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)

Although euthanasia has been a pressing ethical and public issue, empirical data are lacking in Japan. We aimed to explore Japanese nurses’ attitudes to patients’ requests for euthanasia and to estimate the proportion of nurses who have taken active steps to hasten death. A postal survey was conducted between October and December 1999 among all nurse members of the Japanese Association of Palliative Medicine, using a self-administered questionnaire based on the one used in a previous survey with Australian nurses in (...) 1991. The response rate was 68%. A total of 53% of the respondents had been asked by patients to hasten their death, but none had taken active steps to bring about death. Only 23% regarded voluntary active euthanasia as something ethically right and 14% would practice it if it were legal. A comparison with empirical data from the previous Australian study suggests a significantly more conservative attitude among Japanese nurses. (shrink)

Objective—To demonstrate Japanese doctors' and nurses' attitudes towards and practices of voluntary euthanasia (VE) and to compare their attitudes and practices in this regard. Design—Postal survey, conducted between October and December 1999, using a self-administered questionnaire.Participants—All doctor members and nurse members of the Japanese Association of Palliative Medicine.Main outcome measure—Doctors' and nurses' attitude towards and practices of VE.Results—We received 366 completed questionnaires from 642 doctors surveyed (response rate, 58%) and 145 from 217 nurses surveyed (68%). A total of 54% (95% (...) confidence interval (CI): 49-59) of the responding doctors and 53% (CI: 45-61) of the responding nurses had been asked by patients to hasten death, of whom 5% (CI: 2-8) of the former and none of the latter had taken active steps to bring about death. Although 88% (CI: 83-92) of the doctors and 85% (CI: 77-93) of the nurses answered that a patient's request to hasten death can sometimes be rational, only 33% (CI: 28-38) and 23% (CI: 16-30) respectively regarded VE as ethically right and 22% (CI: 18-36) and 15% (CI: 8-20) respectively would practise VE if it were legal. Logistic regression model analysis showed that the respondents' profession was not a statistically independent factor predicting his or her response to any question regarding attitudes towards VE. Conclusions—A minority of responding doctors and nurses thought VE was ethically or legally acceptable. There seems no significant difference in attitudes towards VE between the doctors and nurses. However, only doctors had practised VE. (shrink)

To consider whether or not we should aim to create a perfect healthy utopia on Earth, we focus on the SF novel Harmony, written by Japanese writer Project Ito, and analyze various issues in the world established in the novel from a bioethical standpoint. In the world depicted in Harmony, preserving health and life is a top priority. Super-medicine is realized through highly advanced medical technologies. Citizens in Harmony are required to strictly control themselves to achieve perfect health and must (...) always disclose their health information to the public and continuously prove their health. From a bioethical standpoint, the world in Harmony is governed by a “healthy longevity supremacy” principle, with being healthy equated to being good and right. Privacy no longer exists, as it is perceived ethical for citizens to openly communicate health-related information to establish one’s credibility. Moreover, there is no room for self-determination concerning healthcare because medical interventions and care are completely routinized, automated, centralized, and instantly provided. This is a situation where the community exhibits extremely powerful and effective paternalism. One can argue that healthy longevity is highly preferred. But is it right to aim for a perfectly healthy society at all costs? Should we sacrifice freedom, privacy, vivid feelings, and personal dignity to achieve such a world? In our view, the answer is no, as this would require the loss of many essential values. We conclude by proposing an alternative governing principle for future healthcare, and refer to it as the “do-everything-in-moderation” principle. (shrink)

ABSTRACT Objectives: the purpose of this study is to explore laypersons’ attitudes towards and experiences of medical research, and to compare them with those of physicians in Japan. Designs and Participants: fourteen Japanese adults from the general public and seven physicians participated in one of three focus interviews. Setting: Osaka, Japan. Results: trust and distrust in the physician by whom the participants were invited to participate in research played a considerable role in their decisions about participation. That the participants felt (...) an obligation to participate was also expressed. The lay participants perceived medical research as something entirely outside of their world. A greater willingness to volunteer for research was expressed if there were direct benefits to themselves or their families. Research methods such as use of placebos, double blinds, and randomisations seemed to cause negative attitudes to medical research. All physicians were convinced of the need for medical research, including double‐blinded randomised control trials, and its significant role in medical progress. Most physicians thought that the greater awareness of the need for medical research in the community and a better understanding of the psychology of potential research participants were necessary and urgent. Conclusions: there is a good possibility that the lay public and medical professionals have sharply different beliefs about and attitudes towards every aspect of medical research. Building up a better and equal patient‐doctor relationship based on trust is a key issue in medical research, and it is mandatory to fill the gap in perception regarding medical research between them through fully informed debates. (shrink)

