Currently in Japan, it is extremely difficult to realize the basic wish of protecting personal dignity at the end of life. A patient’s right to refuse life-sustaining treatment has not been substantially warranted, and advance directives have not been legally enforceable. Unfortunately, it is not until the patient is moribund that all concerned parties start to deliberate on whether or not death with dignity should be pursued. Medical intervention is often perceived as a worthwhile goal to not only preserve life, (...) but also provide psychological benefit to the family, regardless of its effect on the patient. To feel they are doing something, family members tend to act against the imperative “Do not inflict on others what you would not wish done to you,” and permit extraordinary measures they would not want themselves. Another complication in Japanese culture is the necessity of unanimous decisions for end-of-life care. If there is conflict between a patient and his/her family on accepting medical intervention, the view of the latter is more likely to prevail due to different perceptions of human dignity. As a result, incapacitated patients in Japanese clinical settings often suffer through extraneous medical procedures, particularly during end-of-life care. Patient dignity is in danger from a national refusal to accept major bioethical principles such as having respect for patient autonomy, serving the best interests of the patient, doing no harm, and ensuring fairness at the end of life. We argue that more education about human dignity and legislation for death with dignity are necessary. Peace of mind for patients during end-of-life care will never be achieved in this society unless drastic changes take place in medical ethics and law. (shrink)

BackgroundHealthcare professionals use the ethics of justice and care to construct moral reasoning. These ethics are conflicting in nature; different value systems and orders of justice and care are applied to the cause of actual moral conflict. We aim to clarify the structure and factors of healthcare professionals’ moral conflicts through the lens of justice and care to obtain suggestions for conflict resolutions.MethodSemi-structured interviews about experiences of moral conflict were conducted with Japanese nurses recruited using the snowball sampling method. Interviews (...) were conducted based on the real-life moral conflict and choice interview. Interviews were recorded and transcribed verbatim, then analyzed based on the interpretive method of data analysis. Verbatim transcripts were read four times, first to get an overall sense of the conflict, then to understand the person’s thoughts and actions that explain the conflict, and third and fourth to identify perspectives of justice and care, respectively. Each moral perspective was classified into categories according to Chally’s taxonomy.ResultsAmong 31 responses, 2 that did not mention moral conflict were excluded, leaving 29 responses that were analyzed. These responses were classified into six cases with conflict between both justice and care perspectives or within one perspective, and into two cases without conflict between perspectives. The “rules” category of justice and the “welfare of others” category of care were included in many cases of conflict between two perspectives, and they frequently occurred in each perspective.ConclusionsThe nurses in this study suggest that they make moral judgments based on moral values that are intertwined with justice and care perspectives complex manner.Organizational, professional, and patient-related factors influenced conflicts between justice and care. Additionally, multiple overlapping loyalties created conflicts within justice perspectives, and multifaceted aspects of care-provider’s responsibility and patient need created conflicts within care. Decision-making biased towards one perspective can be distorted. It is important to consider ethical issues from both perspectives to resolve conflicts, especially the effective use of the ethics of care is recommended. (shrink)

Empirical surveys about medical futility are scarce relative to its theoretical assumptions. We aimed to evaluate the difference of attitudes between laypeople and physicians towards the issue. A questionnaire survey was designed. Japanese laypeople (via Internet) and physicians with various specialties (via paper-and-pencil questionnaire) were asked about whether they would provide potentially futile treatments for end-of-life patients in vignettes, important factors for judging a certain treatment futile, and threshold of quantitative futility which reflects the numerical probability that an act will (...) produce the desired physiological effect. Also, the physicians were asked about their practical frequency and important reasons for futile treatments. 1134 laypeople and 401 (80%) physicians responded. In all vignettes, the laypeople were more affirmative in providing treatments in question significantly. As the factors for judging futility, medical information and quality of life (QOL) of the patient were rather stressed by the physicians. Treatment wish of the family of the patient and psychological impact on patient side due to the treatment were rather stressed by laypeople. There were wide variations in the threshold of judging quantitative futility in both groups. 88.3% of the physicians had practical experience of providing futile treatment. Important reasons for it were communication problem with patient side and lack of systems regarding futility or foregoing such treatment. Laypeople are more supportive of providing potentially futile treatments than physicians. The difference is explained by the importance of medical information, the patient family’s influence to decision-making and QOL of the patient. The threshold of qualitative futility is suggested to be arbitrary. (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)

