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)

Background Regulations on forgoing life-sustaining treatment 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 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 text Findings 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: 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; foregoing LST for patients who are not in this stage, as is allowed in Japan and England, because here too there are areas of controversy, including whether the law in this area does enough to respect the autonomy of incapacitated patients; whether ‘foregoing’ LST should encompass withholding and withdrawing treatment; this is also an ethically disputed area, particularly in the Asian countries we examine; 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 decision-making with and for those incapacitated patients who lack families, surrogate decision-makers or ADs. Conclusion Comparison 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)

Objective: Population based cohort studies involving genetic research have been initiated in several countries. However, research published to date provides little information on the willingness of the general population to participate in such studies. Furthermore, there is a need to discover the optimal methods for acquiring fully informed consent from the general population. We therefore examined the results of a population based genetic cohort study to identify the factors affecting the participation rate by members of the general public and also (...) specifically to examine the impact of different consent procedures on the rate of participation by prospective candidates and their subsequent withdrawal rate from the study.Design: Descriptive analyses.Setting and participants: The study evaluated two non-genetic subcohorts comprising 3166 people attending for a health checkup during 2002, and two genetic subcohorts comprising 2195 people who underwent a checkup during 2003.Main outcome measurements: Analysis endpoints were differences in participation rates between the non-genetic and genetic subcohorts, differences between providing non-extensive and extensive preliminary information, and changes in participation status between baseline and at 6 months.Results: Participation rates in the genetic subcohorts were 4·7–9·3% lower than those in the non-genetic subcohorts. The odds ratios of participation in genetic research were between 0·60 and 0·77, and the OR for withdrawal from the research was over 7·70; providing preliminary extensive information about genetic research reduced the withdrawal risks but worsened participation rates .Conclusions: The general population responded sceptically towards genetic research. It is crucial that genetic researchers utilise an informative and educational consent process worthy of public trust. (shrink)

In his 1975 paper “The Meaning of ‘Meaning’”, Hilary Putnam famously argued for semantic externalism. Little attention has been paid, however, to the fact that already in 1973, Putnam had presented the idea of the linguistic division of labor and the Twin Earth thought experiment in his comment on Wilfrid Sellars’s “Meaning as Functional Classification” at a conference, and Sellars had replied to Putnam from a broadly inferentialist perspective. The first half of this paper aims to trace the development of (...) Putnam’s semantic externalism, situate his debate with Sellars in it, and reconstruct the two arguments he presented against Sellars. The second half of this paper aims to reconstruct how Sellars replied to Putnam. I argue that Sellars not only accepts the social character of language but also suggests how inferentialists can accommodate the contribution of the world. Sellars’s key idea is that substance terms have a “promissory note aspect” which is to be cashed out in a successor conceptual framework. I reconstruct Sellars’s position as ideal successor externalism, and compare it with temporal externalism. (shrink)

Interventions performed on a pregnant woman's body can affect the fetus in multiple ways. Such effects can be harmful to beneficial to the fetus. Unfortunately, the effects of new drugs and compoun...

Anthropomorphic agents used in online-shopping need to be trusted by users so that users feel comfortable buying products. In this paper, we propose a model for designing trustworthy agents by assuming two factors of trust, that is, emotion and knowledgeableness perceived. Our hypothesis is that when a user feels happy and perceives an agent as being highly knowledgeable, a high level of trust results between the user and agent. We conducted four experiments with participants to verify this hypothesis by preparing (...) transition operators utilizing emotional contagion and knowledgeable utterances. As a result, we verified that users' internal states transitioned as expected and that the two factors significantly influenced their trust states. (shrink)

Amid continuing social unrest from the Great East Japan Earthquake and subsequent Fukushima nuclear accident of 2011, the Japanese government announced plans for a major biobanking project in the disaster-stricken areas, to be administered by the ‘Tohoku Medical Megabank Organization’ (ToMMo). This project differs from previous biobanking projects in that it 1) was initiated mainly to boost post-disaster recovery and reconstruction; and 2) targets the area’s survivors as its primary subjects. Here, we review the ethics of the ToMMo biobanking project (...) within the wider context of disaster remediation. (shrink)

This study aimed to propose a novel method for designing a product recommendation virtual agent that can keep users motivated to interact with the agent. In prior papers, many methods of keeping users motivated postulated real-time and multi-modal interactions. The proposed novel method can be used in one-direction interaction. We defined the notion of the “hidden vector,” that is, information that is not mentioned by a PRVA and that the user can suppose spontaneously. We conducted an experiment to verify the (...) hypothesis that PRVAs having a hidden vector are more effective than other PRVAs. As a result, it was shown that PRVAs having a hidden vector were perceived as being more persuasive than other PRVAs and strongly motivated the users to use the PRVAs. From these results, the proposed method was shown to be effective. (shrink)

