In 1999 the second heart transplantation was performed in Japan, 31 years after the first operation held in 1968. Several academic topics in terms of bioethics have yet to be solved. We have to make clear theoretically (1) who posseses organs of a brain dead human being, (2) what is private ownership at all, (3) how macro and micro politics works over a brain dead body, (4) what is the ontological essence of a brain dead being lying before the family members, and (5)the relationship between brain death and ecology.

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Constitution of many countrys are used to state the dignity of an individual. Then does a person have a right to a genetically unique nature? If genetically identical persons violate the right to a genetically unique nature each other, then to produce twins is to be forbiden. Twin babies grow under the almost same environmental conditions. But clone babies grow under the completely different environmental conditions. A clone person and the original person can not have identical traits even if they have identical genetic make-up (DNA). A clone-baby-prohibitionist claims that to intend to have a clone-baby is faul bacause both the intentionality of the process and the violation of uniqueness stand in this case, while to intend to have twin babies is legal bacause the naturality of the process stands even if the violation of uniqueness stands. He thinks that identical genetic make-up (DNA) violates the right to have a genetically unique nature only when the process be intentional.

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The characteristics of informed consent in occupational health practice is described mainly from the legal point of view. It is indicated that the practice of informed consent for workers is difficult under the present Industrial Safety and Health Act in Japan. Under this act the responsibility of employers for safety and health of workers is regarded as the most important it does not ensure the legal independency of occupational physicians in the company. In particular, there is the possibility that the genetic screening in the workplace will induce serious ethical problems to workers in the near future. In this paper, I discuss the methods to solve these ethical problems in occupational health, and introduce an ethical guideline for occupational physicians.

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A Law Concerning the Transplantation of Organs was enacted on 16 Oct. 1997 in Japan. In this law a "brain dead" patient is considered dead only in the case of organ donation, but in otherwise is still considered alive. From a practical standpoint I would like to propose that brain death can be determined by different standards, according to the following purposes : (1) Organ donor patients should be diagnosed by the Takeuchi criteria (The Brain Death Advisory Council in the Ministry of Health and Welfare). (2) in case of withdrawal of life-support, a physician is able to make a decision by the determination of no brain-stem reflexes without relying on EEG. (3) a physician able to make a decision for aggresive treatment of severely brain-injured patient on the basis of several brain-stem reflex tests. (4)a physician would not diagnose brain death when the patient's family does not accept the patient's death.

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The purpose of this paper is to demonstrate how to resolve the conflicts between various plural ethical principles in the clinical setting. The following three elements were discussed. First, ethical decision-making requires principles which are universalizable as a minimal condition. We believe that a principle which allows for double standards has to be abandoned. Even widely accepted traditional principles suggest be discarded when they allw biased and arbitrary conclusions. Second, sound ethical consideration requires us to regard general ethical principles as prima facie. An ethical dilemma would never be untangled when a given principle is considered absolute and overriding. Neither of sanctitiy of life nor autonomy should be held as an unblemished norm under any circumstances. Third, rational and consistent preferences of patients should be deemed as the ground of moral judgements. Patient's preference must be medically relevant, well informed and stable. The most appropriate principle should maximize the extent of preference-satisfaction of patients. We have to choose one principle from several conflicting ones based on the probability to bring out the best consequence, i.e., the maximal satisfaction of patient's preferences in the clinical setting. Recent clinical studies conducted in Japan showed that individualistic and autonomy-based western moral theories cannot fully solve ethical problems. Our traditional partial and relation-based morality has also failed to prevent patients from agonising unnecessary physical and psychological predicaments. Therefore, it is crucial to know the health care Japanese people really desire and determine which ethical principle to employ to fulfil their preferences.

