Currently in Japan, it is extremely difficult to realize the basic wish of protecting personal dignity at the end of life. A patient’s right to refuse life-sustaining treatment has not been substantially warranted, and advance directives have not been legally enforceable. Unfortunately, it is not until the patient is moribund that all concerned parties start to deliberate on whether or not death with dignity should be pursued. Medical intervention is often perceived as a worthwhile goal to not only preserve life, (...) but also provide psychological benefit to the family, regardless of its effect on the patient. To feel they are doing something, family members tend to act against the imperative “Do not inflict on others what you would not wish done to you,” and permit extraordinary measures they would not want themselves. Another complication in Japanese culture is the necessity of unanimous decisions for end-of-life care. If there is conflict between a patient and his/her family on accepting medical intervention, the view of the latter is more likely to prevail due to different perceptions of human dignity. As a result, incapacitated patients in Japanese clinical settings often suffer through extraneous medical procedures, particularly during end-of-life care. Patient dignity is in danger from a national refusal to accept major bioethical principles such as having respect for patient autonomy, serving the best interests of the patient, doing no harm, and ensuring fairness at the end of life. We argue that more education about human dignity and legislation for death with dignity are necessary. Peace of mind for patients during end-of-life care will never be achieved in this society unless drastic changes take place in medical ethics and law. (shrink)

BackgroundHealthcare professionals use the ethics of justice and care to construct moral reasoning. These ethics are conflicting in nature; different value systems and orders of justice and care are applied to the cause of actual moral conflict. We aim to clarify the structure and factors of healthcare professionals’ moral conflicts through the lens of justice and care to obtain suggestions for conflict resolutions.MethodSemi-structured interviews about experiences of moral conflict were conducted with Japanese nurses recruited using the snowball sampling method. Interviews (...) were conducted based on the real-life moral conflict and choice interview. Interviews were recorded and transcribed verbatim, then analyzed based on the interpretive method of data analysis. Verbatim transcripts were read four times, first to get an overall sense of the conflict, then to understand the person’s thoughts and actions that explain the conflict, and third and fourth to identify perspectives of justice and care, respectively. Each moral perspective was classified into categories according to Chally’s taxonomy.ResultsAmong 31 responses, 2 that did not mention moral conflict were excluded, leaving 29 responses that were analyzed. These responses were classified into six cases with conflict between both justice and care perspectives or within one perspective, and into two cases without conflict between perspectives. The “rules” category of justice and the “welfare of others” category of care were included in many cases of conflict between two perspectives, and they frequently occurred in each perspective.ConclusionsThe nurses in this study suggest that they make moral judgments based on moral values that are intertwined with justice and care perspectives complex manner.Organizational, professional, and patient-related factors influenced conflicts between justice and care. Additionally, multiple overlapping loyalties created conflicts within justice perspectives, and multifaceted aspects of care-provider’s responsibility and patient need created conflicts within care. Decision-making biased towards one perspective can be distorted. It is important to consider ethical issues from both perspectives to resolve conflicts, especially the effective use of the ethics of care is recommended. (shrink)

Empirical surveys about medical futility are scarce relative to its theoretical assumptions. We aimed to evaluate the difference of attitudes between laypeople and physicians towards the issue. A questionnaire survey was designed. Japanese laypeople (via Internet) and physicians with various specialties (via paper-and-pencil questionnaire) were asked about whether they would provide potentially futile treatments for end-of-life patients in vignettes, important factors for judging a certain treatment futile, and threshold of quantitative futility which reflects the numerical probability that an act will (...) produce the desired physiological effect. Also, the physicians were asked about their practical frequency and important reasons for futile treatments. 1134 laypeople and 401 (80%) physicians responded. In all vignettes, the laypeople were more affirmative in providing treatments in question significantly. As the factors for judging futility, medical information and quality of life (QOL) of the patient were rather stressed by the physicians. Treatment wish of the family of the patient and psychological impact on patient side due to the treatment were rather stressed by laypeople. There were wide variations in the threshold of judging quantitative futility in both groups. 88.3% of the physicians had practical experience of providing futile treatment. Important reasons for it were communication problem with patient side and lack of systems regarding futility or foregoing such treatment. Laypeople are more supportive of providing potentially futile treatments than physicians. The difference is explained by the importance of medical information, the patient family’s influence to decision-making and QOL of the patient. The threshold of qualitative futility is suggested to be arbitrary. (shrink)

