In Japan, where a prominent gap exists in what is considered a patient’s best interest between the medical and patient sides, appropriate decision-making can be difficult to achieve. In Japanese clinical settings, decision-making is considered an act of choice-making from multiple potential options. With many ethical dilemmas still remaining, establishing an appropriate decision-making process is an urgent task in modern Japanese healthcare. This paper examines ethical issues related to shared decision-making (SDM) in clinical settings in modern Japan from the psychocultural-social (...) perspective and discusses the ideal decision-making process in present Japan. Specifically, we discuss how five psychocultural-social tendencies – “surmise (Sontaku),” “self-restraint (Jishuku),” “air (atmosphere or mood, Kuuki),” “peer pressure (or tuning pressure, Docho-Atsuryoku),” and “community (Seken)”—which have often been referred to as characteristics of present-day Japanese people, may affect the ideal practice of SDM in Japanese clinical settings. We conclude that health care professionals must be aware of the possible adverse effects of the above Japanese psychocultural-social tendencies on the implementation of SDM and attempt to promote autonomous decision-making, thereby allowing patients to make treatment choices that sufficiently reflect their individual and personal views of life, experiences, goals, preferences, and values. (shrink)

Madhvācārya’s Bhāgavatatātparyanirṇaya is the oldest Bhāgavata commentary available to us, most probably predating the Advaitic commentary of Śrīdhara. Thus Madhva’s commentary occupies a crucial place in the development of the Bhāgavata tradition. In this paper, I examine Madhva’s commentary on the first verse of the Bhāgavatapurāṇa, focusing on his exegesis. In so doing, I shall point out how Madhva emphasizes what are arguably the two most important doctrines of Dvaita Vedānta, namely, Viṣṇu’s absolute independence and the reality of the world. (...) With this teaching Madhva vehemently rejects absolute monism and the idea that the world is illusory, which, we might say, are the core doctrines of Advaita Vedānta. This paper is also a modest attempt to revise the general perception of Vedānta as ‘the exegetical tradition on the prasthānatraya’. I argue that we need to include commentaries on the purāṇas within our understanding of Vedāntic discourse since, starting with Madhva, the purāṇas such as the Bhāgavata became an important text for Vedānta authors to comment upon. This is evidenced by the proliferation of commentaries on the Bhāgavata in the early modern period. The Bhāgavatapurāṇa attracted commentaries produced not only by Vaiṣṇava authors such as Sanātana, Jīva, Vallabha and Vīrarāghava but also by Advaita authors like Madhusūdana Sarasvatī and Śaivas such as Rāghavānanda. In this connection, toward the end of this paper I will point out Madhva’s influence on the Gauḍīya school that flourished in the early modern period. (shrink)

This article presents a critique of the health promotion policy of Japan, which is based on an examination of the social importance of and justification for health promotion. This is done to suggest the proper direction that the future Japanese policy could take, and to question the adequacy of the term of ‘health promotion’. We find the ‘social progress’ characterization of the ‘Second Term of National Health Promotion Movement in the Twenty-First Century - Health Japan 21 ’ to be problematic. (...) While there are clear restraints found in terms of social costs related to the policy, the aims toward social justice provided by the policy are not clear. Considering the social importance and justification of health promotion, and the present conditions seen in Japan, we believe that it is necessary clearly to position health promotion as a form of social justice. Having said this, the term ‘health promotion’ is in itself misleading and can belie the range of activities required to action these policies. Therefore, we propose considering the selection of a different and more appropriate term for health promotion that concretely defines policies that actively work toward definitive health equity. (shrink)

The use of single-use items is now ubiquitous in medical practice. Because of the high costs of these items, the practice of reusing them after sterilisation is also widespread especially in resource-poor economies. However, the ethics of reusing disposable items remain unclear. There are several analogous conditions, which could shed light on the ethics of reuse of disposables. These include the use of restored kidney transplantation and the use of generic drugs etc. The ethical issues include the question of patient (...) safety and the possibility of infection. It is also important to understand the role of informed consent before reuse of disposables. The widespread practice of reuse may bring down high healthcare costs and also reduce the huge amount of hospital waste that is generated. The reuse of disposables can be justified on various grounds including the safety and the cost effectiveness of this practice. (shrink)