In Japan, few studies and ethical debates have addressed medical futility, but articles suggesting the practice of such treatment exist. The present study aimed to explore attitudes about this by examining personal practical experiences of those who have been involved in judging treatments as futile. We employed a qualitative descriptive design with content analysis of semi-structured and focus group interviews with 11 Japanese physicians and 9 nurses of a university hospital in Japan. The interviews mined their practical experience to identify (...) why they provided treatment that was regarded futile, factors for determining futility, and attitudes toward foregoing futile treatments. All participants had provided treatments judged as futile for various reasons, such as patient request, inadequate decision-making processes, request from another physician, and the lack of standards with which to judge futility, among others. In addition to medical science factors , participants also considered non-medical science factors to determine if a treatment was futile. Almost all participants agreed that futility should be defined and that such treatments should be foregone, but they did not take a proactive stance towards this due to factors related to the healthcare worker‟s situation or the patient. Although the implications of the present study are somewhat limited, our results indicate that futile treatments are provided at multiple treatment departments. Health-care workers employ a variety of factors to determine futility, including non-medical science factors. As provision of such treatment is not always performed for reasons of patient autonomy, diverse approaches should be employed to cope with situations regarding futile treatments. (shrink)

Healthcare professionals must make decisions for patients based on ethical considerations. However, they rely on clinical ethics consultations (CEC) to review ethical justifications of their decisions. CEC consultants support the cases reviewed and guide medical care. When both healthcare professionals and CEC consultants face ethical problems in medical care, how is their judgment derived? How do medical judgments differ from the ethical considerations of CECs? This study examines CECs in Japan to identify differences in the ethical judgment of clients and (...) CEC consultants. (shrink)

In recent years, a number of news stories were reported worldwide involving brain-dead pregnant women. Debates over providing life support to braindead pregnant women and delivery of their children have been around for some decades. Maintaining a woman’s life solely for fetal viability has become a major controversial social issue. Opposing opinions exist where one side supports the woman and her child should be left to die in dignity and the other side claims to protect the unborn child’s right to (...) live. Each group has strong beliefs. This paper addresses main aspects when considering the continuation of somatic support to the brain-dead pregnant woman for the purpose of fetus delivery including; human death, dignity of the woman, rights of the fetus, proportionality of acts, and the woman’s donor status, and independence of mother and fetus. Then, the authors present several diverse opinions and positions concerning the legitimacy of life support for brain-dead women based on them and critically evaluate them. We show that each and every claim can be ethically refuted. This paper also approaches to those claims from three different points of views, which are that of the brain-dead woman, her fetus and her family. We believe that the brain-dead woman’s wish and dignity, the child’s predicted wellbeing after birth, and the family’s beliefs and welfare should all be counted equally when making the final decision. In conclusion, we argue that the decision can be ethically justified only when the interests of all parties are appropriately taken into consideration and protected. (shrink)

As of 2009, the number of donors in Japan is the lowest among developed countries. On July 13, 2009, Japan's Organ Transplant Law was revised for the first time in 12 years. The revised and old laws differ greatly on four primary points: the definition of death, age requirements for donors, requirements for brain- death determination and organ extraction, and the appropriateness of priority transplants for relatives.In the four months of deliberations in the National Diet before the new law was (...) established, various arguments regarding brain death and organ transplantation were offered. An amazing variety of opinions continue to be offered, even after more than 40 years have elapsed since the first heart organ transplant in Japan. Some are of the opinion that with the passage of the revised law, Japan will finally become capable of performing transplants according to global standards. Contrarily, there are assertions that organ transplants from brain- dead donors are unacceptable because they result in organs being taken from living human beings.Considering the current conditions, we will organize and introduce the arguments for and against organ transplants from brain- dead donors in contemporary Japan. Subsequently, we will discuss the primary arguments against organ transplants from brain- dead donors from the perspective of contemporary Japanese views on life and death. After introducing the recent view that brain death should not be regarded as equivalent to the death of a human being, we would like to probe the deeply-rooted views on life and death upon which it is based. (shrink)

