Background According to some medical ethicists and professional guidelines, there is no ethical difference between withholding and withdrawing life-sustaining treatment. However, medical professionals do not always agree with this notion. Patients and their families may also not regard these decisions as equivalent. Perspectives on life-sustaining treatment potentially differ between cultures and countries. This study compares Japanese physicians’ and citizens’ attitudes toward hypothetical cases of withholding and withdrawing life-sustaining treatment.Methods Ten vignette cases were developed. A web-based questionnaire was administered to 457 (...) citizens and 284 physicians to determine whether they supported withholding or withdrawing treatment.Results In a case where a patient had an advance directive refusing ventilation, 77% of the physicians and 68% of the citizens chose to withhold treatment. In a case where there was an advance directive but the patient’s family requested treatment, 55% of the physicians and 45% of the citizens chose to withhold the ventilator. When a family requested withdrawal of the ventilator but patient wishes were unknown, 19% of the physicians and 48% of the citizens chose to withdraw the ventilator. However, when the patient had also indicated their wishes in writing, 49% of the physicians and 66% of the citizens chose to withdraw treatment. More physicians were prepared to withdraw dialysis (84%) and artificial nutrition (81%) at a patient’s request than mechanical ventilation (49%).Conclusions A significant proportion of Japanese physicians and citizens were reluctant to withhold or withdraw life-sustaining treatment, even in cases where the patient had indicated their wishes in writing. They were more likely to withhold than withdraw treatment, and more likely to withdraw artificial nutrition than mechanical ventilation. Japanese physicians gave significant weight to family views about treatment but were less likely to agree to withdraw treatment than citizens, indicating a potential source of conflict in clinical settings. (shrink)

Human interaction has two principle functions: building and maintaining relationships with others and exchanging information. The function of building and maintaining relationships with others relates to interpersonal coordination; this behavior pattern is expected to predict the outcome of social relationships, such as between therapists and patients. It is unclear, however, whether the exchange of information is associated with interpersonal coordination. In the present study, we tested a hypothesis of whether body movement synchrony occurs in a natural conversation and whether this (...) synchrony has a positive correlation with the degree of information exchange. Fifty participants were engaged in a conversation task; each had different roles in the conversation. We measured their body movements during this conversation using an optical motion capture system. Similar to methods that can be found in previous research, we calculated body movements and quantified their synchrony applying the methods previously reported that automatically quantified their body movements. Moreover, we determined the participants’ degree of information exchange concerning the conversation using a questionnaire. We observed that the body movement synchrony of pairs who talked with each other was significantly higher than that of pairs who did not talk with each other, and that this synchrony was positively associated with the degree of information exchange. These results suggest that body movement synchrony predicted information exchange. (shrink)

Background In current Western medical ethics, patient-centered medicine is considered the norm. However, the cultural background of collectivism in East Asia often leads to family-centered decision-making. In Japan, prior studies have reported that family-centered decision-making is more likely to be preferred in situations of disease notification and end-of-life decision-making. Nonetheless, there has been a recent shift from collectivism to individualism due to changes in the social structure. Various personal factors have also been reported to influence moral decision-making. Therefore, this study (...) examined whether the current trend in attitudes of healthcare decision-making in Japan is family-centered or patient-centered among the general public and physicians. In addition, the personal factors that influence this tendency were examined.Methods Three vignettes on disease notification and two vignettes on decision-making during end-of-life care were created, and 457 members of the public and 284 physicians were asked about their attitudes (behavioral intentions) regarding these vignettes.Results Approximately, 95% of physicians were patient-centered in explaining the patient’s severe medical condition. However, approximately 80% of physicians emphasized the wishes of the family over patient wishes when making life-sustaining decisions. Nearly half the general public emphasized the patient’s wishes in the explanation of a severe medical condition and in life-sustaining decisions. In both the public and physician groups, personal factors, particularly the presence or absence of a disease under treatment and prior caregiving experience, influenced ethical attitudes toward medical treatment decisions.Conclusions In relatively low-conflict situations, such as the announcement of a patient’s medical condition, physicians tended to be patient-centered, while they tended to be family-centered in situations of strong conflict in withholding life-sustaining treatment. The fact that personal factors influenced the family-centered response in situations of strong conflict highlights the importance of not only acquiring knowledge of medical ethics but also learning to fairly apply this knowledge in practice. (shrink)