A murder case that had some features in common with the Tarasoff case occurred in Sasebo City, Japan, in 2014. A 15-year-old high school girl was murdered and her 16-year-old classmate was arrested on suspicion of homicide. One and a half months before the murder, a psychiatrist who had been examining the girl called a prefectural child consultation centre to warn that she might commit murder, but he did not reveal her name, considering it his professional duty to keep it (...) confidential. Article 134 of the Japanese Criminal Law states that doctors should not disclose patient information obtained in clinical practice without a legitimate reason, but the Japanese Supreme Court has not specified what constitutes a legitimate reason. Mass media and commentators suggested that the murder could have been prevented if the psychiatrist had disclosed the girl's name to the authorities or had isolated her coercively in a psychiatric ward. However, the authors disagree with such claims. This article discusses obligations imposed on concerned individuals and third party members in cases involving ethical dilemmas regarding patient confidentiality and information disclosure. It is concluded that everyone should fulfill their obligations to prevent such tragedies and one should judge the appropriateness of others’ actions based not on the consequences of their actions, but on the processes used to decide on a course of action and their commitment. It is necessary for us to establish a society in which concerned parties can do what they think is ethically best without fearing ungrounded charges. (shrink)

Progress in artificial intelligence technological innovation raises questions about the role of medical staff and the meaning of medical specialization. This study involved a qualitative survey of medical professionals and ordinary citizens to expand knowledge of this topic. A combination of Neo-Socratic Dialogue and Transfer Dialogue techniques, was used to acquire knowledge related to emerging forms of medical care and changing work demands after the implementation of AI, qualitatively analyzing the TD transcript only. Eleven subjects participated in two surveys. The (...) main points raised during TD were classified into five categories: i) Functions which AI could perform/would find difficult to perform, ii) Changes in medicine caused by AI, iii) Necessary preparations for the application of AI to medicine, iv) Concerns about AI, and v) Others. The survey findings suggest that initiatives to promote the acceptance of each individual in society and appropriate technological development are essential to the process of preparing for the changes in medicine following the implementation of AI. These preparatory conditions cannot be limited to medical professionals, and must extend to workers across all disciplines and to society as a whole. (shrink)

Basic emotions such as happiness, sadness, and anger are universal, regardless of the human species, and are governed by specific brain regions. A recent report revealed that mentalizing, which is the ability to estimate other individuals’ emotional states via facial expressions, can be preserved with the help of awake surgery. However, it is still questionable whether we can maintain the ability to understand others’ emotions by preserving the positive mapping sites of intraoperative assessment. Here, we demonstrated the cortical regions related (...) to basic emotions via awake surgery for patients with frontal glioma and investigated the usefulness of functional mapping in preserving basic emotion. Of the 56 consecutive patients with right cerebral hemispheric glioma who underwent awake surgery at our hospital, intraoperative assessment of basic emotion could be successfully performed in 22 patients with frontal glioma and were included in our study. During surgery, positive responses were found in 18 points in 12 patients. Of these, 15 points from 11 patients were found at the cortical level, mainly the premotor and posterior part of the prefrontal cortices. Then, we focused on cortical 15 positive mappings with 40 stimulations and investigated the types of emotions that showed errors by every stimulation. There was no specific rule for the region-emotional type, which was beyond our expectations. In the postoperative acute phase, the test score of basic emotion declined in nine patients, and of these, it decreased under the cut-off value in three patients. Although the total score declined significantly just after surgery, it recovered within 3 months postoperatively. Our study revealed that through direct electrical stimulation, the premotor and posterior parts of the prefrontal cortices are related to various kinds of basic emotion, but not a single one. When the region with a positive mapping site is preserved during operation, basic emotion function might be maintained although it declines transiently after surgery. (shrink)