A placebo is a substance or intervention believed to be inactive, but is administered by the healthcare professional as if it was an active medication. Unlike standard treatments, clinical use of placebo usually involves deception and is therefore ethically problematic. Our attitudes toward the clinical use of placebo, which inevitably includes deception or withholding information, have a tremendous effect on our practice regarding truth-telling and informed consent. A casual attitude towards it weakens the current practice based on shared decision-making and (...) mutual trust between patients and healthcare professionals. Issues concerning the clinical use of placebo are thus intimately related to patient-provider relationships, the public's trust in medicine, and medical education. A review of recent survey studies suggests that the clinical use of placebo appears to be fairly well accepted among healthcare professionals and is common in clinical settings in various countries. However, we think that an ethical discussion is urgently needed because of its controversial nature. If judged to be ethically wrong, the practice should end. In the present paper, we discuss the ethicality of the clinical use of placebo with deception and argue against it, concluding that it is unethical and should be banned. We will show that most arguments in favor of the clinical use of placebo can be refuted and are therefore incorrect or weak. These arguments will be presented and examined individually. Finally, we will briefly consider issues relevant to the clinical use of placebo without deception. (shrink)

The aim of the present paper is to evaluate the role of a patient’s religious and non-religious beliefs in making decisions about medical care. Faith exerts a profound influence on our spiritual lives and on our daily actions, including ethical decisions. Religion determines the believer’s fundamental worldview, view of humanity, perspective on life and death, and values. In this paper, we investigated the treatment of medical decisions based on religious or non-religious beliefs. To understand this issue, it is necessary to (...) assess the uniqueness and validity of religious beliefs, as well as the rationality of beliefs. We concluded that decisions based on religious and non-religious beliefs shouldbe treated in the same way and that the distinguishing features of valid beliefs are deeply held and do not cause harm to others. In addition, we stated that the root beliefs we hold, whether religious or secular, cannot necessarily be explained logically, and that patient decisions should be judged by the logical consistency of their reasoning with their beliefs as starting points. (shrink)

‘Substance’ (substantia, zelfstandigheid) is a key term of Spinoza’s philosophy. Like almost all of Spinoza’s philosophical vocabulary, Spinoza did not invent this term, which has a long history that can be traced back at least to Aristotle. Yet, Spinoza radicalized the traditional notion of substance and made a very powerful use of it by demonstrating – or at least attempting to demonstrate -- that there is only one, unique substance -- God (or Nature) -- and that all other things are (...) merely modes or states of God. Some of Spinoza’s readers understood these claims as committing him to the view that only God truly exists, and while this interpretation is not groundless, we will later see that this enticing and bold reading of Spinoza as an ‘acosmist’ comes at the expense of another audacious claim Spinoza advances, i.e., that God/Nature is absolutely and actually infinite. But before we reach this last conclusion, we have a long way to go. So, let me first provide an overview of our plan. In the first section of this paper we will examine Spinoza’s definitions of ‘substance’ and ‘God’ at the opening of his magnum opus, the Ethics. Following a preliminary clarification of these two terms and their relations to the other key terms defined at the beginning of the Ethics, we will briefly address the Aristotelian and Cartesian background of Spinoza’s discussion of substance. In the second section, we will study the properties of the fundamental binary relations pertaining to Spinoza’s substance: inherence, conception, and causation. The third section will be dedicated to a clarification of Spinoza’s claim that God, the unique substance, is absolutely infinite. This essential feature of Spinoza’s substance has been largely neglected in recent Anglo-American scholarship, a neglect which has brought about an unfortunate tendency to domesticate Spinoza’s metaphysics to more contemporary views. The fourth section will study the nature of Spinoza’s monism. It will discuss and criticize the interesting yet controversial views of the eminent Spinoza scholar, Martial Gueroult, about the plurality of substances in the beginning of the Ethics; address Spinoza’s claim in Letter 50 that, strictly speaking, it is improper to describe God as “one”; and, finally, evaluate Spinoza’s kind of monism against the distinction between existence and priority monism recently introduced into the contemporary philosophical literature. The fifth and final section will explain the nature, reality, and manner of existence of modes. We therefore have an ambitious plan; let’s get down to business. (shrink)

"El amor en su singularidad erótica es tratado en esta obra desde el auspicio de la poesía y la filosofía, las cuales nos llevan de la mano a los desolados parajes del mundo biológico-psíquico para retener aquello de lo que "no se puede decir nada". Aun así, no es éste un intento de explicar fenomenológicamente el amor, sino una modesta evocación de los momentos y comportamientos humanos en su tránsito hacia el Eros y la experiencia que de ellos se ha (...) obtenido."-- Cubierta trasera. (shrink)

Planteamiento de la naturaleza, de la filosof a y de su raz n hist rica, al contemplar panor micamente la totalidad de su pasado e intentar reconstruir el dram tico suceso de su origen.

