Crucial problems exist in understanding Japanese traditional customs with regard to autonomous decision making by patients in Japan. These problems are difficult to comprehend because they seem, by western standards, to defy logic. Questions that baffle those outside the Japanese tradition, include: Why do many Japanese patients hesitate to make medical treatment and care decisions for themselves without consulting family, close friends, or someone viewed as being in a superior position? Why do many Japanese physicians fail to disclose the truth (...) directly to the patient, instead customarily conveying information to family members, despite the doctors' awareness of their legal obligation to protect the patient's privacy? Why do many Japanese physicians continue to question whether patients should be told the truth at all? What perpetuates Japan's widespread, but often unnoticed, neglect of the individual's right to self-determination in healthcare decision making? (shrink)

Approximately 30 years ago, a son prepared a cup of milk mixed with insecticide and arranged for his mother to unknowingly administer the poison to his father, who had been suffering severe pain after a cerebral apoplectic attack and demanding that his son assist him. in dying. After drinking the mixture, the father died, and the son was charged with homicide.

The Japanese government took significant steps in making decisions about a newly developing clinical application of gene therapy when, on April 15, 1993, the Government officially accepted the Guidelines for Clinical Research on Gene Therapy submitted by the Health Science Council of the Ministry of Health and Welfare of Japan to the Minister.

Is there only one bioethics? Is a global bioethics possible? Or, instead, does one encounter a plurality of bioethical approaches shaped by local cultural and national traditions? Some thirty years ago a field of applied ethics emerged under the rubric `bioethics'. Little thought was given at the time to the possibility that this field bore the imprint of a particular American set of moral commitments. This volume explores the plurality of moral perspectives shaping bioethics. It is inspired by Kazumasa (...) class='Hi'>Hoshino's critical reflections on the differences in moral perspectives separating Japanese and American bioethics. The essays include contributions from Hong Kong, China, Japan, Texas, the United States, Germany, Switzerland, and Italy. The volume offers a rich perspective of the range of approaches to bioethics. It brings into question whether there is unambiguously one ethics for bioethics to apply. (shrink)

This article studies the treatment effect models in which individuals are classified into unobserved groups based on heterogeneous treatment rules. By using a finite mixture approach, we propose a marginal treatment effect framework in which the treatment choice and outcome equations can be heterogeneous across groups. Under the availability of instrumental variables specific to each group, we show that the MTE for each group can be separately identified. On the basis of our identification result, we propose a two-step semiparametric procedure (...) for estimating the group-wise MTE. We illustrate the usefulness of the proposed method with an application to economic returns to college education. (shrink)

Annual and cumulative incidences of HIV + and AIDS in patients reported by the AIDS Surveillance Committee of the Ministry of Health and Welfare are cited to illustrate some characteristics in Japan: nearly 59% of either HIV + or AIDS patients were infected through injection of blood products or by blood transfusion. A number of plaintiffs have sued the Japanese government and pharmaceutical companies since 1989, but no judicial decisions have yet been made. The incidence of HIV decreases for each (...) of the following routes of infection: the second highest route of transmission being heterosexual, followed by bisexual and unconfirmed or unknown cases, and less frequently homosexual, drug use and lastly via vertical transmission. The most serious bioethical problems with HIV + and AIDs patients in Japan is the social segregation of these patients. There are many emotional fears among the general public and medical personnel about AIDS because of their inadequate scientific knowledge of this disease. The Japan Hospital Association is doing The Stop AIDS Campaign and made several surveys. Japan has become increasingly aware of the importance of AIDS education and a great deal of effort is being made to enhance bioethical considerations. (shrink)

Ethical views of the first-year to sixth-year medical students were studied during bioethics education via questionnaire in 2004. Questions included “would you treat a mentally ill man condemned to death to fit him for execution?”, “is a criminal law suit against a surgeon responsible for a patient's death reasonable?” and “should a surgeon responsible for a patient's death be prosecuted for manslaughter.” The number of students answered “yes, to treat a mentally ill man” tended to increase as they moved up (...) to the senior classes, although there was no statistical significance. A criminal law suit against the surgeon and the charge of manslaughter was responded with a wide variety among the classes, that is the second-year and fifth-year students showed less favorable attitudes to the law suit against the surgeon than the first-year, third-year and fourth-year students. There was no distinct relationship with age, gender or the past bioethics education. Thus, the attitudes of medical students agree on one, and differ on other ethical issues depending on their classes. Although the reason for the difference in ethical views among classes was not clear, these results suggested that ethics education was a sensitive subject for medical students hence the manner of ethics education by teachers was of critical importance. (shrink)

