and mediations by the President's Council on Bioethics. In this article, arguments concerning the conceptual issue highlighted by neurological studies are outlined, by examining the arguments of James Bernat, a supporter of whole brain death, and those of Alan Shewmon, an opponent of the idea. Neurological studies alone do not explicate what kind of entity a human being essentially is, nor what kind of entity a ventilated, brain-dead patient should be regarded as. Therefore, it seems that neurological arguments do not suitably address the various conceptual problems at stake. The paper highlights the kind of human entity both Bernat and Shewmon's views presuppose and shows how their arguments are constituted by this presumption, revealing the foundation on which each philosophical position is based. With this in place, the paper examines whether their views concerning the conceptual issue of brain death preserve consistency with an analysis of the concept of the human being as an entity.

View full abstract

This study investigates the genetic counseling of non-invasive prenatal testing (NIPT) and genetic counseling for parents whose unborn children have been assessed with trisomy 18. Trisomy 18 is the third most common genetic cause of developmental delays, with an occurrence of 1 in 3,600 to 1 in 8,500 pregnancies. Recently, children with trisomy 18 who have undergone cardiac operations have been able to survive longer than average. NIPT for prenatal diagnosis of trisomy 18 is simple, safe, and can be performed early in pregnancy. However, NIPT for trisomy 18 does not present a definitive diagnosis. From 2013 onward, all pregnant women must undergo genetic counseling and have NIPT performed at medical institutions. When discussing the possibility that an unborn child may have trisomy 18, genetic counselors should provide pregnant women all relevant medical information, but they also must discuss the potential physical and emotional effects of the condition on the child and parents. Genetic counselors must be unbiased, calm, and levelheaded, so that pregnant women can understand the situation and their rights clearly before deciding to continue their pregnancies or seek an abortion. These imperatives suggest that guidelines for NIPT and genetic counseling must be drawn up to provide appropriate mental healthcare for pregnant women. It should not be aimed at medical professionals, but rather, pregnant women, and should continue to discuss the relevant ethical concerns regarding NIPT and document the benefits of genetic counseling. This study also discusses factors concerning the right to life of children with chromosomal abnormalities.

View full abstract

In the aftermath of a disaster, research is essential in providing data that can directly or indirectly facilitate the effective management of responses, while minimizing the potential for damage from future events. Research participants drawn from disasters are however somewhat vulnerable, especially as they make efforts aimed at rebuilding their lives. Consequently, in conducting research in these settings, questions concerning how best to balance the need for research with the obligation to respect and protect research participants' interests and rights within the unique stress of a disaster arise. Additionally, any burden placed on research participants should be minimized through the coordinating of the various studies, and by determining the extent of overlap or redundancy of the various research projects. To ensure that important research is expeditiously reviewed, coordinated, and conducted in a manner that protects the participants' interests, it is argued that investigators, institutional review boards, and public health/government officials should participate in discussions concerned with protecting participants' interests, especially in the event of a future disaster.

View full abstract

In Japan, AID (donor insemination) has been practiced for more than 60 years. AID offspring who have sought identifying information about their donors have recently been highlight in Japan and other countries. In some countries, donor offspring now have a legally guaranteed right to obtain donor identifying information, with the movement to respect donor offspring rights expanding worldwide. It is, however, still difficult for many donor offspring to obtain donor information. The voluntary registry of donors/donor offspring, and donor linking are effective means for donor off-spring to locate their donors or biological half-siblings. Indeed, both voluntary registry and donor linking have already taken place in a number of countries. One example comes from the Netherlands, where an NGO named Fiom has introduced voluntary registry and donor linking using DNA testing, with support from the Dutch government. In this paper, the Dutch example is highlighted, and used as a means of exploring the circumstances that led to the establishment of their Artificial Insemination Donors' Information Act (Wet donorgegevens kunstmatige bevruchting), which secures the right of AID offspring over 16 years of age to obtain donor identifying information, as well as details of the DNA-based donor linking practiced by Fiom. In light of this, the paper discusses what can be done to secure Japanese AID offspring's right to know their donor information, and to prepare for the future introduction of a voluntary donor/donor offspring registry and donor linking in Japan.

