This paper aims to examine problems regarding the circumstances under which developing countries attempt to justify temporary restrictions on the right of health care workers to leave, in their efforts to address the problem of brain drain. It proceeds by examining the rationale behind political obligations, which health care workers owe to their fellow citizens. In the context of brain drain, both proponents of associative duty, who defend political obligations by appealing to analogy, and the fair play theory, which considers the voluntary enjoyment of benefits as a basis for political obligations, fail to derive political obligations. I argue, in invoking the framework of public health ethics, that the natural duty of justice, to the effect that it is required to contribute to the maintenance and creation of fundamental human rights when it can be carried out without too many burdens, is more likely to justify the political obligations imposed on health care workers. However, the natural duty of justice may also be used to warrant that citizens living in developed countries bear burdensome obligations.

　　The present study aimed to consider the process and specific support of Advance Care Planning (ACP) by analyzing assistance “between elderly people living alone and home care nurses”. We focused on the timing and methods of communication and care “between care recipient and care provider”, which are an important part of the ACP process, that most effectively lead to realization of the care recipient’s desired way of life. Semi-structured interviews were conducted with 26 home care nurses with at least three years of experience and 36 cases of nursing provided were analyzed. Five elements and specific examples of support to achieve each element were extracted as factors promoting ACP. These five elements were “nurses are trusted by care recipients as professionals,” “clarifying the intentions of care recipients,” “presenting options,” “identifying the causes of anxiety and working to alleviate these,” and “seizing the ideal moment to fulfill intentions through rapid support and skill.” Six elements were also extracted as factors hindering ACP: “no established relationship of trust,” “intentions are difficult to decipher,” “discrepancies between the judgments of medical professionals and the intentions of care recipients,” “anxiety cannot be alleviated,” “the level of consciousness of care recipients is not clear,” and “conflict between the values of care recipients and home care support methods.” The results suggested that incorporating into support “factors promoting ACP” and “matters for home care nurses to consider in order to eliminate factors hindering ACP,” which were identified in this study, could lead to the assurance of ACP quality in home care.

　　The concept of a person is central to the discussions of life and death in bioethics. This concept plays a significant role in the arguments over the moral status of human life particularly in the early stages of life, such as the fetus. However, since personhood is assumed to be a kind of ability or character (self-consciousness) and being a person is tied to the moral status, it raises the moral dilemma that human beings which are not regarded as a person have no moral status. Since the concept of a person plays the reason of such a consequence, the question arises whether this concept is useful for the discussion in medical ethics.

　　 Whereas Ludwig Siep positively answers this question and develops his own concept of a person, Dieter Birnbacher answers negatively and suggests full abandonment of the concept of a person from medical ethics. In this paper, I will clarify that Siep’s attempt fails and that the proposal by Birnbacher is partially wrong by inquiring about the moral acceptability of voluntary active euthanasia. By doing this, I show the usefulness of the concept of a person in medical ethics.

　　The purpose of this paper is to comprehensively explore the characteristics of ethical issues in cancer and non-cancer medical care by gathering case books on existing clinical ethics, and organizing and classifying them according to ethical issue.

　　Through search engines such as CiNii Books, 10 books already published and include 89 cases suitable for interprofessional discussion were identified. By classifying them according to ethical issue, we obtained eight categories of issues: “Selection of treatment at the end of life”, “Selection of a recuperation place”, “How to provide information”, “Refusal of necessary medical care”, “Distribution of medical resources”, “Restraint/restriction of actions”, “Abuse”, and “Others.” Issues under “Selection of treatment at the end of life” differed greatly between cancer and non-cancer care. In addition, in terms of interpersonal conflicts in cancer care, not only “Patient vs. Staff”and “Family vs. Staff” conflicts, but also “Patient vs. Family” conflicts were identified as an issue.

　　In Australia, the state government of Victoria passed the Voluntary Assisted Dying Bill 2017 on November 29, 2017 and it will become legal by June 19, 2019. Victorian residents who are 18 years and over, who have decision-making capacity, and who are diagnosed as having an incurable disease, illness, or medical condition with an estimated life expectancy of six months or less will be given the right to request their doctor to prescribe a permitted lethal substance to terminate their life.