What should Japanese doctors do when asked by a patient for active voluntary euthanasia, when the family wants aggressive treatment to continue? In this paper, we present the results of a questionnaire survey of 366 Japanese doctors, who were asked how they would act in a hypothetical situation of this kind, and how they would justify their decision, 23% of respondents said they would act on the patient’s wishes, and provided reasons for their view; 54% said they would not practice (...) VE, either because they were opposed to VE as such, or because they believed that the wishes of the patient’s family should be respected.Analysis of these responses yielded the following results: Doctors willing to respect the patient’s wishes defended their decision by highlighting the significance of patient autonomy and the patient’s exclusive ownership of his or her life; doctors unwilling to act on the patient’s wishes fell into two broad categories — those who based their reasoning on the family’s objections, and those who provided other reasons for refusing VE. Respondents who said they would not comply with the patient’s wishes because of family objections provided the following kinds of rationale: doctors have serious responsibilities not only to the patient, but also to the patient’s family; the importance of the family-doctor relationship; fear of lawsuits for murder and related criminal offences; the need for agreement among all those affected by the decision, and the belief that the patient’s life is not his or her own, but the family’s. Respondents who gave non-family centred reasons for not complying with the patient’s wishes pointed to values such as the sanctity of life, or the importance of a natural deathIn the remainder of this paper, we discuss the implications of a family-centred approach to VE. (shrink)

Patient families sometimes ask health professionals, ‘What would you do if this were your family member?’ The purpose of this paper is to examine appropriate responses to this Question. Health professionals may say, ‘It all depends on the patient's wishes’, or ‘I don't know what is best, because my family is different from yours in many ways’. Some may believe that the most favourable course of action is the same regardless of who the patient is and explain this to the (...) patient's family, while others may refuse to answer the Question saying it is personal, or argue that such a Question should neither be asked nor answered because it is unreasonable and unprofessional to do so. We believe that, in principle, health professionals should give an honest answer as to what they would do if the patient was their family member, recognising and empathising with the fact that the patient's family is in a difficult and vulnerable position, and that their circumstances forced them to ask such a Question. Moreover, personal and emotional views of health professionals regarding treatment options may help the patient's family make important decisions. An honest answer will help strengthen the trusting relationship between health professionals and the patient's family and support their decision-making. (shrink)

Background: The introduction of healthcare AI to society as well as the clinical setting will improve individual health statuses and increase the possible medical choices. AI can be, however, regarded as a double-edged sword that might cause medically and socially undesirable situations. In this paper, we attempt to predict several negative situations that may be faced by healthcare professionals, patients and citizens in the healthcare setting, and our society as a whole. Discussion: We would argue that physicians abuse healthcare AI (...) through their excessive and dependent use of it, and they will focus only on the AI services in their office and patient medical data and information, and forget to observe the patient in their clinical encounters. In the era of AI introduction, data from the wearable terminal or AI advice will become the primary target of the physician’s interest, and could be regarded as a patient surrogate. Paternalism would be paradoxically resurrected by the introduction of state-of-the-art AI. A physician’s conflict of interest related to AI as a commercial product could strongly influence his or her actions in clinical settings. We also worry that the general public will become uneasy and hypersensitive slaves to information, compulsively and uninterruptedly requesting healthcare information concerning their own health and advice from AI. An AI system capable of expressing proper and timely empathy to suffering patients could deprive healthcare professionals of their roles in terms of hospitality and emotional exchange. Finally, entire societies would soon share and consolidate healthcare sensitive information from all in the general public as part of a totalitarian healthcontrolled society where individual privacy and personal secrets could be neglected. The advent of the healthcontrolled society could lead to the metamorphosis of the concept of privacy itself into something completely different. Conclusion: Although AI which surpasses human healthcare professionals may never appear, hoping for the best and preparing for the worst is the best approach to take. To this end, we present some potential countermeasures including conducting clinical research and social investigations concerning problems surrounding the introduction of AI and developing guidelines for its appropriate use. (shrink)

