The purpose of this study was to evaluate the effectiveness of an educational intervention regarding end-of-life discussion directed at older Japanese adults and their attitude to and acceptance of this intervention. A quasi-experimental design was used. A total of 121 older adults, aged 65 years and over, consented to participate. Data from 55 intervention and 57 control participants were used for the analysis. The intervention consisted of an education program comprising a video, a lecture using a handout, and discussion among (...) participants. The control group received only the handout. Both groups were followed up after one month. The intervention group’s attitude became more favorable towards advance directives, especially living wills (P = 0.024). In addition, their expression of preference for life-sustaining treatment by means of artificial nutrition was less at follow up, demonstrating that these older adults had become more autonomous (P = 0.008). There was greater acceptance of the intervention as a whole by the intervention group compared with the control group (P = 0.011). Although few participants overall completed living wills, at follow up twice as many in the intervention group had discussed end-of-life matters with family members and/or their physician. (shrink)

In Japan, terminating life-sustaining treatment in non-terminal patients is legally and ethically problematic given the lack of legal regulations regarding the termination of LST, including dialysis treatment. This article describes an ethically problematic case that happened at a hospital in Tokyo in March 2019, in which a patient died after a physician withdrew kidney dialysis upon the patient’s request. Most national newspapers in Japan reported the case extensively and raised the question of ethical and legal permissibility of withdrawing dialysis treatment (...) from non-terminal patients. In this article, we first examine the case within the current policy framework in Japan and then discuss how Japan can improve its end-of-life practice, focusing specifically on the patient’s right to self-determination and treatment refusal. We recommend that policymakers consider legalizing the termination of LST and the patient’s right to refuse treatment based on the principle of respect for autonomy. (shrink)

BackgroundRegulations on forgoing life-sustaining treatment (LST) have developed in Asian countries including Japan, Korea and Taiwan. However, other countries are relatively unaware of these due to the language barrier. This article aims to describe and compare the relevant regulatory frameworks, using the (more familiar) situation in England as a point of reference. We undertook literature reviews to ascertain the legal and regulatory positions on forgoing LST in Japan, Korea, Taiwan, and England.Main textFindings from a literature review are first presented to (...) describe the development of the regulatory frameworks surrounding the option of forgoing LST in each country. Based on the findings from the four countries, we suggest five ethically important points, reflection on which should help to inform the further development of regulatory frameworks concerning end-of-life care in these countries and beyond. There should be reflection on: (1) the definition of – and reasons for defining – the ‘terminal stage’ and associated criteria for making such judgements; Korea and Taiwan limit forgoing LST to patients in this stage, but there are risks associated with defining this too narrowly or broadly; (2) foregoing LST for patients who arenotin this stage, as is allowed in Japan and England, because here too there are areas of controversy, including (in England) whether the law in this area does enough to respect the autonomy of (now) incapacitated patients; (3) whether ‘foregoing’ LST should encompass withholdingandwithdrawing treatment; this is also an ethically disputed area, particularly in the Asian countries we examine; (4) the family’s role in end-of-life decision-making, particularly as, compared with England, the three Asian countries traditionally place a greater emphasis on families and communities than on individuals; and (5) decision-making with and for those incapacitated patients who lack families, surrogate decision-makers or ADs.ConclusionComparison of, and reflection on, the different legal positions that obtain in Japan, Korea, Taiwan, and England should prove informative and we particularly invite reflection on five areas, in the hope the ensuing discussions will help to establish better end-of-life regulatory frameworks in these countries and elsewhere. (shrink)

Minerals originated from eastern Democratic Republic of Congo (DRC) are blamed for financing violent conflict in the area over the past decade and have been called conflict minerals. They vividly demonstrate a key human rights issue facing responsible supply chain management. The conflict minerals issue has led to a significant shift in responsible supply chain management in two ways: extending producer responsibility to respect human rights in the total supply chain through establishing traceability and transparency; and developing legally binding supply (...) chain responsibility.This article examines an emerging effort to source conflict‐free minerals using closed‐pipe supply chain in the DRC as a new strategy to respond to the above paradigm shift. By exploring whether this new strategy can contribute to conflict prevention in the DRC, this article argues that the closed‐pipe supply chain allows building long‐term relationship with various stakeholders and has the potential to transform socio‐economic structures in the producing communities, thereby leading to peacebuilding in the long run. (shrink)