　　 Twenty-three years ago, Australia’s Northern Territory legislated the Rights of the Terminally Ill Act 1995, the world’s first voluntary euthanasia law. It was operative for only nine months before it was nullified by the Euthanasia Laws Act 1997 passed by the Federal Parliament. Twenty years later, Victoria has become the first and only state in Australia to legislate for the right of terminally ill people to request voluntary assisted dying. The Victorian legislative framework is described by the Andrews’ government to be “the safest, and most conservative model in the world.”

　　This paper proposes to analyze the characterization of Victorian legislation on voluntary assisted dying. It will focus on the 68 safeguards that have been stressed heavily by the government, and compare it with legislation in other jurisdictions on physician-assisted dying.

　　Research biobanks in Japan have recently started to collect and store perinatal specimens such as cord blood and placenta tissue. These specimens are an important resource for the study of genetic epidemiology and regenerative medicine. However, there are no laws specifically covering biobanks in Japan, so these projects are currently governed by the “Ethical Guidelines for Medical and Health Research Involving Human Subjects,” as well as other guidelines and the Civil Code.

　　The National Cerebral and Cardiovascular Center’s Biobank has collected and stored several kinds of perinatal specimens and donors’ medical records since April 2014, and is now confronting new ethical, legal, and social issues (ELSI) related to these activities. These conflicts must be resolved. The ELSI relating to perinatal specimen storage differ from those relating to adult or dead fetus specimens. In most cases, mothers give informed consent regarding their child(ren)’s perinatal specimen collection and storage during pregnancy. However, other questions have now arisen: How long does proxy consent hold good, do fathers have the right to consent to (or refuse) what is done with specimens, and when should a donor be informed about such storage and any long-term observation studies? These issues are arising because such donors are not yet adults, but they will be eventually. More discussions about the ELSI relating to stored perinatal specimens, informed consent of all parties, and the legal character of human tissue are needed in Japan. Management issues relating to perinatal specimen storage at the time of informed consent concern proxy consent, and issues relating to how long specimens are stored concern informing the donor children themselves. We will consider practical management solutions to resolve these issues.

Introduction: Recently, there has been an increasing growth in studies on Brain-Computer Interfacing (BCI) so as to bring this technology into the phase of practical availability. BCI will contribute to a wide range of human activities, ranging from assisting patients with severe motility disturbance to a variety of nonclinical uses like controlling of cargo-loading machines, gaming or silent speech. The influence of this technology will not stop at the level of individual patients and users, who utilize the technology, but include society as a whole. This will necessitate a deliberation of its ethical, legal, and social consequences. However, currently, these deliberations are not organized in a comprehensive manner. The purpose of this article, therefore, is to provide an overview of preceding ELSI discussions on output BCI and to unveil where further explorations are mandated.

Methods: The authors analyzed discussions on BCI in the form of published studies by employing a systematic review and thematic analysis.

Results: Previous ELSI discussions on BCI can be classified into four main categories: BCI research ethics; BCI’s impact on society; BCI’s possible influences on human nature; and Nature of BCI ethics.

Discussion & Conclusion: While the existing discussions have provided sufficient topics of ELSI on BCI, they have yet to set out the framework to formulate arguments on each topic in an organized manner. Especially, we need more profound arguments about the nature of BCI ethics, namely more philosophical discussions on BCI, to fully appreciate the other categories of BCI research ethics, BCI’s impact on society, and BCI’s possible influences on human nature. The arguments go beyond finding topics, which will include an exploration of the methodology of ELSI discussions about BCI, which should enhance further studies.

　　This paper focused on ethics education provided in specialized nursing care courses and analyzed the content of collected course syllabuses and textbooks adopted in 4-year training courses for care workers. As a result, all specialized nursing care courses include ethics and are based on ethics at courses setting stage. Next three core categories were extracted, namely ethics learned from care workersʼ rules of professional conduct, ethics learned from basic knowledge on bioethics, and ethics learned from care workersʼ specialized skills and on-site experience. Based on the analysis of these three core categories, the following six objectives of ethics education in nursing care subjects were identified: (i) to learn concrete details of highly abstract concepts in ethics education; (ii) to learn the significance of diverse values and individuality through providing livelihood support; (iii) to learn people in need of nursing care, thereby being aware of their conflicted feelings and ethics problems in receiving support from others; (iv) to learn the meaning of the influence of care workers on care receiversʼ decision making; (v) to learn that better communication skills develop an ethical attitude; and (vi) to specifically consider ethical issues through practical work and case studies.