View full abstract

As is well known, "human dignity" is considered one of the most important bioethical concepts. It is so important that in the first section of the Basic Law for the Federal Republic of Germany, for example, dignity is qualified as being inviolable. Nevertheless, the content and status of the concept is not always clearly understood. In this study, an attempt is made to elucidate the historical origin of this concept, with the aim of highlighting its transcendent background. To this end, the texts of Pope Innocentius III and Giovanni Pico del la Mirandola, among others, are referred to. Paradoxically enough, the concept (the meaning of which tends to promote positively the human values) can be more suitably understood when seen through the almost antithetic notion of the "misery of human conditions". Dignity is the counterpart of misery. In both examples of this study, the human being's relationship to God, or some transcendent entity, is essential. It is consequently argued that to acquire a thorough understanding of human dignity, the concept's transcendent origin needs to be remembered, even if used in the context of secular decision-making processes, as is often the cases in bioethical discussions. Moreover, the contemporary world is predominantly secular. Therefore, the use of the concept of human dignity in important bioethical documents presupposes two, divergent, judgments. The first, the importance of which we want to underscore, consists in the insistence in the transcendent origin of dignity, even though the bioethical discussions are frequently pragmatic and have some coordinating character. The second solution consists in the efforts to interpretively reread and resituate the transcendent nature of the concept, in order to pretend to not know its historical background. Although acknowledging enough the secular character of contemporary society, we think that the concept of human dignity is useful to confirm the nature of our mind that needs to be linked with some transcendent values, even in the face of intra-mundane matters. Only with this recognition, the concept is able to get its entire signification.

View full abstract

This study investigates the factors that inform both the recognition of "abuse" and the less easily defined principle of "inappropriate action", while exploring measures intended to promote "awareness" of abusive and inappropriate actions. In developing these measures, an anonymous, self-reporting questionnaire survey of a total of 240 staff members at care-related facilities was conducted. The results show that a high rate of the recognition of "abuse" was observed for "actions in which the elderly individuals are clearly harmed," while "actions in which there appears to be no direct harm to the elderly individuals themselves" were recognized as "inappropriate actions." Actions recognized as "non-problematic" (by some 30% of the subjects) were associated with one of the following background themes: "prioritizing safety," "convenience of facility," and "prioritizing family." Furthermore, rates of recognition of "abuse" were higher among care workers than among those in other occupations, and were higher for staff with more than three years' experience than those with less than three years. The paper suggests that the ability to perceive "abuse" or "inappropriate actions" cannot be acquired simply through education-accumulation of hands-on caring experience is also important. Therefore, together with enhanced staff training and education, continuing education involving case studies and other workplace-based training regimes is required. Actions that do not directly harm elderly individuals may themselves raise ethical issues concerning confidentiality and the respect for autonomy. An increased ability to recognize such "inappropriate actions" is also needed.

View full abstract

This study aims to shed light on patients' perspectives of the role that nurses played in their treatment, as seen from 26 (recovered) Taiwanese Hansen's Disease patients, while also documenting the details of the nursing care that the patients received. Bringing clarity to these matters, from the viewpoint of patients who were kept under quarantine and supervision, is used as a means of questioning anew the nursing care provided for Hansen's Disease patients in Taiwan. With regard to patients' images of the nurses, for instance, respondents described them as "showing fear of infection," "staying in a specific place," "busy," "trainees," and "young girls living in the neighborhood." The activities that patients considered nurses to have been predominantly engaged in included "things concerning medical care," "cleaning the doctor's room," "things concerning medicine," "carrying patients' amputated limbs," and "nothing recognizable." With regard to their relationships with the nurses, some respondents commented that they felt that they were not respected, describing the relationships as fitting the values of "not having respect for a person" and "physical distance," whereas many others mentioned kind forms of behavior by the nurses not concerned with medical care, such as "adheres to the hospital rules," "involvement with children," and "relationships off the job." The respondents' primary concern had however been technical skill. The frequently mentioned features of "impressive nurses" included "having technical skills," "not fearing infection," and "being kind." The respondents considered that nurses feared infection, and they recognized the nurses' uniforms as a symbol of the fear of being infected by them. When remembering nurses, the respondents (in all age groups analyzed) associated the nurses' fear of infection with their clothes. None of the respondents mentioned any concern or showed a clear recognition of the fact that the nurses were people who did something for them. Rather, the respondents simply recognized that what the nurses were engaged in was the work that had been assigned to them. It might be possible to complement the findings of this research by asking the nurses questions as well.

