This study examines public health nurses’ perceptions and concerns about the implications of Japan’s new long-term care insurance law concerning care provision for elderly people and their families. Respondents voiced their primary concern about this law as access to services for all elderly people needing care, and defined their major responsibility as strengthening health promotion and illness prevention programmes. Although wanting to expand their roles to meet the health care, social and public policy advocacy needs of elderly persons and their (...) families, respondents also stated their concern for the possible lack of enough resources for this expansion to support family caregivers adequately. They viewed their first function as developing collaborative relationships with local government officials to help to assure sufficient resources to provide the necessary foundation for long-term care programmes to deliver services to all those in need. These concerns fall within the larger ethical issue of distributive justice in a society based on the obligations of the state to citizens and the family to its members, especially elderly relatives, who, according to traditional Japanese values, retain respect. (shrink)

Background: Patients in different countries have different attitudes toward self‐determination and medical information. Little is known how much respect Japanese patients feel should be given for their wishes about medical care and for medical information, and what choices they would make in the face of disagreement. Methods: Ambulatory patients in six clinics of internal medicine at a university hospital were surveyed using a self‐administered questionnaire. Results: A total of 307 patients participated in our survey. Of the respondents, 47% would accept (...) recommendations made by physicians, even if such recommendations were against their wishes; 25% would try to persuade their physician to change their recommendations; and 14% would leave their physician to find a new one. Seventy‐six percent of the respondents thought that physicians should routinely ask patients if they would want to know about a diagnosis of cancer, while 5% disagreed; 59% responded that physicians should inform them of the actual diagnosis, even against the request of their family not to do so, while 24% would want their physician to abide by their family's request and 14% could not decide. One‐third of the respondents who initially said they would want to know the truth would yield to the desires of the family in a case of disagreement. Interpretations: In the face of disagreement regarding medical care and disclosure, Japanese patients tend to respond in a diverse and unpredictable manner. Medical professionals should thus be prudent and ask their patients explicitly what they want regarding medical care and information. (shrink)

In the study of religion and terrorism, one of the most familiar incidents is the Sarin gas attack on the Tokyo subway system in 1995. With the execution of Shoko Asahara and his close associates in the summer of 2018, it would appear that the last chapter in this tragic tale has finally been written. I would argue, however, that there are still lessons to be learned from this event. In the present article, I describe the complexity of the (...) epistemic situation in which I found myself when I finally met AUM Shinrikyo in the spring of 1995. In addition to misunderstandings arising from monolithic inferences regarding AUM’s membership, I came to feel that certain anomalous items of information were swept under the rug—information that hinted at a more complex array of factors influencing AUM Shinrikyo and the subway attack. (shrink)

In the aftermath of the Aum case, various suggestions as to the causes of dangerous cult mentality, and possible measures for its prevention have been offered in the Japanese media, but it seems that a much more penetrating diagnosis is necessary than that thus far proffered. To merely lay blame to the person of Shoko Asahara, or the phenomenon of mind control, or an insensitivity, ineptitude, or lack of resources on the part of the Japanese police, is to grossly (...) oversimplify and objectify a problem which has complex roots within the structure of the very institutions and values which Japanese society regards as its greatest assets. (shrink)