　　In living kidney transplantations, some patients are ineligible due to medical incompatibility, or the results of transplantation is not satisfactory. To address these issues, in addition to immunosuppressant drug therapy, patients outside Japan seek another option called paired kidney exchange, where several couples of donors and recipients with a mismatched kidney exchange their kidneys for a more matched one. This way, the exchanges can increase the number of kidney transplantations and improve their outcome. This paper conducts a systematic review of literatures on paired kidney exchange; to achieve comprehensive understandings of its up-to-date worldwide practice and problems including medical, technical and ethical ones. As a result, while paired kidney exchange can be said to have some medical utilities, they have several problems such as inequality of outcomes of the transplantation, organ trafficking, anonymity, socio-psychological compulsion and justification for the participation of matched pairs. Given these findings, this paper then examines the statement on paired kidney exchanges made by the Japanese Society for Transplantation.

　　The Japanese elderly people with disability caused by diseases developed in old age sometimes hesitate to obtain a caring environment based on the right to live because of their discrimination against themselves who cannot work anymore. Their ethical perception of labor which had been formed in Japan’s high-growth postwar period has influenced continuously such kind of prejudice recently. At that time manufacturing industry drove economic growth and full employment has been realized. Under this circumstance which David Ricardo, the greatest representative of classical political economy would described as an almost ideal state they thought that those who work were useful for society and those who do not work couldn’t help being discriminated. In the classical school and Marxian economics, the labor theory of value (LTV) that explained value of goods and services by amount of human labor was used not only as an analytical concept, but at the same time functioned as a conceptual device in order to argue their labor morality. In short the LTV is understood as ‘He who does not work, neither shall he eat.’ In Japan this normative concept was incorporated as the basis of the constitution and social welfare policy in which the right to live was determined as accompanied by the obligation to work and then played an important role together with traditional labor philosophy mainly influenced by Buddhism. Due to the paradigm shift, the classical LTV describing industrial capitalism became unable to explain today’s economic situation and also ended its role as a moral law. Accordingly values on not working should be changed. The right to live has to be separated from the obligation to work clearly.

　　Recently medical genetics has made remarkable progress and the use of comprehensive genome analysis is becoming more common in both research and medical care. One of the problems raised by this technology is, however, the issue of how to deal with incidental findings and secondary findings.

　　Thus far, this issue has only been discussed in terms of whether such findings ought to be returned to the patient/subject or to the patient/subject’s genetic relatives. The question of handling findings concerning certain disorders which may affect the safety of third parties, has not been discussed. We can imagine a situation where a condition is discovered in an otherwise healthy patient/subject that has the potential to occur without warning, bringing about a loss of consciousness or even death. In this case, if the patient/subject were, for example, driving a car, not only that person’s life, but the lives of those around could be endangered.

　　 In this paper I will examine some of the issues related to cases in which incidental findings or secondary findings may adversely affect the safety of third parties and how we might deal with these situations. Even though such cases may occur in both research and clinical contexts, for the purposes of this paper I will focus on clinical situations in which a contractual relationship between doctor and patient exists.

　　Various methods have been proposed to work out tentative and plausible solutions for ethical issues in individual cases in clinical settings. As one of these methods, this paper focuses on hermeneutical approaches, which have received little attention in Japan. Their characteristics and challenges are explored and compared with other methods. Hermeneutical approaches regard a given case as a story rather than an ethical issue, and do not rush to find solutions; instead, they deliberately deepen the understanding of the case. The approach was first developed at the Department of Philosophy, Radboud University Nijmegen, around 1990. Their way starts with intuitive grasping of the case, conducting narratological analysis and referencing of ethical concepts, and finally re-examining the initial intuition. Standing in a position close to them in broad terms, the author, however, considers the process of referring to ethical concepts unnecessary, and has constructed another form of hermeneutical approach that requires literary imagination and the ability to raise heuristic questions thoroughly. The author’s method does not set fixed questions in advance but lets the deliberation flow dynamically, depending on the case’s unique circumstances. Because of this, it is difficult to formulate. However, the author attempts to illustrate his method in a semi-formulaic form. In any case, conducting an ethical analysis using a hermeneutical approach requires a reasonable level of literary imagination for each participant. One may think that it is an excessive expectation to demand literary imagination from medical professionals, and that the prevalent schematic methods that do not require imagination are sufficient and easier to use. However, if a person with poor literary imagination, whether a medical professional or an ethics consultant, tries to tackle a clinical ethics issue using any method, we should say that it would be an undesirable or harmful attempt.