BackgroundEach individual’s unique health-related beliefs can greatly impact the patient-clinician relationship. When there is a conflict between the patient’s preferences and recommended medical care, it can create a serious ethical dilemma, especially in an emergency setting, and dramatically alter this important relationship.Case presentationA 56-year-old man, who remained comatose after out-of-hospital cardiac arrest, was rushed to our hospital. The patient was scheduled for emergency coronary angiography when his adolescent daughter reported that she and her father held sincere beliefs against radiation exposure. (...) We were concerned that she did not fully understand the potential consequences if her father did not receive the recommended treatment. A physician provided her with in depth information regarding the risks and benefits of the treatment. While we did not want to disregard her statement, we opted to save the patient’s life due to concerns about the validity of her report.ConclusionsVariations in beliefs regarding medical care force clinicians to incorporate patient beliefs into medical practice. However, an emergency may require a completely different approach. When faced with a patient in a life-threatening condition and unconscious, we should take action to prioritize saving their life, unless we are highly certain about the validity of their advance directives. (shrink)

Self-compassion, sharing some commonalities with positive psychology 2.0 approaches, is associated with better mental health outcomes in diverse populations, including workers. Due to the COVID-19 pandemic, there is heightened awareness of the importance of self-care for fostering mental health at work. However, evidence regarding the applications of self-compassion interventions in work-related contexts has not been systematically reviewed to date. Therefore, this systematic review aimed to synthesize and evaluate the utility of self-compassion interventions targeting work-related well-being, as well as assess the (...) methodological quality of relevant studies. Eligible articles were identified from research databases including ProQuest, PsycINFO, Science Direct, and Google Scholar. The quality of non-randomized trials and randomized controlled trials was assessed using the Newcastle-Ottawa Scale and the Quality Assessment Table, respectively. The literature search yielded 3,387 titles from which ten studies met the inclusion criteria. All ten studies reported promising effects of self-compassion training for work-related well-being. The methodological quality of these studies was medium. All ten studies recruited workers in a caring field and were mostly conducted in Western countries. The Self-Compassion Scale or its short-form was used in almost all instances. Findings indicate that self-compassion training can improve self-compassion and other work-related well-being outcomes in working populations. However, in general, there is need for greater methodological quality in work-related self-compassion intervention studies to advance understanding regarding the applications and limitations of this technique in work contexts. Furthermore, future studies should focus on a broader range of employee groups, including non-caring professions as well as individuals working in non-Western countries. (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)

Ethics is a device which is produced by the human consciousness to regulate the human behaviour or society in a sound manner. Organisms are manipulated by techniques of molecular biology these days. Then, it is so difficult to recognize the problems of life manipulation by the ethical principle raised by our sensing level. To regulate the society greatly influenced by modern life sciences, it is time to utilize the mechanistic knowledge about organisms as a basic principle of ethics (Molecular ethics). (...) Molecular ethics is not an ethics produced only by the humane logic, but adopts the property of genome operating system (OS) as a core principle clarified by the molecular biology. It is substantiated by life sciences, but is not a simple scientific decision-making means. It promotes scientific experiments with the integrity to knowledge. Scientific knowledges are projections of the rule of life. Molecular ethics is an ethics which seeks for the rules of evolution; i.e. rules for transcending human being. On the other hand, traditional ethics (individual ethics; ethics based on indivisualism) is an ethics which regards present human being as a terminus of evolution. In this respect, this is against the principle of genome OS (system of evolution). Life sciences and technologies has been developing to meet our wants, however, those activities nowadays seem to be against those rules of genome OS. Therefore, it is extremely important for us to consider the ethics applicable for the life manipulation era. (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)

Muitos termos possuem um sentido técnico sem que ele seja evidente para todos, por exemplo, a "governança ambiental", termo que remete no contexto atual a uma participação cidadã nesse tipo de questão, por exemplo, da saúde de um ecossistema específico, tal como uma floresta ou um vale agrícola, a partir de preocupações partilhadas e não a partir de uma problemática de controle organizacional. Após ter tornado preciso o que é a expertise e quais são os principais problemas postos pelo recurso (...) à expertise nos contextos da ação cidadã, proponho que as expertises técnicas podem ser postas no mesmo patamar que outros tipos de expertise, referindo principalmente aos saberes comuns, à prática e à experiência concreta, dita "de campo", o que corresponde a uma ampliação. Sugere-se, então, o modelo de fórum híbrido como quadro teórico possível dessa reformulação da concepção de expertise. Many terms have a technical meaning although it is not evident for everyone, for example, the "environmental governance", term that refers in the present context to citizen participation on this type of question, for example, of the health of a specific ecosystem, such as a forest or an agricultural field, from shared preoccupations and not from a problematic of organizational control. After having made precise what is the expertise and what are the main problems posed by the recourse to the expertise in the contexts of citizen action, I propose that technical expertise can be tantamount to other types of expertise, referring mainly to profane knowledge, to the practice and concrete experience called "of field", which corresponds to an enlargement. Then it is suggested the model of an hybrid forum as a possible theoretical frame of this reformulation of the conception of expertise. (shrink)

