BackgroundFew comparative studies of clinical ethics consultation practices have been reported. The objective of this study was to explore how American and Japanese experts analyze an Alzheimer's case regarding ethics consultation.MethodsWe presented the case to physicians and ethicists from the US and Japan (one expert from each field from both countries; total = 4) and obtained their responses through a questionnaire and in-depth interviews.ResultsEstablishing a consensus was a common goal among American and Japanese participants. In attempting to achieve consensus, the (...) most significant similarity between Japanese and American ethics consultants was that they both appeared to adopt an "ethics facilitation" approach. Differences were found in recommendation and assessment between the American and Japanese participants. In selecting a surrogate, the American participants chose to contact the grandson before designating the daughter-in-law as the surrogate decision-maker. Conversely the Japanese experts assumed that the daughter-in-law was the surrogate.ConclusionOur findings suggest that consensus building through an "ethics facilitation" approach may be a commonality to the practice of ethics consultation in the US and Japan, while differences emerged in terms of recommendations, surrogate assessment, and assessing treatments. Further research is needed to appreciate differences not only among different nations including, but not limited to, countries in Europe, Asia and the Americas, but also within each country. (shrink)

Healthcare professionals must make decisions for patients based on ethical considerations. However, they rely on clinical ethics consultations (CEC) to review ethical justifications of their decisions. CEC consultants support the cases reviewed and guide medical care. When both healthcare professionals and CEC consultants face ethical problems in medical care, how is their judgment derived? How do medical judgments differ from the ethical considerations of CECs? This study examines CECs in Japan to identify differences in the ethical judgment of clients and (...) CEC consultants. (shrink)

1. Hōriron -- 2. Hōshisō -- 3. Jitteihō no kiso riron.

Collection of texts published previously.

This research examines the current status of clinical ethics consultation (CEC) in Japan through a nationwide study conducted with chairs of ethics committees and clinical ethics committees among 1028 post-graduate clinical teaching hospitals. We also qualitatively analyzed their viewpoints of the CEC’s benefits and problems related to hospital consultation services to identify the critical points for CEC and inform the development of a correctly functioning system. The questionnaire included structured questions about hospital CEC organization and service purpose and operation and (...) open-ended questions about the benefits and problems of initiating CEC. The questionnaire comprised the presence/absence of an ethics committee, CEC services and membership when services were implemented, users, and the number of cases handled since inception. In addition, the respondents also provided their impressions of the CEC system’s impact on their hospital by describing (a) the benefits of CEC services and (b) the ineffectual or harmful aspects of the CEC system. Qualitative data were examined using qualitative content analysis to determine the impact of establishing a CEC and the difficulties of practice. One hundred twenty-five questionnaires were returned from either the chair of the ethics committee or clinical ethics committee in teaching hospitals. Of these, 90 (72%) reported they provided CEC services. Additionally, 36 respondents (34.6%) reported that their existing research and clinical ethics committees had conducted CEC services, and 35 (33.7%) reported having a newly established clinical ethics committee conducting CEC services. Three positive effects of establishing and four challenges in managing CEC were also identified. (shrink)

Our aim in this article is to define the difficulties that clinical ethics services encounter when they are asked to demonstrate the value a clinical ethics service (CES) could and should have for an institution and those it serves. The topic emerged out of numerous related presentations at the Un- Conference hosted by the Cleveland Clinic in August 2018 that identified challenges of articulating the value of clinical ethics work for hospital administrators. After a review these talks, it was apparent (...) that the field of clinical ethics may be at a crisis of sorts due to increased pressure to provide explicit measures to healthcare institutions to concretely demonstrate that CESs make a valuable difference in healthcare delivery. In this article, we grapple with how to satisfy the need for demonstrable value in a field in which metrics alone may not capture the scope of clinical ethics practice. We suggest that capturing the value of a CES has been difficult because the benefits of ethics consultation may be overt or attributable to the CES, but are often hidden due to the systems-level and process-oriented nature of clinical ethics work. Part of the difficulty in demonstrating the value of CESs is capturing and conveying all of the ways the integration of a CES throughout an institution positively affects patients, families, visitors, healthcare professionals, administrators, and the institution itself. Our aim is to (1) elucidate the multifaceted value added by a CES, including value that tends to be hidden and (2) suggest how to demonstrate value to others in a way that is not simplistic or reductionistic. (shrink)