Maquiavelo y su tiempo.--Reacción de algunos escritores españoles de los siglos XVII y XVIII ante la doctrina de Maquiavelo.--El maquiavelismo y las prácticas de gobierno.

Objective: This study examined the process through which elderly patients with new-onset acute leukemia make treatment decisions from the time of diagnosis, in order to identify factors influencing this decision-making process in Japan. Methods: Semi-structured interviews were conducted with twenty-two elderly patients with leukemia. The data were analyzed using the modified grounded theory approach. Results: The process of decision-making in elderly patients with leukemia includes three stages: Initial reactions at diagnosis, change in attitudes, and entrusting the physician with the treatment (...) plan. Initial reactions at diagnosis were affected by interactions with others that brought peace of mind to the patients. Change in attitudes was affected by encouragement from others to undergo treatment and their own motivation to face treatment. Patients came to entrust their treatment plan completely to their physician, because they wanted to feel relief and did not want to have to grapple with difficult medical information that was relevant to decision-making about their disease and treatment options. Conclusions: The process of decision-making in elderly patients with leukemia is affected by several factors and included three stages. Our present study findings can provide suggestions on how medical professionals might better support the process of decision-making in elderly patients with leukemia. (shrink)

DICTIONARY OF SPANISH VERBS WITH THEIR ENGLISH EQUIVALENTS AND MODELS OF CONJUGATION/DICCIONARIO CON LOS VERBOS EN ESPAÑOL, SU TRADUCCIÓN AL INGLÉS Y CONJUGACIONES.

1. Escritos doctrinales -- 2. Escritos histórico-filosóficos.

Appearing in English for the first time, this book comprises two of Ortega’s most important works, ¿Qué es conocimiento? and the essay “Ideas y creencias.” This is Ortega’s attempt to systematically present the foundations of his metaphysics of human life and, on that basis, to provide a radical philosophical account of knowledge. In so doing, he criticizes idealism and overcomes it. Accordingly, this book goes well beyond a treatise on epistemology; in fact, as understood in modern philosophy, this discipline and (...) its questions are shown to be derivative and, in that sense, they are transcended here by Ortega’s systematic effort. -/- Written during the time of his maturity, these works are representative of his fruitful and radical period. Both ¿Qué es conocimiento? and “Ideas y creencias” are equally decisive not only for the understanding and radical completion of Ortega’s work, but also for their relevance to the work of continental philosophers during the same period and for years to come (e.g., Husserl, Jaspers, Heidegger, Sartre, and others). (shrink)

The renowned Sri Lankan scholar Y. Karunadasa examines the Abhidhamma perspective on the nature of phenomenal existence. He begins with a discussion of dhamma theory, which provides the ontological foundation for Abhidhamma philosophy. (The dhamma theory is an Abhidhammic innovation that gives an overview of the bare phenomenon that form this world; it's a theory of real existents.) He then explains the category of "the conceptual" as the Abhidhamma's answer to the objects of common-sense realism. Among the other topics discussed (...) are the theory of double truth (ultimate and conceptual truth), the analysis of mind, the theory of cognition, the analysis of matter, the nature of time and space, the theory of momentary being, and conditional relations. The volume concludes with an appendix that examines why the Theravāda came to be known as Vibhajjavāda, "the doctrine of analysis." Not limiting himself to abstract analysis, Karunadasa draws out the Abhidhamma's underlying premises and purposes--the Abhidhamma provides a detailed description of reality in order to identify all sources of suffering and thereby point to a complete cure for the problem of suffering. (shrink)

I. El destino del normativismo en la ciencia jurídica contemporanea.--II. El fundamento de la seguridad social.

I. El hombre y la epoca.--II. Las doctrinas.--III. Notas. Apendices. Bibliografía.