A murder case that had some features in common with the Tarasoff case occurred in Sasebo City, Japan, in 2014. A 15-year-old high school girl was murdered and her 16-year-old classmate was arrested on suspicion of homicide. One and a half months before the murder, a psychiatrist who had been examining the girl called a prefectural child consultation centre to warn that she might commit murder, but he did not reveal her name, considering it his professional duty to keep it (...) confidential. Article 134 of the Japanese Criminal Law states that doctors should not disclose patient information obtained in clinical practice without a legitimate reason, but the Japanese Supreme Court has not specified what constitutes a legitimate reason. Mass media and commentators suggested that the murder could have been prevented if the psychiatrist had disclosed the girl's name to the authorities or had isolated her coercively in a psychiatric ward. However, the authors disagree with such claims. This article discusses obligations imposed on concerned individuals and third party members in cases involving ethical dilemmas regarding patient confidentiality and information disclosure. It is concluded that everyone should fulfill their obligations to prevent such tragedies and one should judge the appropriateness of others’ actions based not on the consequences of their actions, but on the processes used to decide on a course of action and their commitment. It is necessary for us to establish a society in which concerned parties can do what they think is ethically best without fearing ungrounded charges. (shrink)

In Japan, few studies and ethical debates have addressed medical futility, but articles suggesting the practice of such treatment exist. The present study aimed to explore attitudes about this by examining personal practical experiences of those who have been involved in judging treatments as futile. We employed a qualitative descriptive design with content analysis of semi-structured and focus group interviews with 11 Japanese physicians and 9 nurses of a university hospital in Japan. The interviews mined their practical experience to identify (...) why they provided treatment that was regarded futile, factors for determining futility, and attitudes toward foregoing futile treatments. All participants had provided treatments judged as futile for various reasons, such as patient request, inadequate decision-making processes, request from another physician, and the lack of standards with which to judge futility, among others. In addition to medical science factors , participants also considered non-medical science factors to determine if a treatment was futile. Almost all participants agreed that futility should be defined and that such treatments should be foregone, but they did not take a proactive stance towards this due to factors related to the healthcare worker‟s situation or the patient. Although the implications of the present study are somewhat limited, our results indicate that futile treatments are provided at multiple treatment departments. Health-care workers employ a variety of factors to determine futility, including non-medical science factors. As provision of such treatment is not always performed for reasons of patient autonomy, diverse approaches should be employed to cope with situations regarding futile treatments. (shrink)

La Meditación de la técnica contiene las reflexiones de José Ortega y Gasset sobre un fenómeno de invasora presencia en el mundo contemporáneo. Trata, en suma, de inscribir el hecho de la técnica en el marco de una antropología filosófica, fundada en el sistema orteguiano, para así contribuir a la comprensión del momento histórico contemporáneo. El volumen incluye, además del curso ¿Qué es la técnica?, desarrollado en 1933 en la Universidad de Santander, otros textos afines: la conferencia El mito del (...) hombre allende a la técnica pronuncida en Darmstadt y varios ensayos sobre el conocimiento científico, que prueban la permanente atención que Ortega prestó a las novedades de la ciencia contemporánea. En esta nueva edición el texto se ha revisado y corregido conforme a los manuscritos originales o las primeras ediciones. La principal novedad es una Introducción al curso ¿Qué es la técnica?, sólo editada póstumamente. (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)

A placebo is a substance or intervention believed to be inactive, but is administered by the healthcare professional as if it was an active medication. Unlike standard treatments, clinical use of placebo usually involves deception and is therefore ethically problematic. Our attitudes toward the clinical use of placebo, which inevitably includes deception or withholding information, have a tremendous effect on our practice regarding truth-telling and informed consent. A casual attitude towards it weakens the current practice based on shared decision-making and (...) mutual trust between patients and healthcare professionals. Issues concerning the clinical use of placebo are thus intimately related to patient-provider relationships, the public's trust in medicine, and medical education. A review of recent survey studies suggests that the clinical use of placebo appears to be fairly well accepted among healthcare professionals and is common in clinical settings in various countries. However, we think that an ethical discussion is urgently needed because of its controversial nature. If judged to be ethically wrong, the practice should end. In the present paper, we discuss the ethicality of the clinical use of placebo with deception and argue against it, concluding that it is unethical and should be banned. We will show that most arguments in favor of the clinical use of placebo can be refuted and are therefore incorrect or weak. These arguments will be presented and examined individually. Finally, we will briefly consider issues relevant to the clinical use of placebo without deception. (shrink)