Technoscientific research, a kind of scientific research conducted within the decontextualized approach (DA), uses advanced technology to produce instruments, experimental objects, and new objects and structures, that enable us to gain knowledge of states of affairs of novel domains, especially knowledge about new possibilities of what we can do and make, with the horizons of practical, industrial, medical or military innovation, and economic growth and competition, never far removed from view. The legitimacy of technoscientific innovations can be appraised only in (...) the course of considering fully what sorts of objects technoscientific objects are: objects that embody scientific knowledge confirmed within DA; physical/chemical/biological objects, realizations of possibilities discovered in research conducted within DA, brought to realization by means of technical/experimental/instrumental interventions; and components of social/ecological systems, objects that embody the values of technological progress and (most of them) values of capital and the market. What technoscientific objects are - their powers, tendencies, sources of their being, effects on human beings and social/economic systems, how they differ from non technoscientific objects - cannot be grasped from technoscientific inquiry alone; scientific inquiry that is not reducible to that conducted within DA is also needed. The knowledge that underlies and explains the efficacy of technoscientific objects is never sufficient to grasp what sorts of object they are and could become. Science cannot be reduced to technoscience. (shrink)

In this wide-ranging interview with three members of the Department of Philosophy at the University of Sao Paolo (Brazil) Wylie explains how she came to work on philosophical issues raised in and by archaeology, describes the contextualist challenges to ‘received view’ models of confirmation and explanation in archaeology that inform her work on the status of evidence and contextual ideals of objectivity, and discusses the role of non-cognitive values in science. She also is pressed to explain what’s feminist about feminist (...) research and in that connection outlines her account of feminist standpoint theory and the relevance of feminist analysis to science. (shrink)

This pilot study examines how a number of American and Japanese journalists make the tough calls regarding an escalating social problem: whether to identify juveniles who have been charged with serious capital crimes. Divergent societal and journalistic values of the two countries are explored via a survey of journalists from Honolulu and Hiroshima. Newsroom policies and practices are described regarding general and specific cases of juvenile crime. In general, Japanese journalists are far more likely than U.S. journalists to withhold names. (...) Tables and additional background information are found at jmme.org. (shrink)

The aim of this paper is to highlight how business schools can improve the ethical behaviour of future managers. It assesses the positions of ethical judgement and ethical intent within a sample of UK business students, together with an analysis of underlying explanatory factors to those positions, such as levels of depression, anxiety, stress, motivation and self-compassion. A range of scales were used to evaluate the ethical stance and psychological characteristics of a group of UK business students. The results indicate (...) that feelings of self-compassion, a sense of self-direction and mental health affect the ethical judgement and intent of students in a range of business and university scenarios. It is recommended that in addition to more formal ethics education, universities consider the mental health and psyche of their students to improve the efficacy of ethical training. (shrink)

Semantic studies on diagrammatic notations (Barwise & Etchemendy, ; Shimojima, ; Stenning & Lemon, ) have revealed that the “non-deductive,” “emergent,” or “perceptual” effects of diagrams (Chandrasekaran, Kurup, Banerjee, Josephson, & Winkler, ; Kulpa, ; Larkin & Simon, ; Lindsay, ) are all rooted in the exploitation of spatial constraints on graphical structures. Thus, theoretically, this process is a key factor in inference with diagrams, explaining the frequently observed reduction of inferential load. The purpose of this study was to examine (...) the empirical basis for this theoretical suggestion, focusing on the reality of the constraint-exploitation strategy in actual practices of diagrammatic reasoning. Eye movements were recorded while participants used simple position diagrams to solve three- or four-term transitive inference problems. Our experiments revealed that the participants could exploit spatial constraints on graphical structures even when (a) they were not in the position of actually manipulating diagrams, (b) the semantic rule for the provided diagrams did not match their preferences, and (c) the constraint-exploitation strategy invited a partly adverse effect. These findings indicate that the hypothesized process is in fact robust, with the potential to broadly account for the inferential advantage of diagrams. (shrink)

Journal Name: Cognitive Linguistics Issue: Ahead of print.

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)

Domestic Rituals of the Atharvaveda in the Paippalāda Tradition of Orissa: Śrīdhara’s Vivāhādikarmapañjikā, vol. 1: Book One, Part One, General Prescriptions. Edited with an introduction by Arlo Griffiths and Shilpa Sumant. Collection Indologie, vol. 135. Pondicherry: institut français de pondichéry, École française d’extrême-orient, 2018. Pp. cxxxiv + 172.

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)

Previous research has shown that although infants follow the gaze direction of robots, robot gaze does not facilitate infants’ learning for objects. The present study examined whether robot gaze affects infants’ object learning when the gaze behavior was accompanied by verbalizations. Twelve-month-old infants were shown videos in which a robot with accompanying verbalizations gazed at an object. The results showed that infants not only followed the robot’s gaze direction but also preferentially attended to the cued object when the ostensive verbal (...) signal was present. Moreover, infants showed enhanced processing of the cued object when ostensive and referential verbal signals were increasingly present. These effects were not observed when mere nonverbal sound stimuli instead of verbalizations were added. Taken together, our findings indicate that robot gaze accompanying verbalizations facilitates infants’ object learning, suggesting that verbalizations are important in the design of robot agents from which infants can learn. Keywords: gaze following; humanoid robot; infant learning; verbalization; cognitive development. (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)