In everyday medical settings in Japan, physicians occasionally tell an elderly patient that their symptoms are “due to old age,” and there is some concern that patient care might be negatively impacted as a result. That said, as this phrase can have multiple connotations and meanings, there are certain instances in which the use of this phrase may not necessarily be indicative of ageism, or prejudice against the elderly. One of the goals in medical care is to address pain and (...) suffering that develops with age in elderly individuals, and whether or not aging is a disease is inconsequential. However, assuming that an individualized and thorough examination has been performed, there are some conditions that can be attributed only to age. Accordingly, physicians must acknowledge the merits and drawbacks of using the phrase “due to old age,” and exercise caution when using it. Both physicians and their elderly patients must share a common awareness of the incomplete and limited nature of modern medicine and its scope, and physicians must help their elderly patients accept and live with the aging phenomenon. (shrink)

This study aimed to: (1) develop and evaluate the Moral Distress Scale for Psychiatric nurses (MDS-P); (2) use the MDS-P to examine the moral distress experienced by Japanese psychiatric nurses; and (3) explore the correlation between moral distress and burnout. A questionnaire on the intensity and frequency of moral distress items (the MDS-P: 15 items grouped into three factors), a burnout scale (Maslach Burnout Inventory — General Survey) and demographic questions were administered to 391 Japanese psychiatric nurses in 2007—2008. These (...) nurses experienced relatively low levels of moral distress despite the fact that they were commonly confronted by morally distressing situations. All the circumstances in which the participants experienced moral distress were included in the ‘low staffing’ factor, which reflects the characteristics of Japanese psychiatric care. The frequency score of the low staffing factor was a significant predictor of burnout. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 37.4 (2003) 41-50 [Access article in PDF] Encounter Between Hyper-Media and Art Education:A Retrospection of Jean-Jacques Rousseau or Memories of Art and EducationToday both art and education are experiencing profound change as a result of emerging technologies. This essay attempts to redefine art education by considering the latest media art as the culmination of change in art. Statements about art education are only viable (...) in the meta-context of art, as art education must start with the work to objectify, as well as structure, "art." Atthe same time, these meta-statements can cast light on the "foundation" of art.Attempts to view the totality of art up to the present time from the "end" of history (meta) and questioning of the "beginning" of art and mankind (foundation) are two sides of the same phenomenon.Media art is an example of this phenomenon which reflects both the meta-context and foundation of art. For example, the work of Jean-Louis Boissier boasts both a radical as well as refined image. 1 His exhibition, "Salle Rousseau" further extends the scale of his conventional work based on the texts of Jean-Jacques Rousseau. 2 This essay revises the text written for the catalogue for the exhibition and aims at analyzing the close relationship between media art and art education, sketching the phases of [End Page 41] meta-statements and foundations which emerge as a result of the interaction of art, media, and education. A Place for Retrospection Boissier's work is well-known for its references to Rousseau. Having been involved in art education, it was natural for me to develop a strong interest in Rousseau, whom I consider to be a founder of modern art and education. The fact that the Boissier's exhibition was held at the "Kyoto Art Centre" in Muromachi, Kyoto supports this belief. Kyoto was the first place in Japan where primary schools based on the school district system were introduced. The Kyoto Art Centre is located at the former Meirin Primary School which was founded at the dawn of modern Japanese education. In its turn, Meirin Primary School succeeded Shingaku-juku. 3 Thus, the location for the BoissierExhibition, dating back to the very beginning of education in Japan, is a place that encourages reflection on the past.While Boissier recollects Rousseau with his unique interactive texts, Rousseau recollects his own past. We, the spectators, are immersed in multiple layers of memories and recollections. Sometimes, however, Rousseau's recollections break through the intricacy and multiple layers and appear to achieve a rapport with the people and flowers which once existed. I have long been attracted by the fresh literal expressions particularly evident in "The Confessions" and other works. The beauty of such expressions must have been born from his affectionate view of nature as illustrated by his hobby of plant collection. View of Nature I cannot help recalling Rousseau whenever I think about the relationship between nature and mankind. Rousseau was a person who could talk beautifully about the direct relationship between nature and mankind. In his writings of "Les riveries du promeneur solitaire" and "Quoted Passage," Rousseau recollects his peaceful life on St. Pierre Island in Lake Bieler in Switzerland where he spent nearly one and a half months after being deported from France as well as his hometown, Geneva because of problems caused by the publication of The Social Contract and Emile. For me, this text is inseparable from the looped image of shallow water which forms the background of the work entitled Flora petrinsularis (1993 and 1994) by Boissier.The beautiful text by Rousseau captivates us without any external help and, at the same time, shows what nature meant to him. The relationship with nature described here is the food as well as foundation of his life. This attitude of accepting nature in the deepest part of his mind is pure agreement with nature as pointed out by Jean Starobinski and represents an experience of fusion... (shrink)