In recent years, a number of news stories were reported worldwide involving brain-dead pregnant women. Debates over providing life support to braindead pregnant women and delivery of their children have been around for some decades. Maintaining a woman’s life solely for fetal viability has become a major controversial social issue. Opposing opinions exist where one side supports the woman and her child should be left to die in dignity and the other side claims to protect the unborn child’s right to (...) live. Each group has strong beliefs. This paper addresses main aspects when considering the continuation of somatic support to the brain-dead pregnant woman for the purpose of fetus delivery including; human death, dignity of the woman, rights of the fetus, proportionality of acts, and the woman’s donor status, and independence of mother and fetus. Then, the authors present several diverse opinions and positions concerning the legitimacy of life support for brain-dead women based on them and critically evaluate them. We show that each and every claim can be ethically refuted. This paper also approaches to those claims from three different points of views, which are that of the brain-dead woman, her fetus and her family. We believe that the brain-dead woman’s wish and dignity, the child’s predicted wellbeing after birth, and the family’s beliefs and welfare should all be counted equally when making the final decision. In conclusion, we argue that the decision can be ethically justified only when the interests of all parties are appropriately taken into consideration and protected. (shrink)

As of 2009, the number of donors in Japan is the lowest among developed countries. On July 13, 2009, Japan's Organ Transplant Law was revised for the first time in 12 years. The revised and old laws differ greatly on four primary points: the definition of death, age requirements for donors, requirements for brain- death determination and organ extraction, and the appropriateness of priority transplants for relatives.In the four months of deliberations in the National Diet before the new law was (...) established, various arguments regarding brain death and organ transplantation were offered. An amazing variety of opinions continue to be offered, even after more than 40 years have elapsed since the first heart organ transplant in Japan. Some are of the opinion that with the passage of the revised law, Japan will finally become capable of performing transplants according to global standards. Contrarily, there are assertions that organ transplants from brain- dead donors are unacceptable because they result in organs being taken from living human beings.Considering the current conditions, we will organize and introduce the arguments for and against organ transplants from brain- dead donors in contemporary Japan. Subsequently, we will discuss the primary arguments against organ transplants from brain- dead donors from the perspective of contemporary Japanese views on life and death. After introducing the recent view that brain death should not be regarded as equivalent to the death of a human being, we would like to probe the deeply-rooted views on life and death upon which it is based. (shrink)

José Ortega y Gasset publicó en 1939, en la colección Austral, este ensayo filosófico que obtuvo una gran repercusión internacional en su día y sigue siendo en la actualidad una de las obras clave del pensamiento orteguiano. Esta edición conmemora los setenta años transcurridos desde entonces y ofrece la única edición autorizada y revisada personalmente por el autor.

The aim of the present paper is to evaluate the role of a patient’s religious and non-religious beliefs in making decisions about medical care. Faith exerts a profound influence on our spiritual lives and on our daily actions, including ethical decisions. Religion determines the believer’s fundamental worldview, view of humanity, perspective on life and death, and values. In this paper, we investigated the treatment of medical decisions based on religious or non-religious beliefs. To understand this issue, it is necessary to (...) assess the uniqueness and validity of religious beliefs, as well as the rationality of beliefs. We concluded that decisions based on religious and non-religious beliefs shouldbe treated in the same way and that the distinguishing features of valid beliefs are deeply held and do not cause harm to others. In addition, we stated that the root beliefs we hold, whether religious or secular, cannot necessarily be explained logically, and that patient decisions should be judged by the logical consistency of their reasoning with their beliefs as starting points. (shrink)