View full abstract

The world population is rapidly ageing. Congruently, the number of people with dementia globally is also increasing. Many countries are now trying to find ways to make decisions for end-of-life care on behalf of individuals who lack the mental capacity. An important example of such an attempt is the British Mental Capacity Act (MCA) 2005. This characteristically includes Lasting Powers of Attorney (LPA), in which a person nominates someone to make healthcare decisions on their behalf in the event of future incapacity, and the Independent Mental Capacity Advocate (IMCA) service that empowers an advocate to work with and support persons who lack the capacity, and who represents their best interests. Focusing on these two services, this article will explain the MCA 2005, and assess its impact on end-of-life care in Britain, utilizing official reports and academic papers. In addition, the article highlights some of the problems and challenges negotiated by the MCA 2005. As Japan faces the same problems of an ageing population and a need for good decision-making policies in end-of-life care, policy-makers and health care providers need to discuss a legal framework and guidelines that not only concern advance directives, but also proxy decision making plans.

View full abstract

On February 13, 2012, the Supreme Court of Japan handed down a ruling on the unlawful disclosure of confidential information committed by a physician, relating to the criminal case commonly known as "the leak scandal during the investigation for the arson and murder case in Nara prefecture." This decision examined whether or not an act committed by a physician who has been ordered to conduct an expert examination and make a medical determination (including diagnosis based on his/her knowledge and experience as a physician) and who discloses, without justifiable grounds, another person's confidential information, constitutes the crime of unlawful disclosure of confidential information under Article 134 of the Japanese Penal Code. Diverging from Japanese legal history, the concurring opinion of the decision cites the Hippocratic Oath, which provides a judicial explanation for confidentiality, while also providing an ethical perspective. This article considers how the scope of legal confidentiality has changed, by examining the introduction of ethical perspectives made after this decision. Ultimately, in the aforementioned case, the Supreme Court of Japan adopted the argument that a relationship of mutual trust is not a necessary legal requirement for the crime of revealing a secret to be committed. Because the argument was explained from a relatively ambiguous ethical perspective, the scope of legal confidentiality has been expanded considerably, so that it now covers not only the disclosure of confidential information, but also that of any person other than the subject of the expert examination which the physician has come to know in the course of said expert examination. The present article provides a critical analysis of this judicial opinion, asserting that to understand the limits of the legal duty of confidentiality, it is indeed necessary to discern whether or not such a relationship of mutual trust exists. Analyzing the leading case concerning the legal duty of confidentiality, as well as the commentary upon it, this article finally argues that it is necessary to reconsider the relationship between law and ethics (or morality) from the perspective of legal positivism.

View full abstract

Contemporary discourses concerning "death and dying," such as those found in a "living will" or "advance directives," are subject to the principle of "autonomy" and demand "self-determination" for death in many cases. However, is it so important that we decide our "own" type of death in end-of-life? This paper asserts that "co-suffering" between dying people and those caring for them is more important than "autonomy". In so doing, the paper first introduces an argument made by Lois Shepherd, who has examined a number of related cases and laws, confirming the significance of the paradigm shift from "autonomy" to "suffering." Secondly, it revisits "euthanasia and death with dignity" cases in Japan, showing that the deciding factor of judgments was frequently a compassion for the "suffering of family members," rather than patients themselves. However, in more recent cases from Japan, medicalization and legalization of euthanasia are presented on the basis of the right to self-determination, with the concerns of family members disappearing from the cases. It is concluded that it is crucial to reconstruct "intimate spheres of co-suffering," where dying people and those caring for them (the family and so on) suffer together.