In many countries, prenatal testing for certain fetal abnormalities is offered via publicly funded screening programs. The concept of reproductive autonomy is regarded as providing a justificatory basis for many such programs. The purpose of this study is to re‐examine the normative basis of public prenatal screening for fetal abnormalities by changing our perspective from that of autonomy to obligation. After clarifying the understanding of autonomy adopted in the justification for public prenatal screening programs, we identify two problems concerning this (...) justification: first, the extent to which the government is obliged to meet this demand is not evident; and, second, it is not clear whether the provision of public screening is the most appropriate way to promote autonomy. Next, to tackle these problems, we focus on Onora O’Neill’s argument of rights and obligations. Drawing on this argument, we show that, in addressing the problems above, it is important to change our normative perspective from rights or autonomy to obligation. Our argument will show that since the government does not have an incontrovertibly fundamental obligation to promote autonomy, this obligation needs to be constrained in terms of compatibility with other fundamental obligations. In addition, even if a government is obliged to promote autonomy to some degree, there could be more appropriate means to achieve it than providing public prenatal screening; therefore, it is not necessary for government obligations to extend to the provision of public prenatal screening. (shrink)

The global increase in patients with chronic conditions has led to increased interest in ethical issues regarding such conditions. A basic biomedical principle—respect for autonomy—is being reexamined more critically in its clinical implications. New accounts of this basic principle are being proposed. While new accounts of respect for autonomy do underpin the design of many public programs and policies worldwide, addressing both chronic disease management and health promotion, the risk of applying such new accounts to clinical setting remain understudied. However, (...) the application of new accounts of respect for autonomy to clinical settings could support disrespectful attitudes toward or undue interference with patients with chronic conditions. Reconsidering autonomy and respect using Kantian accounts, this paper proposes respect for persons as an alternative basic bioethical principle to respect for autonomy. Unlike the principle of respect for persons in the Belmont Report, our principle involves respecting any patient’s decisions, behaviors, emotions, or life-style regardless of his or her “autonomous” capabilities. Thus, attitudes toward patients should be no different irrespective of the assessment of their decisional or executive capabilities. (shrink)

Destination therapy is the permanent implantation of a left ventricular assist device in patients with end-stage, severe heart failure who are ineligible for heart transplantation. DT improves both the quality of life and prognosis of patients with end-stage heart failure. However, there are also downsides to DT such as life-threatening complications and the potential for the patient to live beyond their desired length of life following such major complications. Because of deeply ingrained cultural and religious beliefs regarding death and the (...) sanctity of life, Japanese society may not be ready to make changes needed to enable patients to have LVADs deactivated under certain circumstances to avoid needless suffering. Western ethical views that permit LVAD deactivation based mainly on respect for autonomy and dignity have not been accepted thus far in Japan and are unlikely to be accepted, given the current Japanese culture and traditional values. Some healthcare professionals might regard patients as ineligible for DT unless they have prepared advance directives. If this were to happen, the right to prepare an advance directive would instead become an obligation to do so. Furthermore, patient selection for DT poses another ethical issue. Given the predominant sanctity of life principle and lack of cost-consciousness regarding medical expenses, medically appropriate exclusion criteria would be ignored and DT could be applied to various patients, including very old patients, the demented, or even patients in persistent vegetative states, through on-site judgment. There is an urgent need for Japan to establish and enact a basic act for patient rights. The act should include: respect for a patient’s right to self-determination; the right to refuse unwanted treatment; the right to prepare legally binding advance directives; the right to decline to prepare such directives; and access to nationally insured healthcare. It should enable those concerned with patient care involving DT to seek ethical advice from ethics committees. Furthermore, it should state that healthcare professionals involved in the discontinuation of life support in a proper manner are immune to any legal action and that they have the right to conscientiously object to LVAD deactivation. (shrink)