This study aimed to identify the learning and business incubation processes and their impact on developing the performance of business incubators in Gaza Strip, and the study relied on the descriptive analytical approach, and the study population consisted of all employees working in business incubators in Gaza Strip in addition to experts and consultants in incubators where their total number reached (62) individuals, and the researchers used the questionnaire as a main tool to collect data through the comprehensive survey method, (...) where (55) questionnaires were retrieved with a recovery rate of (88.7%). The results of the study showed that there is a high approval of the variables of the study, where the dimension of incubation operations came with a relative weight (84.89%), followed by the learning dimension which got a relative weight (82.50%), while the performance level of the incubators got a relative weight (80.12%) and as the study results showed There is a positive relationship statistically between the two dimensions of learning and business incubation processes and performance development in business incubators, and the linear regression analysis model showed that the main effect in improving the performance of business incubators is "after business incubation operations" while it showed weak effect after learning. The study came out with several recommendations, the most important of which is that business incubators seek to reinforce the learning process and incubation processes for business, and the need to periodically evaluate their performance, and that a more effective mechanism be designed to follow up with companies after the end of the incubation period and monitor the progress of these companies. (shrink)

"This concise, elegant essay on the roots and historical justification of philosophy marks a decisive step in posing the problem of what philosophy is. With consummate clarity and the charisma that distinguished him as a lecturer, Jos Ortega y Gasset re-creates ""that moment when Parmenides began talking about something exceptionally strange, which he called 'being.'"" How and why, he asks, did such a surprising adventure come about?Considering the human qualities that prompt a curiosity about existence and eternity, Ortega examines philosophy's (...) etymology, its connection to poetry, and its differentiation from religion and other modes of thought. He lucidly delineates radical differences of doctrine and style among early Greek thinkers, especially the ""madman of reason"" Parmenides and the ""absolute individual"" Heraclitus. He also considers philosophy's fundamental task of revealing the latent world poised behind the manifest world and discovering the relations between them.""Unable to find lodging among the philosophies of the past,"" Ortega observes, ""we have no choice but to attempt to construct one of our own."" The Origin of Philosophy argues for the vital importance of philosophy as a human endeavor, even while noting that each generation of thought reveals the past as ""a defunct world of errors.""". (shrink)

Fourteen essays by leading scholars from around the world explore the theological, philosophical, and historical connections between the three Abrahamic faiths and ethics. Timely reading for students of religion, philosophy, and ethics.

The potential to collect brain data more directly, with higher resolution, and in greater amounts has heightened worries about mental and brain privacy. In order to manage the risks to individuals posed by these privacy challenges, some have suggested codifying new privacy rights, including a right to “mental privacy.” In this paper, we consider these arguments and conclude that while neurotechnologies do raise significant privacy concerns, such concerns are—at least for now—no different from those raised by other well-understood data collection (...) technologies, such as gene sequencing tools and online surveillance. To better understand the privacy stakes of brain data, we suggest the use of a conceptual framework from information ethics, Helen Nissenbaum’s “contextual integrity” theory. To illustrate the importance of context, we examine neurotechnologies and the information flows they produce in three familiar contexts—healthcare and medical research, criminal justice, and consumer marketing. We argue that by emphasizing what is distinct about brain privacy issues, rather than what they share with other data privacy concerns, risks weakening broader efforts to enact more robust privacy law and policy. (shrink)

Objective: This study examined the process through which elderly patients with new-onset acute leukemia make treatment decisions from the time of diagnosis, in order to identify factors influencing this decision-making process in Japan. Methods: Semi-structured interviews were conducted with twenty-two elderly patients with leukemia. The data were analyzed using the modified grounded theory approach. Results: The process of decision-making in elderly patients with leukemia includes three stages: Initial reactions at diagnosis, change in attitudes, and entrusting the physician with the treatment (...) plan. Initial reactions at diagnosis were affected by interactions with others that brought peace of mind to the patients. Change in attitudes was affected by encouragement from others to undergo treatment and their own motivation to face treatment. Patients came to entrust their treatment plan completely to their physician, because they wanted to feel relief and did not want to have to grapple with difficult medical information that was relevant to decision-making about their disease and treatment options. Conclusions: The process of decision-making in elderly patients with leukemia is affected by several factors and included three stages. Our present study findings can provide suggestions on how medical professionals might better support the process of decision-making in elderly patients with leukemia. (shrink)

