Objective—To demonstrate Japanese doctors' and nurses' attitudes towards and practices of voluntary euthanasia (VE) and to compare their attitudes and practices in this regard. Design—Postal survey, conducted between October and December 1999, using a self-administered questionnaire.Participants—All doctor members and nurse members of the Japanese Association of Palliative Medicine.Main outcome measure—Doctors' and nurses' attitude towards and practices of VE.Results—We received 366 completed questionnaires from 642 doctors surveyed (response rate, 58%) and 145 from 217 nurses surveyed (68%). A total of 54% (95% (...) confidence interval (CI): 49-59) of the responding doctors and 53% (CI: 45-61) of the responding nurses had been asked by patients to hasten death, of whom 5% (CI: 2-8) of the former and none of the latter had taken active steps to bring about death. Although 88% (CI: 83-92) of the doctors and 85% (CI: 77-93) of the nurses answered that a patient's request to hasten death can sometimes be rational, only 33% (CI: 28-38) and 23% (CI: 16-30) respectively regarded VE as ethically right and 22% (CI: 18-36) and 15% (CI: 8-20) respectively would practise VE if it were legal. Logistic regression model analysis showed that the respondents' profession was not a statistically independent factor predicting his or her response to any question regarding attitudes towards VE. Conclusions—A minority of responding doctors and nurses thought VE was ethically or legally acceptable. There seems no significant difference in attitudes towards VE between the doctors and nurses. However, only doctors had practised VE. (shrink)

史料をとことんまで精査、圧倒的な現地調査から、近現代がつくりだした鎮魂の起源と思想の源流をたどる。.

In this paper a viewpoint that time is an informational and thermal entity is presented. We consider a model for a simple relaxation process for which a relationship among event, time and temperature is mathematically formulated. It is then explicitly illustrated that temperature and time are statistically inferred through measurement of events. The probability distribution of the events thus provides an intrinsic correlation between temperature and time, which can relevantly be expressed in terms of the Fisher information metric. The two-dimensional (...) differential geometry of temperature and time then leads us to a finding of a simple equation for the scalar curvature, R=-1\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$R = -1$$\end{document}, in this case of relaxation process. This basic equation, in turn, may be regarded as characterizing a nonequilibrium dynamical process and having a solution given by the Fisher information metric. The time can then be interpreted so as to appear in a thermal way. (shrink)

CHAPTER 1 Ichikawa' s View of the Body INTRODUCTION In 1975, Ichikawa Hiroshi published a remarkable book on the concept of the body entitled, ...

Background A baby hatch called the “Stork’s Cradle” has been in place at Jikei Hospital in Kumamoto City, Japan, since May 10, 2007. Babyklappes were first established in Germany in 2000, and there are currently more than 90 locations. Attitudes regarding baby hatches are divided in Japan and neither opinions for nor against baby hatches have thus far been overwhelming. To consider the appropriateness of baby hatches, we present and examine the validity of each major objection to establishing baby hatches. (...) Discussion There are various objections to baby hatches as follows: It violates a child’s right to know the identity of his or her biological parents by allowing anonymous birth; it neglects fulfillment of the biological parents’ basic obligation to raise their child and its very availability induces abandonment of infants; some people abuse it for very selfish reasons; it cannot save babies’ lives; the rights of one parent can be ignored if the other surrenders a child without his or her consent; it puts a baby in medical jeopardy; and it has no clear legal basis. The authors would argue that there are many plausible refutations for each objection mainly based on priority of child’s right to life, pregnant women’s vulnerability and necessity of anonymity, social responsibility to protect and raise children, differences between dropping a child off at a baby hatch and child neglect, limited function of social childcare center, inevitability of abuse by a minority of people, necessary distinction between outcomes that occur only because baby hatches exist and those that occur regardless of their existence, important local direct and upmost measures for women in trouble, and difference between ambiguous legality and illegality. Summary We argue that a certain number of baby hatches should continue to be established as a last resort, in a form that can maintain anonymity if the parent dropping the child off so desires. It should be supported if it is initiated with good intentions; if the maximum possible effort is made at said facility to protect the interests, rights, and safety of the child; and if no clear evidence of harm exists. (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)