Annual and cumulative incidences of HIV+ and AIDS in patients reported by the AIDS Surveillance Committee of the Ministry of Health and Welfare are cited to illustrate some characteristics in Japan: nearly 59% of either HIV+ or AIDS patients were infected through injection of blood products or by blood transfusion. A number of plaintiffs have sued the Japanese government and pharmaceutical companies since 1989, but no judicial decisions have yet been made. The incidence of HIV decreases for each of the (...) following routes of infection: the second highest route of transmission being heterosexual, followed by bisexual and unconfirmed or unknown cases, and less frequently homosexual, drug use and lastly via vertical transmission. The most serious bioethical problems with HIV+ and AIDS patients in Japan is the social segregation of these patients. There are many emotional fears among the general public and medical personnel about AIDS because of their inadequate scientific knowledge of this disease. The Japan Hospital Association is doing The Stop AIDS Campaign and made several surveys. Japan has become increasingly aware of the importance of AIDS education and a great deal of effort is being made to enhance bioethical consideration. (shrink)

Annual and cumulative incidences of HIV + and AIDS in patients reported by the AIDS Surveillance Committee of the Ministry of Health and Welfare are cited to illustrate some characteristics in Japan: nearly 59% of either HIV + or AIDS patients were infected through injection of blood products or by blood transfusion. A number of plaintiffs have sued the Japanese government and pharmaceutical companies since 1989, but no judicial decisions have yet been made. The incidence of HIV decreases for each (...) of the following routes of infection: the second highest route of transmission being heterosexual, followed by bisexual and unconfirmed or unknown cases, and less frequently homosexual, drug use and lastly via vertical transmission. The most serious bioethical problems with HIV + and AIDs patients in Japan is the social segregation of these patients. There are many emotional fears among the general public and medical personnel about AIDS because of their inadequate scientific knowledge of this disease. The Japan Hospital Association is doing The Stop AIDS Campaign and made several surveys. Japan has become increasingly aware of the importance of AIDS education and a great deal of effort is being made to enhance bioethical considerations. (shrink)

インフォームド・コンセント、脳死と臓器移植、生体肝移植、終末医療と尊厳死、体外受精...。これら医療の新しい問題をどう考えたらいいのか。バイオエシックスが生まれ育った北米で二十年を過ごし、日本の医療倫 理の確立のために活躍してきた著者が、患者中心の医療の倫理とは何か、わが国になじむ倫理とは何かを、情熱をこめて語る。.

Here, we used event-related potentials to test the predictions of two prominent accounts of code-switching in bilinguals: The Matrix Language Framework (MLF; Myers-Scotton, 1993) and an application of the Minimalist Program (MP; Cantone & MacSwan, 2009). We focused on the relative order of the noun with respect to the adjective in mixed Welsh-English nominal constructions given the clear contrast between pre- and post-nominal adjective position between Welsh and English. MP would predict that the language of the adjective should determine felicitous (...) word order (i.e., English adjectives should appear pre-nominally and Welsh adjectives post-nominally). In contrast, MLF contends that it is the language of the finite verb inflection rather than that of a particular word that governs felicitous word order. To assess the predictions of the two models, we constructed sentences featuring a code-switch between the adjective and the noun, that complied with either English or Welsh word-order. Highly proficient Welsh-English bilinguals made semantic acceptability judgements upon reading the last word of sentences which could violate MP assumptions, MLF assumptions, both assumptions, or neither. Behaviourally, MP violations had no significant effect, whereas MLF violations induced an average drop of 11% in acceptability judgements. Neurophysiologically, MP violations elicited a significant Left Anterior Negativity (LAN) modulation, whereas MLF violations modulated both P600 and LAN mean amplitudes. In addition, there was a significant interaction between MP and MLF status in the P600 range: When MP was violated, MLF status did not matter, and when MP criteria were met, MLF violations resulted in a P600 modulation. This interaction possibly reflects a general preference for noun over adjective insertions, and may provide support for MLF over MP at a global sentence processing level. Model predictions also manifested differently in each of the matrix languages: When the matrix language was Welsh, MP and MLF violations elicited greater P600 mean amplitudes than MP and MLF adherences, however this pattern was not observed when the matrix language was English. We discuss methodological considerations relating to the neuroscientific study of code-switching, and the extent to which our results shed light on adjective-noun code-switching beyond findings from production and experimental-behavioural studies. (shrink)