During clinical ethics consultation training, hands-on practice after acquiring the necessary knowledge under an experienced clinical ethics consultant's supervision is an effective method of obtaining technical and practical skills. However, in regions where clinical ethics consultation is still nascent, few experienced clinical ethics consultants exist. The number of clinical ethics consultation cases is small, making on-the-job training significantly difficult. To address this problem, this study developed a remote supervision program using e-mail and ZOOM and evaluated its effectiveness using Kirkpatrick's learning (...) effectiveness model. The findings confirmed the good learning effects of both programs. In particular, ZOOM's learning effectiveness was greater than e-mail's in Level 2 learning effects. Nevertheless, remote supervision may be an effective method when in-person training is difficult, such as in countries with developing clinical ethics consultations or during the outbreak of infection. (shrink)

This study aims to develop guidelines of key concepts and specific considerations to make the research more ethical when conducting neurological examinations and treatment interventions in mentally ill patients. We analyzed guideline development theory and literature, previous issues, and discussions with specialists of philosophy, medicine, sociology, and bioethics. The selection of research participants, drafting of intervention plans, and informed consent process were examined with reference to the dual burden; the minimal risk as a general rule of ethical allowance levels, assent (...) and dissent to assess the individual’s judgment capacity for consent, relational autonomy for personal consent with assistance by the proxy, and risk/benefit assessments. When conducting studies, this guideline requires that these three processes be set up appropriately on a case-by-case basis. (shrink)

This study analyzed the effects of aging on post-error behavioral adjustments from the perspective of cognitive control. A modified error awareness task was administered to young and older adults. In this task, two buttons were placed on the left and right sides in front of the participants, who were instructed to use the right button to perform a go/no-go task, and were notified if they made an error. There were three experimental conditions : participants had to push the right button (...) once in Condition A and twice in Condition B and C when a go-stimulus was presented. Conversely, participants were asked to withhold their response when a no-go stimulus was presented. Response inhibition differed depending on the experimental condition. The participants were asked to push the left button as quickly as possible when an error occurred. The results showed relatively longer reaction times to sudden errors among older adults compared with young adults. Furthermore, the difference in the error responses strongly influenced older adults’ response time after an error. These results suggest that the shift from proactive to reactive control may significantly influence post-error behavioral adjustments in older adults. (shrink)

This research examines the current status of clinical ethics consultation (CEC) in Japan through a nationwide study conducted with chairs of ethics committees and clinical ethics committees among 1028 post-graduate clinical teaching hospitals. We also qualitatively analyzed their viewpoints of the CEC’s benefits and problems related to hospital consultation services to identify the critical points for CEC and inform the development of a correctly functioning system. The questionnaire included structured questions about hospital CEC organization and service purpose and operation and (...) open-ended questions about the benefits and problems of initiating CEC. The questionnaire comprised the presence/absence of an ethics committee, CEC services and membership when services were implemented, users, and the number of cases handled since inception. In addition, the respondents also provided their impressions of the CEC system’s impact on their hospital by describing (a) the benefits of CEC services and (b) the ineffectual or harmful aspects of the CEC system. Qualitative data were examined using qualitative content analysis to determine the impact of establishing a CEC and the difficulties of practice. One hundred twenty-five questionnaires were returned from either the chair of the ethics committee or clinical ethics committee in teaching hospitals. Of these, 90 (72%) reported they provided CEC services. Additionally, 36 respondents (34.6%) reported that their existing research and clinical ethics committees had conducted CEC services, and 35 (33.7%) reported having a newly established clinical ethics committee conducting CEC services. Three positive effects of establishing and four challenges in managing CEC were also identified. (shrink)

On 11 March 2011, Japan experienced a major disaster brought about by a 9.0-magnitude earthquake and a massive tsunami that followed. This disaster caused extensive damage to the Fukushima Daiichi nuclear power plant with the release of a large amount of radiation, leading to a crisis level 7 on the International Atomic Energy Agency scale. In this report, we discuss the obligations of physicians to provide care during the initial weeks after the disaster. We appeal to the obligation of general (...) beneficence and argue that physicians should go to disaster zones only if there is no significant risk, cost or burden associated with doing so. We conclude that physicians were not obligated to go to Fukushima given the high risk of radiation exposure and physical and psychological harm. However, we must acknowledge that there were serious epistemic difficulties in accurately assessing the risks or benefits of travelling to Fukushima at the time. The discussion that follows is highly pertinent to all countries that rely on nuclear energy. (shrink)