This paper attempts to make intelligible the logic contained in the Diamond Sutra. This 'logic' is called the 'logic of not'. It is stated in a propositional form: 'A is not A, therefore it is A'. Since this formulation is contradictory or paradoxical when it is read in light of Aristotelean logic, one might dismiss it as nonsensical. In order to show that it is neither nonsensical nor meaningless, the paper will articulate the philosophical reasons why the Sutra makes its (...) position in this contradictory form. The thesis to be presented is that as long as one understands the 'logic of not' from a dualistic, either-or egological standpoint, it remains contradictory, but in order to properly understand it, one must effect a perspectival shift from the dualistic, egological stance to a non-dualistic, non-egological stance. This thesis is advanced with a broader concern in mind: to reexamine how the self understands itself, how it understands others, and how it understands its intra-ecological relationship with nature. (shrink)

Purpose This study aims to map Swedish students’ attitudes towards Snowden’s revelations and their effects in the political and socio-cultural environment of Sweden. Design/methodology/approach A questionnaire was answered by 190 Swedish university students. The quantitative responses to the survey and qualitative considerations of free text answers were statistically analysed. Findings Swedish students had a high level of knowledge about the Snowden revelations; they actively searched for information, gave a positive judgement of Snowden’s actions and were willing to follow his example (...) in Sweden, although not in the USA. They trusted their country and most of its institutions and authorities except for secret service agencies and the internet and computer software companies. Practical implications This study could be used as a design of education for university students, especially in information technology programmes. Social implications The study can be used for developing and applying policies on privacy, surveillance and whistle-blowing. Originality/value This study is part of a bigger international study to map students’ attitudes towards Snowden’s revelations and their opinions about privacy, surveillance and whistle-blowing opening up for cross-cultural analyses. (shrink)

NAGATOMO SHIGENORI PRELUDE: INTRODUCING YUASA YASUO) An Initial Encounter with Professor YUASA In June,, TP Kasulis1 and I went to see Professor Yuasa at...

When one side is illuminated, the other side remains in darkness.My reason for addressing the topic for this article is to attempt a philosophical reconstruction of the "logic of not" in such a way as to guide us into entertaining a holistic mode of thinking. In preparation for this investigation, for comparative purposes I will engage a conceptual paradigm that is dominant in the Western philosophical tradition, namely the paradigm that is framed in terms of an either-or, ego-logical dualistic stance (...) and that undergirds our daily life in knowing and understanding thing-events. I will use the phrase "thing-event" throughout this article as a way of attempting to capture a sense of the whole rather than thematizing... (shrink)

In Japan, people are negative towards life-prolonging treatments. Laws that regulate withholding or discontinuing life-prolonging treatments and advance directives do not exist. Physicians, however, view discontinuing life-prolonging treatments negatively due to fears of police investigations. Although ministerial guidelines were announced regarding the decision process for end-of-life care in 2007, a consensus could not be reached on the definition of end-of-life and conditions for withholding treatment. We established a forum for extended discussions and consensus building on this topic.

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)

Since Japan adopted the concept of informed consent from the West, its inappropriate acquisition from patients in the Japanese clinical setting has continued, due in part to cultural aspects. Here, we discuss the current status of and contemporary issues surrounding informed consent in Japan, and how these are influenced by Japanese culture.

This essay investigates why and how East Asian thought, particularly Chinese thought, has traditionally developed differently from that of Western philosophy by examining the linguistic differences discerned in the Chinese language and Western languages. To accomplish this taks, it focuses on the understanding of "being" that relates to the theoretical thinking of the West and the image- thinking of East Asia, while providing a psychological basis for the latter.

: This essay investigates why and how East Asian thought, particularly Chinese thought, has traditionally developed differently from that of Western philosophy by examining the linguistic differences discerned in the Chinese language and Western languages. To accomplish this task, it focuses on the understanding of "being" that relates to the theoretical thinking of the West and the image-thinking of East Asia, while providing a psychological basis for the latter.