This study investigates simple games. A fundamental research question in this field is to determine necessary and sufficient conditions for a simple game to be a weighted majority game. Taylor and Zwicker showed that a simple game is non-weighted if and only if there exists a trading transform of finite size. They also provided an upper bound on the size of such a trading transform, if it exists. Gvozdeva and Slinko improved that upper bound; their proof employed a property of (...) linear inequalities demonstrated by Muroga. In this study, we provide a new proof of the existence of a trading transform when a given simple game is non-weighted. Our proof employs Farkas’ lemma, and yields an improved upper bound on the size of a trading transform. We also discuss an integer-weight representation of a weighted simple game, improving the bounds obtained by Muroga. We show that our bound on the quota is tight when the number of players is less than or equal to five, based on the computational results obtained by Kurz. Furthermore, we discuss the problem of finding an integer-weight representation under the assumption that we have minimal winning coalitions and maximal losing coalitions. In particular, we show a performance of a rounding method. Finally, we address roughly weighted simple games. Gvozdeva and Slinko showed that a given simple game is not roughly weighted if and only if there exists a potent certificate of non-weightedness. We give an upper bound on the length of a potent certificate of non-weightedness. We also discuss an integer-weight representation of a roughly weighted simple game. (shrink)

In the study of reference assignment, the question of what pragmatic criteria are used to evaluate the resulting interpretation seems not yet to have been properly dealt with. This paper addresses the issue by examining factors which affect the acceptability of various cases of bridging reference. It demonstrates that even highly successful accounts of reference assignment which place major emphasis on accessibility factors, e.g. the accessibility of candidate referents and the accessibility of contextual assumptions, must nonetheless involve some pragmatic criterion (...) with which hearers can evaluate the resulting interpretation. Moreover, it argues that the pragmatic criterion used in reference assignment is not the truth-based one, which has been widely accepted, but the criterion of consistency with the principle of relevance proposed by Sperber and Wilson. Various accounts are tested against a wide range of examples on which I have conducted experimental tests with several sets of subjects. (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)

In Japan, many incidents regarding manga-like virtual agents have happened recently, in which critics have indicated that virtual agents used in public spaces are too sexual. Prior study defined this perception as “moe-phobia.” In many cases, critics have pointed to agents' clothes. However, after verifying actual moe-phobia incidents, I hypothesize that these incidents are associated with not only the agents' clothes but also the situations in which they are used. I conducted an experiment with three factors and two levels to (...) verify this hypothesis. The independent values were the agents' clothes, usage scenario, and the gender of the participants. The dependent values were the agents' trustworthiness, familiarity, likability, sexuality, and suitability as perceived by humans. I conducted the experiment with female and male groups and conducted a three-way ANOVA for each dependent value for each group. As a result, I observed a different tendency regarding the impression of the agents between female and male groups; however, both groups had the same tendency regarding the perceived suitability. The female and male participants judged the agents' suitability from not only their clothes but also the scenario. (shrink)

AimTo examine the association of body mass index [kg/m2] and its classifications with brain structure in individuals with a wide range of BMI group.Materials and methodsThe participants included 382 right-handed individuals. The intelligence quotient was assessed using the Japanese Adult Reading Test. Voxel-based morphometry and diffusion tensor imaging 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)

In 2005 Japan completed its first census after the Personal Information Protection Law went into force in April 2005. The debate about the new law raised privacy concerns for the first time among the public. The news-media also provided several examples of possible lack of safeguards in the data collection of sensitive personal information required for the census. The result was the highest non-response rate ever for the Japanese census. Consequently, its accuracy and role as a source for the reliable (...) national statistics for health/welfare policy-making is now critically threatened. In this paper we argue the necessity to adopt specific safeguards to protect personal data in any future census if the trend of increasing non-response rates is to be reversed. We provide some suggestions for such safeguards, and criticize the Japanese government’s response of focusing exclusively on the mechanism of data collection as a means of meeting the privacy challenge. (shrink)

Background: Sharing of tissue samples for research and disease surveillance purposes has become increasingly important. While it is clear that this is an area of intense, international controversy, there is an absence of data about what researchers themselves and those involved in the transfer of samples think about these issues, particularly in developing countries. Methods: A survey was carried out in a number of Asian countries and in Egypt to explore what researchers and others involved in research, storage and transfer (...) of human tissue samples thought about some of the issues related to sharing of such samples. Results: The results demonstrated broad agreement with the positions taken by developing countries in the current debate, favoring quite severe restrictions on the use of samples by developed countries. Conclusions: It is recommended that an international agreement is developed on what conditions should be attached to any sharing of human tissue samples across borders. (shrink)

Spontaneous mirror self-recognition is achieved by only a limited number of species, suggesting a sharp “cognitive Rubicon” that only few can pass. But is the demarcation line that sharp? In studies on monkeys, who do not recognize themselves in a mirror, animals can make a difference between their mirror image and an unknown conspecific. This evidence speaks for a gradualist view of mirror self-recognition. We hypothesize that such a gradual process possibly consists of at least two independent aptitudes, the ability (...) to detect synchronicity between self- and foreign movement and the cognitive understanding that the mirror reflection is oneself. Pigeons are known to achieve the first but fail at the second aptitude. We therefore expected them to treat their mirror image differently from an unknown pigeon, without being able to understand that the mirror reflects their own image. We tested pigeons in a task where they either approached a mirror or a Plexiglas barrier to feed. Behind the Plexiglas an unknown pigeon walked at the same time toward the food bowl. Thus, we pitched a condition with a mirror-self and a foreign bird against each other, with both of them walking close toward the food bowl. By a detailed analysis of a whole suit of behavioral details, our results make it likely that the foreign pigeon was treated as a competitor while the mirror image caused hesitation as if being an uncanny conspecific. Our results are akin to those with monkeys and show that pigeons do not equal their mirror reflection with a conspecific, although being unable to recognize themselves in the mirror. (shrink)