Destination therapy is the permanent implantation of a left ventricular assist device in patients with end-stage, severe heart failure who are ineligible for heart transplantation. DT improves both the quality of life and prognosis of patients with end-stage heart failure. However, there are also downsides to DT such as life-threatening complications and the potential for the patient to live beyond their desired length of life following such major complications. Because of deeply ingrained cultural and religious beliefs regarding death and the (...) sanctity of life, Japanese society may not be ready to make changes needed to enable patients to have LVADs deactivated under certain circumstances to avoid needless suffering. Western ethical views that permit LVAD deactivation based mainly on respect for autonomy and dignity have not been accepted thus far in Japan and are unlikely to be accepted, given the current Japanese culture and traditional values. Some healthcare professionals might regard patients as ineligible for DT unless they have prepared advance directives. If this were to happen, the right to prepare an advance directive would instead become an obligation to do so. Furthermore, patient selection for DT poses another ethical issue. Given the predominant sanctity of life principle and lack of cost-consciousness regarding medical expenses, medically appropriate exclusion criteria would be ignored and DT could be applied to various patients, including very old patients, the demented, or even patients in persistent vegetative states, through on-site judgment. There is an urgent need for Japan to establish and enact a basic act for patient rights. The act should include: respect for a patient’s right to self-determination; the right to refuse unwanted treatment; the right to prepare legally binding advance directives; the right to decline to prepare such directives; and access to nationally insured healthcare. It should enable those concerned with patient care involving DT to seek ethical advice from ethics committees. Furthermore, it should state that healthcare professionals involved in the discontinuation of life support in a proper manner are immune to any legal action and that they have the right to conscientiously object to LVAD deactivation. (shrink)

Background Destination therapy is the permanent implantation of a left ventricular assist device in patients with end-stage, severe heart failure who are ineligible for heart transplantation. DT improves both the quality of life and prognosis of patients with end-stage heart failure. However, there are also downsides to DT such as life-threatening complications and the potential for the patient to live beyond their desired length of life following such major complications. Because of deeply ingrained cultural and religious beliefs regarding death and (...) the sanctity of life, Japanese society may not be ready to make changes needed to enable patients to have LVADs deactivated under certain circumstances to avoid needless suffering. Main text Western ethical views that permit LVAD deactivation based mainly on respect for autonomy and dignity have not been accepted thus far in Japan and are unlikely to be accepted, given the current Japanese culture and traditional values. Some healthcare professionals might regard patients as ineligible for DT unless they have prepared advance directives. If this were to happen, the right to prepare an advance directive would instead become an obligation to do so. Furthermore, patient selection for DT poses another ethical issue. Given the predominant sanctity of life principle and lack of cost-consciousness regarding medical expenses, medically appropriate exclusion criteria would be ignored and DT could be applied to various patients, including very old patients, the demented, or even patients in persistent vegetative states, through on-site judgment. Conclusion There is an urgent need for Japan to establish and enact a basic act for patient rights. The act should include: respect for a patient’s right to self-determination; the right to refuse unwanted treatment; the right to prepare legally binding advance directives; the right to decline to prepare such directives; and access to nationally insured healthcare. It should enable those concerned with patient care involving DT to seek ethical advice from ethics committees. Furthermore, it should state that healthcare professionals involved in the discontinuation of life support in a proper manner are immune to any legal action and that they have the right to conscientiously object to LVAD deactivation. (shrink)

Abstract:The objective in this article is to apply a Daoist model of an ethic derived from the Laozi on writings of the Huang Lao tradition to offer a unique Daoist cosmically derived ethic in its own terms. Having our point of departure in the Laozi we refer to its paradoxical language as a living riddle that is inherent in the tradition, and as such it suggests a "model of modeling." We find this model in Laozi 25, according to which self-so (...) (ziran 自然) serves as foundation for an ethic that is neither dichotomizing nor resting on human moral conventions, but serves rather as a guiding philosophy of living. On this basis we explore the question of an ethic in the Huang Lao tradition. (shrink)

Originally published: Oxford: Clarendon Press, 1932.

