BackgroundInstances of surrogate decision-making are expected to increase with the rise in hospitalised older adults in Japan. Few large-scale studies have comprehensively examined the entire surrogate decision-making process. This study aimed to gather information to assess the current state of surrogate decision-making in Japan.MethodsA cross-sectional survey was conducted using online questionnaires. A total of 1000 surrogate decision-makers responded to the questionnaire. We examined the characteristics of surrogate decision-makers and patients, content of surrogate decision-making meeting regarding life-sustaining treatment between the doctors (...) and surrogate decision-makers, extent of involvement of the various parties in the surrogate decision-making process, judgement grounds for surrogate decision-making, and frequency of involvement in the surrogate decision-making process.ResultsOf the participants, 70.5% were male and 48.3% were eldest sons. Only 7.6% of the patients had left a written record of their preferences and 48.8% of the surrogates reported no knowledge of the patient having expressed their prior intentions regarding medical care in any form. Respondents indicated that their family meetings with healthcare professionals mostly included the information recommended by guidelines in a surrogate decision-making meeting in Japan. Most participants reported a good understanding of the meeting content. Although many participants based their decisions on multiple grounds, surrogates’ considerations may not adequately reflect respect for patient autonomy in Japan. Specifically, the eldest son considered his own preference more frequently than that of the other surrogate decision-makers. In 26.1% of the cases, either zero or one family meeting with healthcare professionals was held. In these cases, significantly fewer decisions involved the participation of healthcare professionals other than the doctor compared to cases with multiple meetings.ConclusionsSurrogate decisions in Japan are most commonly made by eldest sons and may not frequently consider the perspectives of other surrogates. The finding that patient preferences were rarely known suggests a role for increased advance care planning. (shrink)

In everyday medical settings in Japan, physicians occasionally tell an elderly patient that their symptoms are “due to old age,” and there is some concern that patient care might be negatively impacted as a result. That said, as this phrase can have multiple connotations and meanings, there are certain instances in which the use of this phrase may not necessarily be indicative of ageism, or prejudice against the elderly. One of the goals in medical care is to address pain and (...) suffering that develops with age in elderly individuals, and whether or not aging is a disease is inconsequential. However, assuming that an individualized and thorough examination has been performed, there are some conditions that can be attributed only to age. Accordingly, physicians must acknowledge the merits and drawbacks of using the phrase “due to old age,” and exercise caution when using it. Both physicians and their elderly patients must share a common awareness of the incomplete and limited nature of modern medicine and its scope, and physicians must help their elderly patients accept and live with the aging phenomenon. (shrink)

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 his book review of Graham Priest's The Fifth Corner of Four, Mark Siderits, while criticising Priest's philology, suggests that Priest's work is 'of considerable interest' for two reasons. First, 'when two independent traditions use similar methods to work on similar issues, it is always possible that one may have hit on approaches that the other missed'. Second, 'the decentering that can be induced by looking at another tradition may trigger fresh insights, even if those insights are not ones that (...) were actually developed by the tradition marked 'other''. The main task of this paper is to unpack Siderits' thought. By analysing some of Priest's work, I will suggest a decentering that must have taken place in China when Buddhism was 'exported to China in Buddhist shipping containers'. For anyone familiar with the forms of Buddhist philosophy developed in India, various forms of Chinese Buddhism can often look strange. Some ideas that were debated and defended by Indian Buddhists do not appear anywhere in Chinese Buddhism and some assumptions have been quietly added to Buddhism by Chinese Buddhists. By showing that Priest's work brings out the 'innovation' that Chinese Buddhists gave to Buddhism, I will suggest that it is this decentering that Siderits suggests Priest makes use of. (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)

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)

In this paper, using Mark Schroeder’s (2008a) expressivist semantic framework for normative language as a case study, I will identify difficulties that even an expressivist semantic theory capable of addressing the Frege-Geach problem will encounter in handling the logical possibility of moral dilemmas. To this end, I will draw on a classical puzzle formulated by McConnell (1978) that the logical possibility of moral dilemmas conflicts with some of the prima facie plausible axioms of the standard deontic logic, which include obligation (...) implies permission. On the tentative assumption that proponents of ethical expressivism should be generally committed to securing the logical possibility of moral dilemmas in their semantic theories, I will explore whether and how expressivists can successfully invalidate obligation implies permission within the framework developed by Schroeder. The case study eventually reveals that this can indeed be a hard task for expressivists. Generalizing from the case study, I will suggest that the source of the difficulty ultimately lies in the mentalist assumption of the expressivist semantic project that the logico-semantic relations exhibited by normative sentences should be modeled in terms of the psychological attitudes that speakers express by uttering them. My final goal will be to show that the difficulty expressivists face in dealing with the logical possibility of moral dilemmas is a reflection of the more general problem that their commitment to the mentalist assumption prevents them from flexibly adopting or dropping axioms in their semantic theories to get the right technical results. (shrink)