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One of the major themes of bio-ethics is to defend human dignity. But the concept of what makes up the idea is obscure. The aim of this paper is to give the new difinition of human dignity. Traditionally the idea was based mainly upon the concept of reasonable autonomy described by Immanuel Kant. Indeed this idea has taken a crucial role in the making of our modern civil society. Thus a person who has such reasonable autonomy should have the right and duty to participate in the society. But the concept cannot be applied to such rights as the right to live, because these rights were employed to be also given to those who neither have such autonomy nor claim the right. These rights have their base upon the other meaning of human dignity, but so far about the meaning no consensus was reached. This situation around human dignity caused confused discussions typically in so called "person-argument" by Michael Tooly or Tristram Engelhardt. Hans Jonas insists on making responsibility a new ethical principle. According to him, this capability of human beings, compared with those of other living creatures on earth, is specific to human beings. This specificity lies in that it obliges itself to make itself continue. That is, those who now have the capability to take responsibility also have the duty to be responsible for those who will have the capability in the future. This principle protects in advance those who are not yet in our present society. We can make the capability of responsibility the new definition of human dignity and apply this as principle to our present problems of bio-ethics.

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The aim of this essay is to analyze problems implicated in the discourse of "communitarian bioethics" in Japanese society. It suggests cultural differences underlying the present situation, and it advocates respect for the cultural values implicit in medical practice. Such a discourse could, however, easily hide many problems, for example paternalistic attitudes of medical doctors and the negligenece of patients' right, which are closely related with Japanese cultural tradition. The main idea of communitarianism, discussed in the 1980's in North America was the critic to the excessive individualistic tendency in society. This was a critical version to individualistic liberalism. And in the context of bioethics, this idea was used to criticize a principle-based bioethics, which was dominant at that time. But, concerning communitarian bioethics discourse in Japan, one can remark on the tendency to defend the Japanese cultural tradition, based on a misunderstanding of the original "communitarian" claim. Communitarian bioethics can contribute to the development of the study of bioethics, which has been influenced too much by "principlism" thought. In order to estimate communitarian bioethics in Japan, we must release it from nationalistic thought.

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In Japan, there is no law to restrict research institutions directly as far as their environmental effects are concerned. So, if the standard of the Building Standards Act is fulfilled, an OK-sign is issued to any institution building plan. I have the view, however, that even though there is no legal problem, people living in the neighborhood of the institutions must have not a small anxiety and concern about their environment as well as much stress. There are a maunder of movements and campaigns across the country against the construction of such institutions. In my paper, I will raise some examples of such movements to reconsider the current relations between scholoars' research institutions and their surroundings. Then, I will make a few suggestions on the relationship. The main point of the suggestions consists of the scholoars' and institutions' "explanation" and the inhabitants' "consent". In other words, the former owes the latter an obligation to secure an environmental safety. The former needs to keep the global standard of Laboratory Biosafety Manual 1993 by WHO strictly when they go on with their studies. They are also requested to work together with the latter for the improvement of proper legal adjustments by state. This will result, in my view, in that the inhabitants' campaign against the construction of the research institutions will end peacefully and will lead to a stable co-existance of smooth research activities by scholars and environmental safety for the inhabitants.

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Right can be defined as "socially admitted desire". Because it can be expressed as desire which should be controlled from an ethical point of view, right is partly incompatible with ethics. Right is a concept based on individualism and liberalism, and it aims to realize liberty of an individual. By asserting rights without restriction, total benefits are often neglected. Concerning ourselves about enviromental disruption and shortages of natural resources resulting from the unrestricted pursuit of human rights, rights should be restricted partly, and totalitarianism on a global scale is needed. In old Indian ethics, ethical rules are composed of inhibiting commandments and recommending encouragements, and right belongs to inhibiting one. By this distinction, proper assertion of rights is thought to be achieved. And by regulating rights in a group unit, especially in a family unit, ethical state which aims at total benefit for all parties may be achieved.

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Advancement in medical knowledge and technology, together with social and political changes, makes it important for nurses to have a special role in providing rights for patients. Until recently, nursing students have received little ethical education. So nurses as professionals are often confronted with and perplexed by various ethical issues in nursing practice. To solve this problem, we established an elective course entitled "Nursing Ethics" for 1 st year students in 1997. We chose teaching methods and materials out of consideration for student's learning need. The students have evaluated this course, but it is just the start of ethical education in nursing at this school. So, we hope that they will continue to think about ethical issues.