View full abstract

In this paper, a hearing survey was conducted on leavers of sanatoriums who live in a society that conceals their medical histories, examines what types of suffering they endured as leavers, and how this affected their considered choice of later abode. As a result, it is revealed that issues concerning medical care have a significant impact on a leaver's choice of later abode. These include the enhancement of general medical institutions that understand their personal medical history of Hansen's Disease, and the extensive care needed for its after effects. However, it also became clear that the leavers purposely avoided each other, even when they should be helping each other. This situation is interpreted as a self-defense mechanism necessary to survive in society, deployed as a means of protecting one another from prejudice and discrimination. As a result, information can be difficult to obtain. Although the society's interest in Hansen's Disease has been diminishing, the stigma leavers' internalize, and the problems of alienation and disease, have not yet been resolved. Those tasked with their help often see them as "leavers of sanatoriums," placing them in protective positions, even though they frequently lead diverse and meaningful lives. Supporting leavers, including respecting each individual's feelings, thus requires urgent attention.

View full abstract

Our capacity for cognitive function and the ability to express our intentions declines with age, and as a result of chronic diseases and other disorders. This often leads to difficulties in making decisions regarding medical treatment and clinical research. This paper aims to examine the range of methods which can be used to ensure that an elderly patient is competent to take part in the attendant decision-making process, and also considers the issue of appropriate medical care in cases of patients who are not considered competent. When considering the alleviation of symptoms, human dignity, and the quality of life of elderly individuals, aggressive yet life-sustaining treatment may not necessarily be desirable (or patient-orientated), and may fail to meet the needs of the patient. The patient and their family face with difficult choices, such as deciding whether or not to switch from aggressive treatment to palliative care, deciding whether to continue with life-sustaining care, or deciding whether to discontinue treatment. There are growing concerns regarding the extent to which elderly people (especially those whose decision-making capacity has declined due to conditions such as Alzheimer's Syndrome) are able to express their intentions freely regarding their treatment. When patients make these difficult choices, the processes through which the patient's intentions are assessed, and how their rights may be guaranteed, need to be considered. If a patient is determined to have no capacity to consent, advance directives provided by the patient while they were able to consent can be used, or an adult guardianship system can be adopted. In recent years, assessment methods have been developed that enable patients who cannot directly express themselves to outline their intentions in writing, or by using verbalization devices that sense eye movement. While various methods of determining capacity to consent have been developed, no fixed standard has been established. In both examples, it is hoped that the human rights and the dignity of elderly patients are fully respected throughout the decision-making process and subsequent treatment.

View full abstract

In the context of contemporary medical treatment, in order to obtain informed consent (IC), the "conversation model" (which requires two-way communication between a doctor/ physician and a patient) is endorsed as a means of promoting the patient's autonomy. It has been pointed out, however, that the model has a number of problems, particularly in terms of its practical efficacy and legal applicability. To address these problems, Howard Brody proposes to add to the model what he calls a "transparency standard," which requires, through physician-centered dialogues, that a doctor or physician adequately make transparent to the patient their decisions concerning the patient's medical treatment and the reasoning behind them. Though this standard enhances the practicality of the model in obtaining IC, it appears to let a doctor or physician practice a sort of paternalism ("moderate paternalism" in my term). Is this version of paternalism justifiable, and if so, in what sense? This paper proposes that while the physician-centered dialogues have a paternalistic tendency, this version of paternalism is acceptable (given the nature of autonomy) as long as the dialogues allow patients to integrate the decisions into their own unique value-systems.

