The concept of contingency is very much debated. In this paper, I’ll offer a novel interpretation of it in Dharmakīrti’s ontology, focusing on his treatment and understanding of vināśa which is, according to Dharmakīrti, not contingent and thus occurs necessarily to everything. I will do so by clarifying some important terms, motivating and explaining Dharmakīrti’s position, and analyzing firsthand some Dharmakīrtian debate excerpts with Nyāya and/or Vaiśeṣika philosophers as the main opponents. In the course of this, I will show that (...) basically, for Dharmakīrti, contingency is tantamount to dependency, whereas Nyāya and/or Vaiśeṣika authors, e.g., Śrīdhara and Bhāsarvajña, claim that something can be dependent on something else and still be necessary. (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)

Background Advance care planning (ACP) is a process in which adults engage in an ongoing dialogue about future medical treatment and care. Though ACP is recommended to improve the quality of end-of-life care, the details of the dialogue experience in ACP are unknown. Objective To explore participants’ experiences of dialogue in an ACP educational program that encouraged them to discuss the value of a way of life. Research design This qualitative descriptive study used the focus group interview method. Data were (...) analyzed using qualitative content analysis. Participants and research context A dialogue-based ACP educational program was conducted in four regions in Japan for local citizens to discuss the value of their way of life. A total of 66 individuals (mean age = 55.5 ± 17.2 years; 50 women and 16 men) participated in focus group interviews. Ethical considerations This study was approved by the Ethical Review Committee of Tokyo Women’s Medical University (no. 4723) and Kyoto University (no. R2099). Findings Five main themes were extracted: discussing one’s thoughts with others in a considerate manner, reflecting on one’s way of life through others, feeling a sense of connection with others through storytelling, realizing the difficulties of talking about “what if” topics, and turning one’s eyes toward the future through the dialogue. These themes were interrelated and illustrated the complexity of the experience of discussing values. Conclusions The results suggest that dialogue in ACP is useful in clarifying values. They also indicated the need for dealing with the ethical challenges of discussing value and the importance of caring for the interlocutor to have a safe dialogue. In the ACP process, safety in dialogue may improve readiness in ACP, and health practitioners who support ACP need to address the ethical challenges entailing dialogue about values. (shrink)

Dharmottara, one of the most outstanding commentators of Dharmakīrti, re-uses arguments in the Pramāṇaviniścayaṭīkā, his broad commentary on Dharmakīrti’s Pramāṇaviniścaya, from his independent essay, the Kṣaṇabhaṅgasiddhi. By analyzing contents of re-used arguments in the Pramāṇaviniścayaṭīkā, this paper clarifies Dharmottara’s intention of paraphrasing his arguments in his commentarial work on Dharmakīrti. I argue that, in terms of content, such arguments are original and never fit into Dharmakīrti’s own system. It can be said that Dharmottara has a clear intention to display his (...) new innovations not only in his independent monograph, but also in his commentarial work. For Dharmottara, a commentary on Dharmakīrti is a better place than an independent monograph for showing off his advanced notions, since it is only in a commentary that his ideas can stand out directly against those of Dharmakīrti. In this sense, Dharmottara writes his commentary strategically. At the end of the article I discuss the significance of composing independent monographs or essays in the intellectual history of medieval India in the case of Dharmottara. (shrink)