We examined the differences between estimating the emotions of protagonists and evaluating those of readers in narrative comprehension. Half of the participants read stories and rated the emotional states of the protagonists, while the other half of the participants rated their own emotional states while reading the stories. The results showed that reading comprehension was facilitated when highly extraverted participants read stories about, and rated the emotional experiences of, extraverted protagonists, with personalities similar to their own. However, the same facilitative (...) effect was not observed for less extraverted participants, nor was it observed for either type of participants under the condition in which participants rated their own emotional experiences. Thus, at least for highly extraverted participants, readers both facilitated the construction of a situation model and correctly estimated the emotional states of protagonists who were similar to themselves, perhaps due to empathy. (shrink)

AimTo examine the association of body mass index (BMI) [kg/m2] and its classifications (underweight [BMI < 18.5], normal [18.5 ≤ BMI < 25], overweight [25 ≤ BMI < 30], and obese [BMI ≥ 30]) with brain structure in individuals with a wide range of BMI group.Materials and methodsThe participants included 382 right-handed individuals (mean age: 46.9 ± 14.3 years, 142 men and 240 women). The intelligence quotient was assessed using the Japanese Adult Reading Test. Voxel-based morphometry (VBM) and diffusion tensor (...) imaging (DTI) were performed to analyze the association of BMI and its classifications with gray and white matter structures, respectively.ResultsAccording to VBM, BMI was significantly and negatively correlated with the bilateral cerebellum exterior volumes. In group comparisons, the right cerebellum exterior volume was significantly lower in the overweight or obese group than in the underweight or normal group, while the bilateral cuneus and calcarine cortex, left cuneus, and left precuneus volume was significantly lower in the underweight group than in the non-underweight group. Sex-related stratification analyses for VBM revealed that BMI was significantly and negatively correlated with the bilateral cerebellum exterior volumes only in women. In group comparisons, the left cerebellum exterior volume was significantly lower in obese women than in non-obese women. The left thalamus proper and the right cerebellum exterior volumes were significantly lower in overweight or obese group than in underweight or normal group in men and women, respectively. The bilateral cuneus and calcarine cortex, left cuneus and carcarine cortex, and bilateral cuneus volume was significantly lower in underweight men than in non-underweight men. In contrast, there were no notable findings on DTI.ConclusionOur results suggest association of continuous BMI, being overweight or obese, and being underweight with decreased gray matter volume in individuals with a wide range of BMI group. Furthermore, sex-related differences are seen in the association of BMI and its classifications with regional gray matter volume reductions. Abnormally high or low BMIs may have a negative influence on regional gray matter volumes. (shrink)

An instantia is a technique to refute other's arguments, found in many tracts from the latter half of the twelfth century. An instantia has (or appears to have) the same form as the argument to be refuted and its falsity is more evident than that of the argument.Precursors of instantiae are among the teachings of masters active in the first half of the century. These masters produce counter-arguments against various inferential forms in order to examine their validity. But the aim (...) of producing counter-arguments change in the latter half of the century into refuting other's arguments to win in debate by any means available. Logicians of that period do not care whether the counter-arguments (instantiae) are sophistical or not, viz. the falsity of instantiae is or is not due to the flaw common to the argument to be refuted.Many instantiae they produce involve logical entanglements into which they themselves have little clear insight. Some instantiae and the attempts to explain them grows into the new theories in the “terminist texts” around 1200 A.D., when instantia literature itself disappears. Some instantiae and the issues they raise have no place in terminist texts, and sink into oblivion. (shrink)

Background The purpose of this study is to explore laypersons' attitudes toward the use of archived (existing) materials such as medical records and biological samples and to compare them with the attitudes of physicians who are involved in medical research. Methods Three focus group interviews were conducted, in which seven Japanese male members of the general public, seven female members of the general public and seven physicians participated. Results It was revealed that the lay public expressed diverse attitudes towards the (...) use of archived information and samples without informed consent. Protecting a subject's privacy, maintaining confidentiality, and communicating the outcomes of studies to research subjects were regarded as essential preconditions if researchers were to have access to archived information and samples used for research without the specific informed consent of the subjects who provided the material. Although participating physicians thought that some kind of prior permission from subjects was desirable, they pointed out the difficulties involved in obtaining individual informed consent in each case. Conclusions The present preliminary study indicates that the lay public and medical professionals may have different attitudes towards the use of archived information and samples without specific informed consent. This hypothesis, however, is derived from our focus groups interviews, and requires validation through research using a larger sample. (shrink)