This study aims to unveil the process of whistleblowing. Two nursing staff members who worked in a psychiatric hospital convicted of large-scale wrongdoing were interviewed. Data were analyzed using a modified grounded theory approach. Analysis of the interviews demonstrated that they did not decide to whistleblow when they were suspicious or had an awareness of wrongdoing. They continued to work, driven by appreciation, affection, and a sense of duty. Their decision to whistleblow was ultimately motivated by firm conviction. Shortly after (...) whistleblowing, wavering emotions were observed, consisting of a guilty conscience, fear of retribution, and pride, which subsequently transformed to stable emotions containing a sense of relief and regret for delayed action. It is necessary for nurses to recognize that their professional responsibility is primarily to patients, not to organizations. Nurses should also have professional judgment about appropriate allegiance and actions. (shrink)

We systematically study several versions of the disjunction and the existence properties in modal arithmetic. First, we newly introduce three classes $\mathrm {B}$, $\Delta (\mathrm {B})$, and $\Sigma (\mathrm {B})$ of formulas of modal arithmetic and study basic properties of them. Then, we prove several implications between the properties. In particular, among other things, we prove that for any consistent recursively enumerable extension T of $\mathbf {PA}(\mathbf {K})$ with $T \nvdash \Box \bot $, the $\Sigma (\mathrm {B})$ -disjunction property, the (...) $\Sigma (\mathrm {B})$ -existence property, and the $\mathrm {B}$ -existence property are pairwise equivalent. Moreover, we introduce the notion of the $\Sigma (\mathrm {B})$ -soundness of theories and prove that for any consistent recursively enumerable extension of $\mathbf {PA}(\mathbf {K4})$, the modal disjunction property is equivalent to the $\Sigma (\mathrm {B})$ -soundness. (shrink)

In the present paper, we evaluate the grounds on which therapeutic approaches are determined in elderly demented patients as a typical group of patients who are conscious but lack the ability to make competent judgments. It is argued that none of the factors that the patient as an individual being has at present and that are complete in that individual - the age of the patient, dementia, personhood, and the ability to feel pain - is likely to be a genuine (...) reason for care-providers including health care workers and patient’s family to discontinue the treatment for severely demented patients. It is also claimed that reasons for discontinuation of the treatment for severely demented patients arise from the relationship between the patient and the care-providers, especially the patient’s family. The human relationships between the patient and the family may be maintained as long as the latter find some significance in the presence of the severely demented patient and recognize him/her as “one of them”. When the patient ceases to be “one of them” for the family and is excluded from “their company”, the reason for supporting the demented member of the family is lost. The benefit to the patient and the value of his/her presence lose the individuality or specificity and are subjected to interpretation by the family. Therefore, the reason for discontinuation of the treatment for a severely demented patient is termination of the relationship between the patient and his/her family. The significance of our conclusion is briefly discussed. (shrink)

While empathy is considered a critical determinant of the quality of medical care, growing evidence suggests it may be associated with both one’s own positive and negative moods among healthcare professionals. Meanwhile, sense of coherence plays an essential role in the improvement of both psychological and physical health. Reportedly, individual SOC reaches full stability after around age 30. The aim of this study was first to evaluate the mediatory role of SOC on the association between empathy and individual moods among (...) 114 healthcare professionals in a general hospital, and then to examine the moderating effect of age on this association. Participants completed a range of self-report demographic questionnaires, Empathy Process Scale, the 13-item Antonovsky’s SOC, and Profile of Mood States. Findings showed that SOC mediated the relations between empathy and both POMS-Vigor and POMS-Depression. Notably, moderated mediation analysis revealed that there was a significant interaction on self-vigor mood in healthcare professionals. The indirect effect of empathy on self-vigor mood through SOC was significant at over mean age “32.83.” Although there was no significant interaction with age regarding the indirect effect of empathy on self-depression mood, in the sub-category level analysis of empathy, we found a significant interaction item [age × empathy for other’s negative affect ] on SOC. This indirect effect was also significant at over mean age “32.83.” Taken, together, the current study highlighted the significant mediator of SOC on that empathy amplifies self-vigor mood and attenuates self-depression mood as a protective factor among the Japanese healthcare professionals. Some components of these processes may depend on the moderating role of age, indicating that we may need to consider the SOC development with age for more effective empathy performance interventions among healthcare professionals. (shrink)