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)

Although it seems natural to consider the last fifty years the contemporary period, because this year (1995) punctuates a historical period celebrating the fiftieth anniversary of the end of the Pacific War, this essay will limit the term “contemporary” roughly to the last twenty‐five years. The reason for this demarcation is that at the beginning of the 1970s, we witnessed a new philosophical mood emerging in Japan. Prior to that period, the Japanese philosophical scene was dominated by the study of (...) European thinkers, such as Husserl, Heiddeger, Sartre, and Merleau Ponty. The end of the students' movement in the early 1970s also marked the end of the ideological disputes launched by Marxism since the early 1930s. Instead, it appears that the Japanese intelligentsia in the early 1970s began to acutely sense problems inherent in the Eurocentric philosophy which had served as a foundation for Western science and technology. This occurred largely through a recognition that scientific technology had yielded, as its unexpected byproduct, a “mind/heartless” society, pollution, and global ecological crises, which had permeated almost all parts of the Japanese archipelago to threaten the psyche of the Japanese people and their mode of living. In this essay, I should like to briefly introduce three representative contemporary Japanese thinkers who have addressed some aspects of these problems in their writings. They are Nakamura Yujiro, Sakabe Megumi, and Yuasa Yasuo. (Because of the limitations of space, this article will restrict itself to these three thinkers, but this should not suggest that there are no other representative thinkers in Japan. Consider particularly those belonging to the neo Kyoto school, such as Nishitani Keiji, Kosaka Masaki, Koyama Iwao, Umehara Takeshi and Ueda Shizuteru. Nishitani's works are well known in the English speaking world, along with those of Abe Masao. Out side of the Kyoto school, we can also mention other thinkers, such as Matsumoto Masao, Hiromatsu Wataru and Ichikawa Hiroshi.). (shrink)

This article briefly introduces the phenomena of ki- energy to the Western readers who are not familiar with them, by relying on Yuasa Yasuo's conceptual scheme. Ki- energy has traditionally been an intense thematic focus of various East-Asian fields of human endeavours such as acupuncture medicine, martial arts and meditational training. The article articulates some of the salient features of this energy as it is understood in these fields, while incorporating knowledge of contemporary scientific research on them. It is written (...) with a view to stimulating further research on it, as it carries important implications for addressing many of the issues we face today. (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)

This essay investigates why and how East Asian thought, particularly Chinese thought, has traditionally developed differently from that of Western philosophy by examining the linguistic differences discerned in the Chinese language and Western languages. To accomplish this taks, it focuses on the understanding of "being" that relates to the theoretical thinking of the West and the image-thinking of East Asia, while providing a psychological basis for the latter.

This study aims to unveil the process of whistleblowing. Two nursing staff members who worked in a psychiatric hospital convicted of large-scale wrongdoing were interviewed. Data were analyzed using a modified grounded theory approach. Analysis of the interviews demonstrated that they did not decide to whistleblow when they were suspicious or had an awareness of wrongdoing. They continued to work, driven by appreciation, affection, and a sense of duty. Their decision to whistleblow was ultimately motivated by firm conviction. Shortly after (...) whistleblowing, wavering emotions were observed, consisting of a guilty conscience, fear of retribution, and pride, which subsequently transformed to stable emotions containing a sense of relief and regret for delayed action. It is necessary for nurses to recognize that their professional responsibility is primarily to patients, not to organizations. Nurses should also have professional judgment about appropriate allegiance and actions. (shrink)

How should the Japanese death penalty system stand in the future? While banning the death penalty has become a global trend, Japanese public opinion still supports it, and the government continues to strongly insist retention of the system. Despite worldwide criticism towards Japanese opinion, until very recently have been no reductions in death penalty sentences or executions. Both abolitionist and retentionist countries have strong arguments to support their opinions, thus there is no decisive argument that overwhelmingly refutes others. Consideration for (...) the feelings of the murder victim’s family is significant, and there are certain actions perpetrated by the criminal which seem unforgivable and for which nothing can compensate. At the same time, homicide is a violence that should never be acceptable and therefore cannot be justified, and human error will always allow for the possibility of wrongful convictions. The authors argue that the death penalty should be abolished in principle, but we cannot deny the existence of a criminal for whom the death penalty would be appropriate. Ethically, it would be questionable to accept life imprisonment without parole as an alternative. We are of the position that there is no definite conclusion concerning the ethicality of the death penalty. (shrink)