In this paper, using Mark Schroeder’s (2008a) expressivist semantic framework for normative language as a case study, I will identify difficulties that even an expressivist semantic theory capable of addressing the Frege-Geach problem will encounter in handling the logical possibility of moral dilemmas. To this end, I will draw on a classical puzzle formulated by McConnell (1978) that the logical possibility of moral dilemmas conflicts with some of the prima facie plausible axioms of the standard deontic logic, which include obligation (...) implies permission. On the tentative assumption that proponents of ethical expressivism should be generally committed to securing the logical possibility of moral dilemmas in their semantic theories, I will explore whether and how expressivists can successfully invalidate obligation implies permission within the framework developed by Schroeder. The case study eventually reveals that this can indeed be a hard task for expressivists. Generalizing from the case study, I will suggest that the source of the difficulty ultimately lies in the mentalist assumption of the expressivist semantic project that the logico-semantic relations exhibited by normative sentences should be modeled in terms of the psychological attitudes that speakers express by uttering them. My final goal will be to show that the difficulty expressivists face in dealing with the logical possibility of moral dilemmas is a reflection of the more general problem that their commitment to the mentalist assumption prevents them from flexibly adopting or dropping axioms in their semantic theories to get the right technical results. (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)

Fuzzy logic has become an important tool for a number of different applications ranging from the control of engineering systems to artificial intelligence. In this concise introduction, the author presents a succinct guide to the basic ideas of fuzzy logic, fuzzy sets, fuzzy relations, and fuzzy reasoning, and shows how they may be applied. The book culminates in a chapter which describes fuzzy logic control: the design of intelligent control systems using fuzzy if-then rules which make use of human knowledge (...) and experience to behave in a manner similar to a human controller. Throughout, the level of mathematical knowledge required is kept basic and the concepts are illustrated with numerous diagrams to aid in comprehension. As a result, all those curious to know more about fuzzy concepts and their real-world application will find this a good place to start. (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 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)

Dharmakīrti argues that there is no pramāṇa (valid means of cognition or source of knowledge) for a thesis that is a self-contradiction (svavacanavirodha). That is, self-contradictions such as ‘everything said is false’ and ‘my mother is barren’ cannot be known to be true or false. The contemporary scholar Tillemans challenges Dharmakīrti by arguing that we can know that self-contradictions are false by means of a formal logical inference. The aims of the paper are to answer Tillemans’ challenge from what we (...) take to be Dharmakīrti’s or Dharmakīrtian (someone who is like Dharmakīrti) perspective and to demonstrate the unique features of Dharmakīrti’s view of inference. By so doing, we show that the epistemology in relation to the formal conception of logic that underlies Tillemans’ challenge is problematic from Dharmakīrti’s or Dharmakīrtian perspective. The paper, thus, presents Dharmakīrti’s view of inference and logical reasoning as well as a Dharmakīrtian challenge to the formal conception of logic that is the dominant contemporary conception. (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 this paper, we argue that a distinction ought to be drawn between two ways in which a given world might be logically impossible. First, a world w might be impossible because the laws that hold at w are different from those that hold at some other world (say the actual world). Second, a world w might be impossible because the laws of logic that hold in some world (say the actual world) are violated at w. We develop a novel (...) way of modelling logical possibility that makes room for both kinds of logical impossibility. Doing so has interesting implications for the relationship between logical possibility and other kinds of possibility (for example, metaphysical possibility) and implications for the necessity or contingency of the laws of logic. (shrink)

Kripke completeness of some infinitary predicate modal logics is presented. More precisely, we prove that if a normal modal logic above is -persistent and universal, the infinitary and predicate extension of with BF and BF is Kripke complete, where BF and BF denote the formulas pi pi and x x, respectively. The results include the completeness of extensions of standard modal logics such as , and its extensions by the schemata T, B, 4, 5, D, and their combinations. The proof (...) is obtained by extending the correspondence between the representation of modal algebras and the completeness of propositional modal logic to infinite. (shrink)

A logic is called 'paraconsistent' if it rejects the rule called 'ex contradictione quodlibet', according to which any conclusion follows from inconsistent premises. While logicians have proposed many technically developed paraconsistent logical systems and contemporary philosophers like Graham Priest have advanced the view that some contradictions can be true, and advocated a paraconsistent logic to deal with them, until recent times these systems have been little understood by philosophers. This book presents a comprehensive overview on paraconsistent logical systems to change (...) this situation. The book includes almost every major author currently working in the field. The papers are on the cutting edge of the literature some of which discuss current debates and others present important new ideas. The editors have avoided papers about technical details of paraconsistent logic, but instead concentrated upon works that discuss more 'big picture' ideas. Different treatments of paradoxes takes centre stage in many of the papers, but also there are several papers on how to interpret paraconistent logic and some on how it can be applied to philosophy of mathematics, the philosophy of language, and metaphysics. (shrink)