View full abstract

The ultimate goal of medicine is to protect human life and dignity, and thus, medical research is considered a humanistic enterprise. However, although medical research is, in most cases, affirmative of the individual, it is sometimes not in harmony with society, and can be dependent on various factors such as time, locality, and the social environment in which the research is being conducted. Even if the significance and benefit of a research program is recognized, it may be criticized on the grounds that it is unsuitable for the social situation, and a reexamination may be demanded. The problem of "The Tohoku Medical Megabank Project," which this paper tackles, is precisely such a case. Questions concerning the studying of genomics in vulnerable areas continue to be raised, and were highlighted right from the beginning of the plan. After considering the views both for and against the project, and by identifying the conflict points, the paper examines directionality and decision-making procedures in the context of ideal medical research and health care policy for those who are affected.

View full abstract

The aim of this study is to investigate the cognizance of home care from the viewpoint of bereaved individuals who have taken care of a terminally ill patient at home. Questionnaires were mailed by a clinic that proposed home hospice care to 100 bereaved individuals, and who have had a family member pass away between six months and two years prior. Forty-five completed questionnaires, which included the families' impressions and comments towards home care, were mailed back and analyzed. Categories were selected from a content analysis of the sentences as summaries towards home care. Families perceived the service as "care with a caring spirit," and "care elevating confidence toward patients' care," and expressed to have "appropriate care given by each professional," "satisfaction with home care," and a "willingness to promote home care". However, families also expressed "regret," and felt that there were "questionable points about the care," which implied that work remains to be done to promote home hospice care in the future. These results suggest that the majority of families were satisfied with services for patients in the home at the end of their life, and the resolution of regret or other questionable problems may lead to more positive changes to home care practice.

View full abstract

This paper, based upon interviews with doctors engaged in terminal care, focuses on doctor-patient dialogues concerning death and those aimed at helping the patient's acceptance of death, from a care viewpoint. Two patterns for doctors discussing death with patients at clinical sites were found. Three steps in the development of doctor-patient discussion concerning death are shown: "avoidance," "helping patients express themselves," and "doctor-patient dialogue." During end-of-life care, "doctor-patient dialogues" are important. Doctors and patients both grow through such dialogues which are not based on the doctor-patient relationship, but on more personal in nature. They are, in short, conversation between two mortal beings with a limited life. Through doctor-patient dialogues, patients accept their own death and doctors learn from patients the importance of more deeply examining their own views of life and death.

View full abstract

How often have we heard the claim that "life is important simply because there is death?" The existence of death, as the final destination in life, forces us to realize the true importance of daily existence. Whether the meaning of death extends beyond the psychological realm and into the ontological is the purview of the "time theory" of analytic philosophy. This paper focuses on Cotard Syndrome, which creates the delusion in patients that they are immortal. The perception of immortality, as a result of this syndrome, frequently induces a deep despair for those affected, as they are deprived of the value of all existence, rather than sustained by the vitality of life and future hopes. Consequently, the reason for such despair in patients with Cotard Syndrome was analyzed from the viewpoint of the modern philosophy of time. It is argued, firstly, that the outline of the future (which should be seen from the viewpoint of death) does not reveal itself because the viewpoint of death is deficient under the immortality delusion of Cotard Syndrome. Secondly, the maturation of this framework, in order to recognize the true value of life, will forever be prevented. Cotard Syndrome paradoxically suggests that the existence of death gives the present life meaning, by connecting it to the ontological significance of the future.

View full abstract

The purpose of this study is to clarify perspectives among nurses on current conditions relating to the contemplation of artificial hydration and nutrition (AHN) in the elderly, and to examine the role of nurses in the decision-making process when AHN is being considered. Seven nurses were interviewed, all of which had experience with the elderly, and the families of those contemplating AHN. On this basis, a qualitative, inductive analysis was carried out. An analysis of the results led to the creation of five core categories: "sequence of events leading up to the consideration of AHN over a relatively long period," "reasons that doctors recommend a particular AHN," "explanations given to families by doctors when contemplating AHN," "circumstances of the families that must make a choice regarding AHN," and "the position nurses should take toward families that must make a decision about AHN." It is shown that nurses frequently believe that it is the families that must make the choice, and that they should not speak in a manner that would impact a family's decision. The results of this study suggest that nurses play the role of providing information regarding the impact of the treatment on a patient's lifestyle, are aware that eliciting information from families acts as an element in the decision-making process, and play a part in starting the decision-making process while proactively and continuously providing support.