The behavioral immune system (BIS) includes perceptual mechanisms for detecting cues of contamination. Former studies have indicated that moisture has a disgusting property. Therefore, moisture could be a target for detecting contamination cues by the BIS. We conducted two experiments to examine the psychophysical basis of moisture perception and clarify the relationship between the perception of moisture and the BIS. We assumed that the number of high luminance areas in a visual image provided optical information that would enable the visual (...) perception of moisture. In two experiments, we presented eight images of dough that contained different amounts of moisture as experimental stimuli. The amount of moisture shown in the images was increased in eight steps, from 28.6% to 42.9% of the total weight of the dough. In Experiment 1, the images were randomly presented on a computer display, and the participants (n = 22) were asked to rank the images in the order of the visually perceived moisture content. In Experiment 2, the participants (n = 15) completed pairwise comparisons based on the perceived moistness of the images. Furthermore, to examine the BIS responses, the participants rated the strength of disgust evoked by the stimuli, their motivation to avoid touching the stimuli, and the estimated magnitude of the risk of contamination by physical contact with the stimuli. The results indicated that the moisture content and the numbers of high luminance areas in the images accurately predicted the perception of moisture, suggesting that the detection of visual moisture was highly accurate, and the optical information served as an essential perceptual cue for detecting moisture. On the other hand, the BIS responses peaked in response to stimuli having approximately 33% to 39% moisture content. These results show that objects containing a moderate amount of moisture could be the target of visually detecting pathogens by the BIS. (shrink)

Social Conformity and Response Bias Revisited: The Influence of "Others" on Japanese Respondents This study was undertaken to investigate the impact of other respondents' answers on individual responses in survey studies. The study employed four different conditions and manipulated the direction and the level of social pressure. The results have confirmed that social desirability bias hugely impacts individual answers. It was found that respondents are seven times more likely to choose a socially unacceptable option if majority of the preceding respondents (...) also have chosen the same option. Additionally, the existence of an interviewer during data collection was found to be a factor pressuring respondents to give more socially acceptable responses. (shrink)

Background There are several psychosocial and ethical issues surrounding the decision to be a living kidney donor. The present study aimed to determine the perceptions of psychosocial and ethical issues that living kidney donors may have, and analyze their psychological characteristics.Methods Face-to-face semi-structured interviews were conducted with 15 donors. Thematic analysis was then performed to categorize the thematic elements of the transcripts. All procedures were approved by the relevant review board.Results Four main categories were identified: Awareness of family dynamics, barriers (...) to a proper understanding, contrasting psychological effects of recipient presence in clinical practice, insufficient information explained in informed consent.Conclusion Donors felt that they took on the “role as a care giver” for the recipient and were less aware of themselves as patients. This is a new concept that has not been shown in previous studies. Donors exist within the recipient and family, and the range of their autonomy may go beyond the traditional concept of autonomy and be rooted in relational autonomy. This study suggested that medical treatment in the presence of the recipient promotes the relational autonomy of the donor. (shrink)

Until recently, many of Japan's medical and bioethical communities had ignored the issue of conflicts of interest . This is no longer the case. Discussion on the economic and ethical problems defined by CIs is now apparent in academic, political, and even industrial spheres. In June 2004, this debate was sparked by a scandal involving AnGes MG, Inc., a bioventure company set up by a faculty member at Osaka University Graduate School of Medicine. AnGes MG developed a gene therapy using (...) the Hepatic Growth Factor for obstructive blood vessel disease. Japanese newspapers reported that “several physicians involved with clinical trials for AnGes obtained unlisted shares of stock. One physician allegedly received 32 million yen after AnGes MG went public on the ‘Mothers’ stock exchange”. (shrink)

Hospital ethics committees (HECs) are expected to play extremely broad and pivotal roles such as case consultation, education of staffs on healthcare ethics, and institutional policy formation. Despite the growing importance of HECs, there are no standards for setup and operation of HECs, and composition and activities of HECs at each institution are rarely disclosed in Japan. In addition, there is also a lack of information sharing and collaboration among HECs. Therefore, the authors established the Consortium of Hospital Ethics Committees (...) (CHEC) in October 2020, which has been regularly hosting a couple of core activities. One is the Healthcare Ethics Forum, held monthly online for CHEC members to freely discuss HECs and healthcare ethics consultation. The other is the Collaboration Conference of Hospital Ethics Committees, intended to provide a place for HEC members and administrative officers from across Japan to exchange information of their HECs, learn from each other, and cooperate to operate HECs appropriately. In this paper, the authors introduced CHEC as well as reported the results of a questionnaire survey conducted at the first conference among participating facilities, suggesting the diverse structures and activities of HECs in Japan. (shrink)

On Jaina philosophy; includes translation in Hindi.