In medical ethics, an appropriate national healthcare system that meets the requirements of justice in healthcare resource allocation is a major concern. Japan is no exception to this trend, and the pros and cons of introducing a two-tier healthcare system, which permits insured medical care services to be provided along with services not covered by social health insurance, have been the subject of debate for many years. The Supreme Court ruled in 2011 that it was valid for the government to (...) ban mixing medical treatments and both the Ministry of Health, Labour and Welfare and Japanese Medical Association oppose the introduction of such a system. In this paper, we examine the main arguments against the introduction of a two-tier healthcare system and ideas that form their basis, which can be broadly divided into opinions based on the importance of equality and those derived from the logical conclusion that the outcomes would be detrimental. We point out issues and shortcomings of each standpoint and argue that the introduction of the system would not necessarily threaten equality and social solidarity in Japanese society, and that abuses of a self-pay tier would be controllable to a certain extent. Then, the authors—who do not actively promote the introduction of a two-tier healthcare system—conclude that the allegation that is completely devoted to one side and the theory that social healthcare is collapsing, which makes the public excessively nervous, cannot be accepted. (shrink)

The logical empiricists often appear as a foil for feminist theories. Their emphasis on the individualistic nature of knowledge and on the value-neutrality of science seems directly opposed to most feminist concerns. However, several recent works have highlighted aspects of Carnap's views that make him seem like much less of a straightforwardly positivist thinker. Certain of these aspects lend themselves to feminist concerns much more than the stereotypical picture would imply.

In his groundbreaking work of 1969, Spinoza's Metaphysics: An Essay in Interpretation, Edwin Curley attacked the traditional understanding of the substance-mode relation in Spinoza, which makes modes inhere in the substance. Curley argued that such an interpretation generates insurmountable problems, as had been already claimed by Pierre Bayle in his famous entry on Spinoza. Instead of having the modes inhere in the substance Curley suggested that the modes’ dependence upon the substance should be interpreted in terms of (efficient) causation, i.e., (...) as committing Spinoza to nothing over and above the claim that the substance is the (efficient) cause of the modes. These bold and fascinating claims generated one of the most important scholarly controversies in Spinoza scholarship of the past thirty-five years. In this chapter I argue against Curley’s interpretation and attempt to reestablish the traditional understanding of Spinozistic modes as inhering in God and as predicated of God. I also criticize Curley’s philosophical motivation for suggesting this interpretation. I do believe, however, that Curley is right about the existence of an intimate connection between the substance-mode relation and causation in Spinoza. In the next chapter I will study the notion of ‘immanent cause’, which merges efficient causality and inherence. I will clarify the relation between immanent, efficient and material causation, and show where precisely Spinoza diverged from the traditional Aristotelian taxonomy of causes. In the second chapter I also discuss the German Idealists’ view of Spinoza as an ‘acosmist’. Under this interpretation Spinoza was a modern reviver of Eleatic monism, who allegedly asserts the mere existence of God, and denies the reality of the world of particular things. Spinozistic modes - according to this reading - are nothing but passing and unreal phenomena. Though this view of Spinoza as an ‘acosmist’ can be supported by some lines in Spinoza’s thought, I believe it should be rejected since it is not consistent with some of the most central doctrines of the Ethics. In the final part of the second chapter I discuss the relation between modes and the attributes under which they fall, and suggest a terminological distinction between a ‘mode of God’ (i.e., a mode under all attributes) and a ‘mode of an attribute’ (i.e., a mode under a specific attribute), a distinction which can help us avoid some common confusions in the treatment of the issue. (shrink)

The acknowledgement of basic human vulnerability in relationships between mental health service users and professionals working in community-based mental health services (in Norway) was a starting point. The purpose was to explore how users of these services describe and make sense of their meetings with other people. The research is collaborative, with researcher and person with experienced-based knowledge cooperating through the research process. Data is derived from 19 interviews with 11 people who depend on mental health services for assistance at (...) least three times a week. Data is analysed according to the Interpretative Phenomenological Analysis (IPA). Results confirm that reciprocity is fundamental for relationships, and that recognizing the individual entails personal involvement. The participants describe a struggle, and recognizing this struggle may help the professional to achieve a deeper understanding of the individual. (shrink)