ABSTRACT Objectives: the purpose of this study is to explore laypersons’ attitudes towards and experiences of medical research, and to compare them with those of physicians in Japan. Designs and Participants: fourteen Japanese adults from the general public and seven physicians participated in one of three focus interviews. Setting: Osaka, Japan. Results: trust and distrust in the physician by whom the participants were invited to participate in research played a considerable role in their decisions about participation. That the participants felt (...) an obligation to participate was also expressed. The lay participants perceived medical research as something entirely outside of their world. A greater willingness to volunteer for research was expressed if there were direct benefits to themselves or their families. Research methods such as use of placebos, double blinds, and randomisations seemed to cause negative attitudes to medical research. All physicians were convinced of the need for medical research, including double‐blinded randomised control trials, and its significant role in medical progress. Most physicians thought that the greater awareness of the need for medical research in the community and a better understanding of the psychology of potential research participants were necessary and urgent. Conclusions: there is a good possibility that the lay public and medical professionals have sharply different beliefs about and attitudes towards every aspect of medical research. Building up a better and equal patient‐doctor relationship based on trust is a key issue in medical research, and it is mandatory to fill the gap in perception regarding medical research between them through fully informed debates. (shrink)

Dogs and cats have been domesticated through different processes. Dogs were the first domesticated animals, cooperating with humans by hunting and guarding. In contrast, cats were domesticated as predators of rodents and lived near human habitations when humans began to settle and farm. Although the domestication of dogs followed a different path from that of cats, and they have ancestors of a different nature, both have been broadly integrated into—and profoundly impacted—human society. The coexistence between dogs/cats and humans is based (...) on non-verbal communication. This review focuses on “gaze,” which is an important signal for humans and describes the communicative function of dogs’ and cats’ eye-gaze behavior with humans. We discuss how the function of the gaze goes beyond communication to mutual emotional connection, namely “bond” formation. Finally, we present a research approach to multimodal interactions between dogs/cats and humans that participate in communication and bond formation. (shrink)