The main goal of the present research is to examine socio-ecological hypothesis on apology and compensation. Specifically, we conducted four studies to test the idea that an apology is an effective means to induce reconciliation in a residentially stable community, whereas compensation is an effective means in a residentially mobile community. In Studies 1, 2a and 2b, American and Japanese participants (national difference in mobility; Study 1) or non-movers and movers (within-nation difference in mobility; Studies 2a and 2b) imagined the (...) situations in which they were hurt by their friends and rated to what extent they would be willing to maintain their friendships upon receipt of apology or compensation. The results showed that compensation was more effective in appeasing residentially mobile people (i.e., Americans and movers) than stable people (i.e., Japanese and non-movers), while apology was slightly more effective appeasing residentially stable people than residentially mobile people (significant in Study 1; not significant in Studies 2a and 2b). In Study 3, by conducting an economics game experiment, we directly tested the hypothesis that mobility would impair the effectiveness of apology and enhance the effectiveness of compensation. The results again partially supported our hypothesis: In the high mobility condition compensation increased one’s willingness to continue the relationship with the offender, when compared to willingness in the low mobility condition. The importance of socio-ecological perspective on the forgiveness literature is discussed. (shrink)

BackgroundIn the coming years, surrogate decision-making is expected to become highly prevalent in Japanese clinical practice. Further, there has been a recent increase in activities promoting advance care planning, which potentially affects the manner in which judgements are made by surrogate decision-makers. This study aims to clarify the grounds on which surrogate decision-makers in Japan base their judgements.MethodsIn this qualitative study, semi-structured interviews were conducted to examine the judgement grounds in surrogate decision-making for critical life-sustaining treatment choices in acute care (...) hospitals.ResultsA total of 228 participants satisfied the inclusion criteria, and 15 were selected for interviews. We qualitatively analysed the content of 14 interview transcripts, excluding one that did not meet the inclusion criteria. Based on this analysis, we extracted 4 core categories, 17 categories, 35 subcategories, and 55 codes regarding judgement grounds in surrogate decision-making. The four core categories were as follows: patient preference-oriented factor (Type 1), patient interest-oriented factor (Type 2), family preference-oriented factor (Type 3), and balanced patient/family preference-oriented factor (Type 4). The Type 4 core category represented attempts to balance the preferences of the patient with those of the surrogate decision-maker.ConclusionsSurrogate decision-makers based their decisions on important aspects related to a patient’s life, and they considered not only the patient’s preferences and best interests but also their own preferences. As the need for surrogate decisions will increase in the future, decision-makers will need to consider judgement grounds from a more diverse perspective. (shrink)

In order to achieve flexible and smooth walking, we must accomplish subtasks (e.g., loading response, forward propulsion or swing initiation) within a gait cycle. To evaluate subtasks within a gait cycle, the analysis of muscle synergies may be effective. In the case of walking, extracted sets of muscle synergies characterize muscle patterns that relate to the subtasks within a gait cycle. Although previous studies have reported that the muscle synergies of individuals with disorders reflect impairments, a way to investigate the (...) instability in the activations of muscle synergies themselves has not been proposed. Thus, we investigated the local dynamic stability and orbital stability of activations of muscle synergies across various walking speeds using maximum Lyapunov exponents and maximum Floquet multipliers. We revealed that the local dynamic stability in the activations decreased with accelerated walking speeds. Contrary to the local dynamic stability, the orbital stability of the activations was almost constant across walking speeds. In addition, the increasing rates of maximum Lyapunov exponents were different among the muscle synergies. Therefore, the local dynamic stability in the activations might depend on the requirement of motor output related to the subtasks within a gait cycle. We concluded that the local dynamic stability in the activation of muscle synergies decrease as walking speed accelerates. On the other hand, the orbital stability is sustained across broad walking speeds. (shrink)

第二次大戦における敗北は、日本の近代化の行く先に必然的に用意されていた、日本史上最大の事件だった。そして日本はその後遺症を抱えたまま、近代化の極たるグローバリゼーションに翻弄され、「第二の敗戦」を経験 しつつある。我々は精神の構えをどう立て直し、やくざ化した世界と伍していくべきなのか。本書では、敗戦をまたいで現われ、西欧近代とひとり格闘し、創造的思考に到達した七人の足跡を是々非々で批評。西欧思考の限 界を超え、日本から発信する文明的普遍性の可能性を探った野心的論考。.