In Japan, where a prominent gap exists in what is considered a patient’s best interest between the medical and patient sides, appropriate decision-making can be difficult to achieve. In Japanese clinical settings, decision-making is considered an act of choice-making from multiple potential options. With many ethical dilemmas still remaining, establishing an appropriate decision-making process is an urgent task in modern Japanese healthcare. This paper examines ethical issues related to shared decision-making (SDM) in clinical settings in modern Japan from the psychocultural-social (...) perspective and discusses the ideal decision-making process in present Japan. Specifically, we discuss how five psychocultural-social tendencies – “surmise (Sontaku),” “self-restraint (Jishuku),” “air (atmosphere or mood, Kuuki),” “peer pressure (or tuning pressure, Docho-Atsuryoku),” and “community (Seken)”—which have often been referred to as characteristics of present-day Japanese people, may affect the ideal practice of SDM in Japanese clinical settings. We conclude that health care professionals must be aware of the possible adverse effects of the above Japanese psychocultural-social tendencies on the implementation of SDM and attempt to promote autonomous decision-making, thereby allowing patients to make treatment choices that sufficiently reflect their individual and personal views of life, experiences, goals, preferences, and values. (shrink)

In a sense, all technology is biotechnology: machines interacting with human organisms. Technology is designed to overcome the frailties and limitations of human beings in a state of nature -- to make us faster, stronger, longer-lived, smarter, happier. And all technology raises questions about its real contribution to human welfare: are our lives really better for the existence of the automobile, television, nuclear power? These questions are ethical and political, as well as medical; and they even reach to the philosophical (...) and spiritual. On the whole, we seem pretty well adapted to our technology, at least on the face of it -- but there have always been doubts about whether the human soul thrives best in the oppressively technological world we have created for ourselves. (I am continually struck by how much time I have to spend fixing the machines that supposedly improve my life.). (shrink)

Kojin Karatani wrote the essays in _History and Repetition_ during a time of radical historical change, triggered by the collapse of the Cold War and the death of the Showa emperor in 1989. Reading Karl Marx in an original way, Karatani developed a theory of history based on the repetitive cycle of crises attending the expansion and transformation of capital. His work led to a rigorous analysis of political, economic, and literary forms of representation that recast historical events as a (...) series of repeated forms forged in the transitional moments of global capitalism. _History and Repetition_ cemented Karatani's reputation as one of Japan's premier thinkers, capable of traversing the fields of philosophy, political economy, history, and literature in his work. The first complete translation of _History and Repetition_ into English, undertaken with the cooperation of Karatani himself, this volume opens with his innovative reading of _The Eighteenth Brumaire of Louis Bonaparte_, tracing Marx's early theoretical formulation of the state. Karatani follows with a study of violent crises as they recur after major transitions of power, developing his theory of historical repetition and introducing a groundbreaking interpretation of fascism (in both Europe and Japan) as the spectral return of the absolutist monarch in the midst of a crisis of representative democracy. For Karatani, fascism represents the most violent materialization of the repetitive mechanism of history. Yet he also seeks out singularities that operate outside the brutal inevitability of historical repetition, whether represented in literature or, more precisely, in the process of literature's demise. Closely reading the works of Oe Kenzaburo, Mishima Yukio, Nakagami Kenji, and Murakami Haruki, Karatani compares the recurrent and universal with the singular and unrepeatable, while advancing a compelling theory of the decline of modern literature. Merging theoretical arguments with a concrete analysis of cultural and intellectual history, Karatani's essays encapsulate a brilliant, multidisciplinary perspective on world history. (shrink)

Ever since its first publication in 1992, The End of History and the Last Man has provoked controversy and debate. Francis Fukuyama's prescient analysis of religious fundamentalism, politics, scientific progress, ethical codes, and war is as essential for a world fighting fundamentalist terrorists as it was for the end of the Cold War. Now updated with a new afterword, The End of History and the Last Man is a modern classic.

Variation in decision-making about end-of-life care among ethnic groups creates clinical conflicts. In order to understand changes in preferences for end-of-life care among Japanese who immigrate to the United States, we conducted 18 focus groups with 122 participants: 65 English-speaking Japanese Americans, 29 Japanese-speaking Japanese Americans and 28 Japanese living in Japan.Negative feelings toward living in adverse health states and receiving life-sustaining treatment in such states permeated all three groups. Fear of being meiwaku, a physical, psychological or financial caregiving burden (...) on loved ones, was a prominent concern. They preferred to die pokkuri (popping off) before they become end stage or physically frail. All groups preferred group-oriented decision-making with family. Although advance directives were generally accepted, Japanese participants saw written directives as intrusive whereas Japanese Americans viewed them mainly as tools to reduce conflict created by dying person's wishes and a family's kazoku no jo– responsibility to sustain the dying patient. These findings suggest that in the United States Japanese cultural values concerning end-of-life care and decision-making process are largely preserved. (shrink)