Jecker and Au’s paper raises important issues concerning health equity in pandemic responses, and the importance of considering the long-term effects of pandemic strategy on population health and well-being.1 We welcome their focus on the experience of Asian countries, including Japan. However, we have some concerns with both the distinction which they draw between elimination and mitigation, and their account of the nature and origins of the Japanese response to the COVID-19 pandemic. First, we believe that the distinction between elimination (...) and mitigation is not fine grained enough to capture the various strategies which countries have taken towards the pandemic. Many of Jecker and Au’s criticisms of the elimination strategy relate to specific policies such as lockdowns, travel restrictions and restrictions on businesses, which have been employed by numerous countries irrespective of their end goal. By contrast to the simple elimination/mitigation dichotomy with which Jecker and Au work, Baker et al have identified five separate COVID-19 strategies, namely: exclusion, elimination, suppression, mitigation and no substantive strategy.2 Baker et al define an elimination strategy as ‘maximum action to exclude disease and eliminate community transmission’ with the goal of reaching ‘zero [disease] transmission in the community’. On this account, Japan’s strategy does …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content: Six Poems GEORGE KALOGERIS The Atomists To see what the matter is, in all of its dense, Teeming particulars, and not through the lens Of a microscope but by the most lucid, precise, Leap of imagination: the first was Leucíppus. But it was his student, Democritus, who stated That human understanding was truly futile, Given the random collisions of atoms. Still, He blinded himself to keep from being (...) distracted. When he broke the long-jump record by two whole feet, Bob Beamon dropped to his knees, buried his face In his hands, and wept in a pit of sand—the trace Of his human, Olympian flight still fresh as a heel-print. When the earthquake struck Kalamáta, and Uncle Sotíri Lost everything, he asked a taxi driver To take him to “a nice high place by the sea. And then come back for me in half an hour.” arion 28.3 winter 2021 58 six poems One Credit Seminar on the Odes of Horace We were sitting around a polished oak table, just getting to Those famous lines near the end of the Sestius Ode: Revenant whitefaced Death is walking not knowing whether He’s going to knock at a rich man’s door or a poor man’s When one of the students (Andrew) said it was “totally weird”— Which led us to look at the paleness of Death’s appearance, Whose pallor is what, when he comes, comes with him: the sickness and shock In his ghastly face. And that’s where we stopped. And then It was Jennifer’s email, saying “I’m sorry for missing class, But I’m having panic attacks. I keep flashing back To March 19th, when I entered my dorm-room and found my boyfriend Dead of an overdose... I can get you a note... What reading should I do to be prepared for next week?” O goodlooking fortunate Sestius, don’t put your hope in the future; The night is falling, the shades are gathering around; The walls of Pluto’s shadowy house are closing you in. There who will be lord of the feast? What will it matter, What will it matter there, whether you fell in love With Lycidas, this or that girl with him, or he With her? So David Ferry’s great translation goes, And its tone of tender, knowing, bemusement is Horace’s Pitying voice, but whose pity has come to speak to us Through the whitefaced mouth of revenant Death, still going From house to house, until he gets to Jennifer’s dorm-room. And what will it matter now if Andrew was drawn to the line About fishermen hauling their caulked boats to the water? It’s late September. We’re sitting around a polished oak table Whose wood is sacred to Jove, whose lightning-bolt Has already sounded deep in the heart of Indian summer. George Kalogeris 59 Greek School The very first poem I ever knew by heart: That sing-song forsaken one assigned to me. Recited on our other Independence Day. When some of the girls were dressed in peasant costumes, And some of the boys in kilts of the freedom fighters. And the timid rest of us in our Sunday best. In the church gym, where Father Mihos called us Up to the microphone, and one by one We showed the parents what we’d learned in Greek school. In Horace’s Ode to his Lyre, the poet prays That his song will serve as the medicine of sorrows, His stricken voice the trembling instrument— Schooled as he was in Sappho, who said the ancient Prescription left a bittersweet taste in her mouth: Glukopikron. For me it’s that first-grade poem I stammer to remember: Egwo tha geino Yiatrós... “I shall grow up to be a doctor...” Just saying that, my elders perk up their ears. And even if Poetry wasn’t the kind of calling Expected of me, and one by one they all Got sick and died, it’s still the medicine That keeps them leaning forward on their folding chairs. 60 six poems Money Doesn’t Grow On Trees But evergreen the... (shrink)

Among the various testimonia assembled by Iwakuma and Ebbesen to the twelfth-century school of philosophers known as the Nominales,Iwakuma Yukio and Sten Ebbesen, “Logico -Theological Schools from the Secon d Half of the 12th Century: A List of Sources,” Vivarium XXX (1992):173–210. four record their commitment to the apparently outrageous thesis that nothing grows. My aim in this essay is to explore the reasons the Nominale s had for maintaining this thesis and to investigate the role that the (...) theory which supported it played in the development of late twelfth- and early thirteenth-century debates over the character of the hypostatic union. My investigation concerns onl y one aspect of twelfth-century NominalismSince this group were apparently the first ever to be called ‘nominalists’ I think that we may justifiably capitalize the name of the theory to indicate that we are referring to their version of it. but once this part of their system is understood, we will be better able to characterise the whole and the way in which the views of the Nominales conflicted with those of their opponents. S o long as the testimonia remain few and rather slight such a reconstruction offers our only hope for finding the Nominales and their influence where their name has not been recorded. (shrink)

Among the various testimonia assembled by Iwakuma and Ebbesen to the twelfth-century school of philosophers known as the Nominales,Iwakuma Yukio and Sten Ebbesen, “Logico -Theological Schools from the Secon d Half of the 12th Century: A List of Sources,” Vivarium XXX (1992):173–210. four record their commitment to the apparently outrageous thesis that nothing grows. My aim in this essay is to explore the reasons the Nominale s had for maintaining this thesis and to investigate the role that the (...) theory which supported it played in the development of late twelfth- and early thirteenth-century debates over the character of the hypostatic union. My investigation concerns onl y one aspect of twelfth-century NominalismSince this group were apparently the first ever to be called ‘nominalists’ I think that we may justifiably capitalize the name of the theory to indicate that we are referring to their version of it. but once this part of their system is understood, we will be better able to characterise the whole and the way in which the views of the Nominales conflicted with those of their opponents. S o long as the testimonia remain few and rather slight such a reconstruction offers our only hope for finding the Nominales and their influence where their name has not been recorded. (shrink)