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.

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)

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.

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)

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)

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)

No laws or official guidelines govern medical assistance for dying in Japan. However, over the past several years, cases of assisted suicide or voluntary euthanasia, rarely disclosed until recently, have occurred in close succession. Inspired by these events, ethical, legal, and social debates on a patient’s right to die have arisen in Japan, as it has in many other countries. Several surveys of Japanese people’s attitudes towards voluntary assisted dying suggest that a certain number of Japanese prefer active euthanasia. Against (...) this background, it is important to discuss voluntary assisted dying cases in Japan and the Japanese views on them and to consider their implications. We review three recent Japanese voluntary assisted dying cases and discuss the various objections to voluntary assisted dying that have been published in response to these in various media outlets. Our counterarguments include the double suffering of people who are unable to give up their desire to die, individuality of death, variability of culture, problem of being an annoyance to (burden on) others, a slippery slope argument supporting voluntary assisted dying, and unfair claims about responsibility and excessive burden on people who are unable to give up their desire to die. We also point out the psychocultural and social problems in Japanese society that these objections reflect, and argue that voluntary assisted dying can be ethically acceptable under certain conditions. We conclude that Japanese society must change in order to enable those who sincerely wish to die to do so in a better way. (shrink)

The argument contained in The End of History and the Last Man consists of an empirical part and a normative part: critics have confused the two and their proper relationship. The assertion that we have reached the "end of history" is not a statement about the empirical condition of the world, but a normative argument concerning the justice or adequacy of liberal democratic political institutions. The normative judgment is critically dependent on empirical evidence concerning, for example, the workability of capitalist (...) and socialist economic systems, but ultimately rests on supra-empirical grounds. The empirical part concerns whether there is something like the Hegelian-Marxist concept of History as a coherent, directional evolution of human societies taken as a whole. The answer to this is yes, and lies in the phenomenon of economic modernization based on the directional unfolding of modern natural science. The latter has unified mankind to an unprecedented degree, and gives us a basis for believing that there will be a gradual spread of democratic capitalist institutions over time. This empirical conclusion, however, does no more than give us hope that there is a progressive character to world history, and does not prove the normative case. The normative grounding of modern liberal democracy has indeed been put in jeopardy by the philosophical "crisis of modernity" inaugurated by Nietzsche and Heidegger. Contemporary postmodernist critiques of the possibility of such a grounding have not, however, adequately come to terms with the destructive consequences of their views for liberal democratic societies. This aporia, discussed most seriously in the Strauss-Kojève debate, is the central intellectual issue of our age. (shrink)

: The technologies at the intersection of assisted reproduction and genetics call for a new regulatory approach, say Franco Furger and Francis Fukuyama, authors of the recent report Beyond Bioethics. In the essay below they map out their recommendation. In the following essays, James Fossett argues that regulation is likelier—and would be better—at the state level, Leonard Fleck calls for more robust public involvement, and John Robertson recommends sticking with the status quo. Turning from procedural to substantive issues, Josephine Johnston (...) takes up Furger and Fukuyama’s suggestion that children have a right to a traditional genetic parentage. (shrink)

BackgroundNo laws or official guidelines govern voluntary assisted dying (VAD) in Japan. A legislative bill on the termination of life-sustaining measures has yet to be sent to deliberations for legislation, due to strong opposition that has prevented it from being submitted to the Diet. However, Japan has recently witnessed several cases involving VAD.Main textAgainst this backdrop, we argue that Japan should begin discussion on VAD legislation, referring to the Voluntary Assisted Dying Act 2017 (VADA2017), which was established in 2017 in (...) Victoria, Australia. VADA2017 puts in place a wide range of stringent safeguards and is considered worldwide to be the safest and most conservative policy on a physician offering assisted dying based on the patient’s premeditated request. We consider what opposing opinions from society would arise in response to the VADA2017. Among these will include arguments against VAD itself, those against the validation of this act, and opinions that oppose even the initiation of the dialogue on VAD.ConclusionsWe conclude that to protect the right to life among those placed in vulnerable positions and, at the same time, to respect decision-making of those who wish for immediate death due to unbearable suffering, the dialogue must immediately begin with that on introducing a policy more conservative than that of the VADA2017, which solidly considers arguments against VAD. (shrink)

Patient families sometimes ask health professionals, ‘What would you do if this were your family member?’ The purpose of this paper is to examine appropriate responses to this Question. Health professionals may say, ‘It all depends on the patient's wishes’, or ‘I don't know what is best, because my family is different from yours in many ways’. Some may believe that the most favourable course of action is the same regardless of who the patient is and explain this to the (...) patient's family, while others may refuse to answer the Question saying it is personal, or argue that such a Question should neither be asked nor answered because it is unreasonable and unprofessional to do so. We believe that, in principle, health professionals should give an honest answer as to what they would do if the patient was their family member, recognising and empathising with the fact that the patient's family is in a difficult and vulnerable position, and that their circumstances forced them to ask such a Question. Moreover, personal and emotional views of health professionals regarding treatment options may help the patient's family make important decisions. An honest answer will help strengthen the trusting relationship between health professionals and the patient's family and support their decision-making. (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)

Moral leadership matters. As world politics enters a new and dangerous era, judgment, constancy, moral purpose, and a willingness to overcome partisan politicking are essential for America's leaders. Tempered Strength finds the alternative standard of leadership that Americans are seeking in the classical philosophy of prudence. Ethan Fishman's new work brings together leading American political scientists—including Ronald Beiner, Kenneth L. Deutsch, and George Anastaplo—to discuss the evolution of a standard of prudential leadership both reasonable in nature and practical in scope. (...) Section One studies the meaning of prudence and its evolution in the history of political science from Aristotelian phronesis to Xenophon, Thomas Aquinas, Edmund Burke, and Michael Oakeshott. Section Two demonstrates how the theory of prudential leadership can be applied to practical political issues. (shrink)

Hello, my name is Francis Fukuyama and I am delighted to be able to participate in this symposium at EAFIT, on The End of History? I am a Senior fellow at Stanford University and in the summer of 1989, I published an article in the journal The National Interest titled The End of History? 30 years have passed since the publication of this article and this was a good opportunity to reflect on what has happened to the state of global (...) democracy and global politics in those three decades. (shrink)

In general, only one diffusion model would be applied to whole field-of-view voxels in the intravoxel incoherent motion-magnetic resonance imaging study. However, the choice of the applied diffusion model can significantly influence the estimated diffusion parameters. The quality of the diffusion analysis can influence the reliability of the perfusion analysis. This study proposed an optimal model mapping method to improve the reliability of the perfusion parameter estimation in the IVIM study. Six healthy volunteers. Volunteers were examined using a 3.0 Tesla (...) scanner. IVIM-MRI of the brain was applied at 17 b-values ranging from 0 to 2,500 s/mm2. The Gaussian model, the Kurtosis model, and the Gamma model were found to be optimal for the CSF, white matter, and gray matter, respectively. In the mean perfusion fraction analysis, the GM/WM ratios were 1.16, 1.80, 1.94, and 1.54 ; in the mean pseudo diffusion coefficient analysis, the GM/WM ratios were 1.18, 1.19, 1.56, and 1.24. With the optimal model mapping method, the estimated fp and D* were reliable compared with the conventional methods. In addition, the optimal model maps, the associated products of this method, may provide additional information for clinical diagnosis. (shrink)