Francis Fukuyama is one of the most significant political theorists of the past thirty years. Bursting into public awareness in 1989 with his provocative thesis about "the end of history," Fukuyama has made fascinating contributions to a wide range of subjects - the importance of trust in societies, the potential dangers of biotechnology, the development of political authority and the modern state, and most recently, the role of identity in politics. This book records a series of conversations with (...) Fukuyama in which he discusses his background and its role in shaping his thinking, the context and genesis of his major works, and his thoughts in light of the dramatic developments of the past decade, especially the rise of populism around the world. The result is a fascinating picture of a major intellectual. The book both provides an overview of Fukuyama's thought and reveals new insights into his best-known work. This book also allows readers to trace the themes which have animated Fukuyama's entire intellectual career. (shrink)

Background Evidence concerning how Japanese physicians think and behave in specific clinical situations that involve withholding or withdrawal of medical interventions for end-of-life or frail elderly patients is yet insufficient. Methods To analyze decisions and actions concerning the withholding/withdrawal of life-support care by Japanese physicians, we conducted cross-sectional web-based internet survey presenting three scenarios involving an elderly comatose patient following a severe stroke. Volunteer physicians were recruited for the survey through mailing lists and medical journals. The respondents answered questions concerning (...) attitudes and behaviors regarding decision-making for the withholding/withdrawal of life-support care, namely, the initiation/withdrawal of tube feeding and respirator attachment. Results Of the 304 responses analyzed, a majority felt that tube feeding should be initiated in these scenarios. Only 18% felt that a respirator should be attached when the patient had severe pneumonia and respiratory failure. Over half the respondents felt that tube feeding should not be withdrawn when the coma extended beyond 6 months. Only 11% responded that they actually withdrew tube feeding. Half the respondents perceived tube feeding in such a patient as a "life-sustaining treatment," whereas the other half disagreed. Physicians seeking clinical ethics consultation supported the withdrawal of tube feeding (OR, 6.4; 95% CI, 2.5–16.3; P < 0.001). Conclusion Physicians tend to harbor greater negative attitudes toward the withdrawal of life-support care than its withholding. On the other hand, they favor withholding invasive life-sustaining treatments such as the attachment of a respirator over less invasive and long-term treatments such as tube feeding. Discrepancies were demonstrated between attitudes and actual behaviors. Physicians may need systematic support for appropriate decision-making for end-of-life care. (shrink)

Francis Fukuyama's controversial new book, Our Posthuman Future: Consequences of the Biotechnology Revolution, has elicited varied reactions, but like it or not, it seems likely to be influential. Here are three opinions. —Ed.

Kojin Karatani wrote the essays in _History and Repetition_ during a time of radical historical change, triggered by the collapse of the Cold War and the death of the Showa emperor in 1989. Reading Karl Marx in an original way, Karatani developed a theory of history based on the repetitive cycle of crises attending the expansion and transformation of capital. His work led to a rigorous analysis of political, economic, and literary forms of representation that recast historical events as a (...) series of repeated forms forged in the transitional moments of global capitalism. _History and Repetition_ cemented Karatani's reputation as one of Japan's premier thinkers, capable of traversing the fields of philosophy, political economy, history, and literature in his work. The first complete translation of _History and Repetition_ into English, undertaken with the cooperation of Karatani himself, this volume opens with his innovative reading of _The Eighteenth Brumaire of Louis Bonaparte_, tracing Marx's early theoretical formulation of the state. Karatani follows with a study of violent crises as they recur after major transitions of power, developing his theory of historical repetition and introducing a groundbreaking interpretation of fascism as the spectral return of the absolutist monarch in the midst of a crisis of representative democracy. For Karatani, fascism represents the most violent materialization of the repetitive mechanism of history. Yet he also seeks out singularities that operate outside the brutal inevitability of historical repetition, whether represented in literature or, more precisely, in the process of literature's demise. Closely reading the works of Oe Kenzaburo, Mishima Yukio, Nakagami Kenji, and Murakami Haruki, Karatani compares the recurrent and universal with the singular and unrepeatable, while advancing a compelling theory of the decline of modern literature. Merging theoretical arguments with a concrete analysis of cultural and intellectual history, Karatani's essays encapsulate a brilliant, multidisciplinary perspective on world history. (shrink)

This paper describes an automatic monitoring system that constantly checks partial update in Web pages and notifies them to a user. While one of the most important advantages of the WWW is update of Web pages, we need to constantly check them out and this task takes much cognitive load. Thus applications to automatically check update of Web pages have been developed, however they can not deal with partial update like update in a particular cell in a table in a (...) Web page. Hence we developed a automatic monitoring system that checks such partial update. A user can give a system regions in which he/she wants to know the update in a Web page as training examples, and it is able to learn rules to identify the partial update by classification learning. By this learning, a user do not need to directly describe the rules. We implemented our system and some executed examples were presented. (shrink)