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In Japan, the general ideas of informed consent was introduced into the medication about ten years ago. We think that the custom of paternalism and omakase-coping is established in Japan even now. In order to sound the problem with the patient-medical profession relationship, we examined the cognition of the citizens and the medical staffs concerning informed consent. As a result, the citizens expects a medical profession to carry out an interaction, for example, a doctor answers the question. It is especially in the group of the females and the younger generation and the persons who had experience of admission into the hospital. The medical staffs thinks that the explanation to a patient is important, but they are indifferent to interact with a patient. It is especially in the group of the doctors. So that we draws the conclusion that the medication with the self-determination of the patent is not yet established in Japan. We thinks that the system of informed consent is one way and one step for the medication with patient's right. Both the patient and the medical profession, the need for communication literacy is keenly felt.

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The concept of palliative care has been well recognized, and emphasizes the importance of physical-psychological-spiritual care for patients in Japan who are in advanced and terminal stages of cancer. Sometimes sedation is performed for intractable symptoms. Patients who had sedation are free from pain and suffering, however there are many ethical issues. In 1997,the Clinical Ethics Committee of Higashi Sapporo Hospital developed Ethical Guidelines for Sedation of patients in terminal stages of cancer, which was based on literature review and experiences in clinical practice in our hospital. Sedation was defined as a medical procedure for relieving patient's distress by reducing the level of consciousness. The Ethical Guidelines include three requirements and eight items for attention.

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Questionnaire surveys were carried out to investigate the change on consciousness of students for brain death and organ transplantation during 5 years from 1992 to 1997. The results showed that, many students did not wish to start the organ transplantation act without prudent consideration, although they approved establishment of the organ transplantation act. There were increases of students who approve brain death and organ transplantation, and wish to have an operation with organ transplantation, while there was a decrease of students who approve family's brain death. There was no change in results on reliance for medical doctor and informed consent. From this study, it was indicated that providing sufficient information and training for total judgement should be required to make a decision on brain death and organ transplantation.

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The purpose of this study was to investigate factors influencing cognition of University students on brain death and organ transplantation. Questionnaire surveys were conducted among University students in 1992 and 1997. The students who accept brain death as the death of human being tended to agree with promotion of organ transplantation, provide their own organs in brain death and accept their family's brain death. More female students agreed with organ transplantation and allowed to provide their orgain in brain death than male students, but female students who did not accept brain death tended to refuse providing their organs. The proportion of students who agree with promotion of organ transplantation increased from 1992 to 1997. Male students who provide their own organ in brain death increased, but such female students decreased during the period. The same tendency was found for cognition on brain death of a family.

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The aim of this paper is to discuss the "cost", which is a problem common to environmental ethics and bioethics, and to think about the sustenance of our life-sphere in terms of our readiness to share the cost. Environmental economics says, "External diseconomy should be internalized." But from the fundamental viewpoint of environmental ehics, we have to make sure that there is no "external" area in global environment and that as the responsibility-sharer, ordinary civil consumers should also play a part. We need to gain an insight into the discriminative structure between developed nations and developing nations, or between city dwellers and rural dwellers. And we need to have a perspective for the global environment, taking root in our local life. At the same time, we need to play a part in environmental self-government of our living place, being ready to share the cost. These days, the beginnings of such contribution can be seen in some local areas. Speaking of bioethics, the cost-benefit theory about the prenatal diagnosis leads to a risky possibility that we may reduce our choice of existence by cutting down forcedly the cost, which should have been shared between us. I think we should consider bearing what I call "the cost of security of our life-sphere" as the expenses to sustain our inner and outer environment of life.