View full abstract

The rise in single-person households in Japan is necessitating that medical institutions proactively confirm the intentions and desires of patients, especially regarding treatment policies. However, because treatment policies must be determined within an extremely short time, often in emergency rooms, a dilemma arises in that the desires of the patient may differ from the solutions the medical professionals consider best. This study, therefore, examines the actual support for decision-making processes that medical teams provide to patients when determining treatment policies in the emergency domain. Furthermore, after clarifying the present conditions and challenges of secondary emergency medical systems in Japan, the paper also discusses the roles played by nurses. It is argued that nurses who provide support for decision-making processes in the emergency domain should act as the advocates of patients, and can also act as a bridge between medical teams and patients, so that they can share and reach agreements on treatment policies, while at the same time making important medical and ethical judgments, based on the intentions of patients.

View full abstract

The frequency in the use of genome sequencing in clinical genetic tests has recently increased. However, "incidental findings" of mutations, which are not included in the original test purpose but that may affect the health of the patients, should also inevitably increase as a result of this method. In July 2013, the American College of Medical Genetics (ACMG) issued recommendations highlighting the fact that when genome and other sequencing is performed in such clinical genetic tests, the results for mutations of particular genes should be returned, regardless of the patient's wishes. However, since then a number of heated arguments concerning the recommendations have been made from ethical, legal, and scientific points of view. This paper categorizes and analyzes the arguments, and examines ways in which to deal with such incidental findings, in light of the background and circumstances found in the Japanese context.

View full abstract

The concept of general consent has received widespread attention in recent years. General consent enables researchers to reuse biological samples and personal data for new studies without obtaining another round of consent from participants. This presents ethical issues and requires careful consideration. A literature review was conducted to determine the requirements for general consent, and the nature of such consent. Firstly, the requirements of general consent were considered from two perspectives: (1) forms of general consent and (2) compensating for the short-comings of general consent via research systems (e.g., the right to withdraw consent, disclosure and transparency of research, prior review for new studies by an institutional review board, or the presence of supervisory systems). Secondly, this topic was analyzed from an ethical standpoint and considered in the context of a biobank adopting general consent. Results of the analysis suggest that "trust" in research systems is essential for the successful implementation of general consent. This type of consent may present a new ethical principle in the relationship between participants and researchers/research organizations, in addition to conventional ethical principles such as "respect for autonomy," "beneficence," or "non-maleficence."

View full abstract

Today, preimplantation genetic diagnosis (PGD) is one of best ways of selecting the sex of a preborn baby. Although the Japan Society of Obstetrics and Gynecology does not allow PGD for sex-selection, it is reported that a number of Japanese couples have gone abroad to use PGD. In light of this trend the author has conducted a literature review and critical analysis of the bioethical arguments concerning PGD in Western countries, in order to examine their merit in a Japanese settings. As a result, the paper summarizes and classifies the arguments against PGD for sex-selection into four types: (1) risk and safety for women, babies, and embryos; (2) sex discrimination against females; (3) imbalance in the sex ratio; and (4) parental attitude toward (preborn) babies. Objections to PGD for sex selection are often made with reference to parental autonomy and freedom. These arguments are analyzed with reference to the Japanese context. Every new biomedical intervention has risk and safety problems, but they can eventually be resolved through technical innovations. Sex discrimination is also problematic, but it is not always true that the use of PGD leads to such discrimination. The imbalanced sex ratio, as a result of sex selection, has been the subject of heated debates in some countries, including India, China and Korea. However, it seems unlikely that Japan faces this problem. This is because an imbalanced sex ratio in Japan would happen only when almost all the couples who use IVF select a male baby, with the help of PGD. Finally, the paper explores virtue ethics that take parental attitudes toward (preborn) babies seriously. The paper concludes that virtue ethics are not always resistant to PGD for sex-selection. It advocates, rather, sex-selection by means of PGD only in certain conditions.

View full abstract