I have first translated Sein und Zeit in Japanese in 1971 in collaboration with my elder colleague Prof. Hara in Tokyo. But in 1976 both he and Martin Heidegger died, and in 1977 a new edition of Sein und Zeit was published as part of Heidegger’s complete works. This new edition included many marginal notes of Heidegger’s and many textual revisions made by Heidegger himself. Therefore, I have published in 2003, based on the old version of my Japanese translation, a (...) totally revised Japanese translation of Sein und Zeit, in which, as translator, I have written a new introduction, many explicatory notes about Heidegger’s marginal notes and textual modifications and a chronological detailed record of Heidegger’s career. Out of this experience, I would like to detail upon two aspects: first, any nowadays reader of this work must study not only the original text itself, but also, by all means, Heidegger’s marginal notes, in order to correctly grasp a development of his thought on Being. Secondary, a reader must especially pay attention to the difficult problem of the relationship between authenticity and inauthenticity of the Being-in-the-world, because here is the most basic problem of the existence of Dasein and it is here the place where the turning point in Heidegger’s later thought on Being has its origin. (shrink)

Is a genuinely consilient concept of human culture possible? I identify some of the major stumbling blocks that prevent mutual illumination between the humanities and evolutionary sciences. Whereas the sciences are often concerned with predictive averages, the arts draw attention to "outliers" that defy general trends. The solution is not to disregard these outliers, but rather to understand the open-ended processes that, by design, produce startling variations. Such open-endedness is an essential part of the evolutionary story, not an insignificant byproduct. (...) Conversely, humanistic scholars have much to gain by engaging, rather than spurning, the evolutionary framework. (shrink)

1. Katachi no odissei -- 2. Rinshō no chi -- 3. Aku no tetsugaku nōto 4. Zōho 21-seiki mondaigun ; Jutsugoshū II -- 5. Shūkyō to kagaku; Jinruichi shō -- 6. Shinpen Nihon bunka ni okeru aku to tsumi ; Shōnenba -- 7. Jutsugoteki sekai to seido -- 8. Seishin no fūga -- 9. Shinpen Pasukaru to sono jidai -- 10. Shinpen kindai Nihon ni okeru seido to shisō.

Hospital ethics committees (HECs) are expected to play extremely broad and pivotal roles such as case consultation, education of staffs on healthcare ethics, and institutional policy formation. Despite the growing importance of HECs, there are no standards for setup and operation of HECs, and composition and activities of HECs at each institution are rarely disclosed in Japan. In addition, there is also a lack of information sharing and collaboration among HECs. Therefore, the authors established the Consortium of Hospital Ethics Committees (...) (CHEC) in October 2020, which has been regularly hosting a couple of core activities. One is the Healthcare Ethics Forum, held monthly online for CHEC members to freely discuss HECs and healthcare ethics consultation. The other is the Collaboration Conference of Hospital Ethics Committees, intended to provide a place for HEC members and administrative officers from across Japan to exchange information of their HECs, learn from each other, and cooperate to operate HECs appropriately. In this paper, the authors introduced CHEC as well as reported the results of a questionnaire survey conducted at the first conference among participating facilities, suggesting the diverse structures and activities of HECs in Japan. (shrink)

Kōzō to kaishaku -- Ei-Bei tetsugaku nyūmon -- Bākure ni okeru shisō taiken -- Ryōkai ni teuite -- Gendai ni okeru sonzai no mondai.