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[in Japanese]

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Because prenatal diagnosis is inseparable with abortion, the choice to receive prenatal diagnostic tests can only be made by the patient or by the patient and her partner. Prenatal counseling serves as a very important part of aiding in the autonomous decision-making process. There is a difference between explaining the facts in order to reach an agreement to take prenatal diagnostic tests and counseling. Not only does prenatal counseling allow for the providing of important information, but it also provides necessary psychological and emotional support during the decision-making process. As for the medical services, many worries would be relieved if enough information about the disorders and diagnoses were given to the patient. The giving of sufficient information often produces the counseling effect. However, that alone would be insufficient. Prenatal counseling is incomplete without providing the patient with a connection to support groups dealing with related issues. A system in which the patient or the patient and her partner are provided with well-balanced support is necessary for effective counseling to take place.

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Since the judgement of Slater v. Stapleton in 1767,the following principles have been established on the basis of an accumulation of judicial precedents. A competent patient may withdraw or suspend treatment according to the doctrine of self-determination. Decisions relating to medical treatment on behalf of a mentally incapacitated adult patient should be made in the patient's best interests as determined by established medical practice. In England, there is no right to die, but a principles exists of self-setermined withdrawal from or withholding of medical treatment, even if this shortens life as a result. However, a consensus on the questions of treating mentally incapacitated adults is still being sought. I will investigate the following points : 1. Principles established through judicial precedents 2. Views of the judiciary and government 3. Views of the British Medical Assosiation and I will look into the question of legalising therapy abatement for menatlly incapacitated patients.

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This paper considers the relationship between consumer education and bioethics (or bioethics education). There are two main reasons why consumer education has a connection with bioethics. The first important thing is that ; both consumer education and bioethics will have to deal with the problem of cost of medical treatments. The second reason is that because consumer education has an ideal to reconstruct of the environment and lifestyles, consumer education has to construct a reasonable medical situation. If we extend consumer education into a medical field such as decisionmakings of patients regarding to cost and ethics, we can find a great possibility of both consumer education and bioethics. The connection between the two is of great importance because although the great existence of global environmental problems is getting more and more serious the spontaneous limitation of consumption is never actualized yet. If we can find a real meaningful connection of the two in the pedagogical aspect, we will be able to have a strong orientation of consumer education with bioethics and find a new way of education. The orientation will be based on consumption ethics. This is the first thesis in which the relationship between the two is discussed, therefore the success of this paper depends on whether the readers can understand the rich possibility of consumer education.

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The purpose of this study was to give stimulatory words to students, to have them report scenes of nursing evoked by the words, to analyze them, and evaluate the view point of nursing ethics to assess the students' understanding of the purpose of clinical teaching of nursing. A questionnaire presenting 19 words was distributed to 18 nursing students at the end of basic clinical teaching of nursing, and they were asked to describe impressive scenes of nursing that they had encountered during the teaching. Scenes evoked by 17 words (80 cases) were reported. There were many reports concerning "working hard (ganbaru)", "heart (kokoro)", "irresponsibility (musekinin)", "pleasantness (sawayaka)", "adversity (kuro)", and "perseverance (gaman)". The students appeared to have described information based facts and understood patients through comprehension of situation. These instinctive responses of nursing students, who are in the process of establishing nursing ethical concepts, suggest that clinical teaching of nursing at hospitals intended to teach students to understand patients as intergrated persons and how to improve their QOL is an effective setting for nursing ethics education.

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There is an argument that a human being must have self-consciousness as a necessary condition in order to be a subject of the right to existence, and that the death of a being which does not meet this condition is permitted to be caused. This argument is called "person argument" or "personality argument." (Kurata) The standpoint which "person argument" sets as a premise, in other words, the way the viewpoint toward human being is set has a big fefect, and "the human being as an existence that weaves sories" is proposed instead. (Hamano) This viewpoint overlaps whith the knowlege of human genetics. On the other hand, it is said that the entire picture of the human genom analysis project which is being carried out at present throughout the world will be revealed by 2003. This shows that the gene diagnosis has become familiar to ordinary patients. The cells of an individual has the same gene ; the gene does not change from the fertilized egg ; the blood relatives share the common gene. (Fukushima) An empirical study on "gene and personality" has been made in this thesis.

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