In this paper, we develop an organization method of page information agents for adaptive interface between a user and a Web search engine. Though a Web search engine indicates a hit list of Web pages to user’s query using a large database, they includes many useless ones. Thus a user has to select useful Web pages from them with page information indicated on the hit list, and actually fetch the Web page for investigating the relevance. Unfortunately, since the page information (...) on a hit list is neither sufficient nor necessary for a user, the adequate information is necessary for valid selection. However which information is adequate depends on a user and a task. Hence we propose adaptive interface AOAI in which different page information agents are organized through man-machine interaction. In AOAI, the page information agents indicating different page information on a hit list like the file-size, network traffic and a page title are prepared at first. A user evaluates them through searching with a search engine, and the agents are organized based on the evaluation. As results, different organizations are achieved depending on a user and a task. Finally we make experiments with subjects and find out AOAI is promising for adaptive interface between a user and a search engine. (shrink)

Approximately one in two hundred persons in the Marshall Islands have active tuberculosis. We examine the historical antecedents of this situation in order to assign ethical responsibility for the present situation. Examining the antecedents in terms of Galtung’s dialectic of personal versus structural violence, we can identify instances in the history of the Marshall Islands when individual subjects made decisions with large-scale ecologic, social, and health consequences. The roles of medical experimenters, military commanders, captains of the weapons industry in particular, (...) and industrial capitalism in general are examined. In that, together with Lewontin, we also identify industrial capitalism as the cause of tuberculosis, we note that the distinction between personal versus structural violence is difficult to maintain. By identifying the cause of the tuberculosis in the Marshall Islands, we also identify what needs be done to treat and prevent it. (shrink)

In the past thirty years, the United States has undergone a profound transformation in its social structure: Crime has increased, trust has declined, families have broken down, and individualism has triumphed over community. Has the Great Disruption of recent decades rent the fabric of American society irreparably? In this brilliant and sweeping work of social, economic, and moral analysis, Francis Fukuyama shows that even as the old order has broken apart, a new social order is already taking its place. (...) The Great Disruption forges a new model for understanding the Great Reconstruction that is under way. (shrink)

Anthropomorphic agents used in online-shopping need to be trusted by users so that users feel comfortable buying products. In this paper, we propose a model for designing trustworthy agents by assuming two factors of trust, that is, emotion and knowledgeableness perceived. Our hypothesis is that when a user feels happy and perceives an agent as being highly knowledgeable, a high level of trust results between the user and agent. We conducted four experiments with participants to verify this hypothesis by preparing (...) transition operators utilizing emotional contagion and knowledgeable utterances. As a result, we verified that users' internal states transitioned as expected and that the two factors significantly influenced their trust states. (shrink)

Clinical ethics support, including ethics consultation, has become established in the field of medical practice throughout the world. This practice has been regarded as useful, most notably in the UK and the USA, in solving ethical problems encountered by both medical practitioners and those who receive medical treatment. In Japan, however, few services are available to respond to everyday clinical ethical issues, although a variety of difficult ethical problems arise daily in the medical field: termination of life support, euthanasia and (...) questions about patient autonomy. In light of these conditions, a group of 17 volunteer educators and researchers from the area of biomedical ethics, including the authors, have formed the Clinical Ethics Support and Education Project, and began providing Japan’s first small team clinical ethics consultation service in October, 2006. Members include scholars of biomedical ethics, scholars of philosophy and ethics, legal professionals and legal scholars, nurses and doctors, consisting of five women and 12 men. Consultation teams, made up of a small number of members, were organised each time a request for consultation was received. Over approximately 15 months (October 2006–December 2007), the programme received 22 consultation requests from medical practitioners and medical institutions, and three from the families of patients. In this paper, we will discuss the status of our consultation service and examples of consultation cases we have handled. In addition, we will examine the process of evaluating small team clinical ethics consultation services, as well as the strengths and weakness of such programmes. (shrink)

This paper considers the efficiency of the political market in the California State legislature. I analyzed the property tax limitation voter initiative, Proposition 13. I found that districts which supported Proposition 13 more strongly were more likely to oppose the incumbents regardless of whether the incumbents had the different preferences for property taxes from their districts. I also studied how legislators voted on the bills adopted after the passage of Proposition 13 to finance local governments. I found that legislators tended (...) to follow the constituents tax-cutting message expressed by the passage of Proposition 13. (shrink)

This paper considers a monthly pattern in government spending. I have found that public spending increases at the end of the fiscal year for both the Japanese central government and the US federal government and that the effects are stronger in recent years than in the past. I then propose two hypotheses that would explain why public spending increases at the end of the fiscal year.

This paper explores preferences and attitudes related to fiscal federalism held by the ASEAN people in the context of environmental issues. Fiscal federalism would predict that local environmental problems will be handled more efficiently by local governments, while national environmental problems will be solved more efficiently by the national government. But it is not obvious whether citizens consider in the same way as economics theory predicts. To unveil this point, I address questions of whether those who have higher consciousness toward (...) environmental issues at the neighbor or local level prefer local governments to decide environment policies, whether those who have more consciousness about environmental issues at the national level prefer the national government to decide the policies, and whether those who have higher consciousness toward environmental problems at global level prefer higher levels government such as the United Nations to decide the policies. By fitting multi-level probit regressions to cross-national survey data collected in ASEAN countries, I found the results supporting the hypotheses. The country analyses show the results which support the hypotheses in Brunei, Indonesia, and the Philippines. (shrink)