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  1. Atsushi Asai (forthcoming). Tsunami-Tendenko and Morality in Disasters. Journal of Medical Ethics:2013-101629.
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  2. Sakiko Masaki, Hiroko Ishimoto & Atsushi Asai (2014). Contemporary Issues Concerning Informed Consent in Japan Based on a Review of Court Decisions and Characteristics of Japanese Culture. BMC Medical Ethics 15 (1):8.
    Since Japan adopted the concept of informed consent from the West, its inappropriate acquisition from patients in the Japanese clinical setting has continued, due in part to cultural aspects. Here, we discuss the current status of and contemporary issues surrounding informed consent in Japan, and how these are influenced by Japanese culture.
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  3. Noriko Nagao, Yasuhiro Kadooka & Atsushi Asai (2014). Comparison of Ethical Judgments Exhibited by Clients and Ethics Consultants in Japan. BMC Medical Ethics 15 (1):19.
    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 (...)
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  4. Kuniko Aizawa, Atsushi Asai & Seiji Bito (2013). Defining Futile Life-Prolonging Treatments Through Neo-Socratic Dialogue. BMC Medical Ethics 14 (1):51.
    In Japan, people are negative towards life-prolonging treatments. Laws that regulate withholding or discontinuing life-prolonging treatments and advance directives do not exist. Physicians, however, view discontinuing life-prolonging treatments negatively due to fears of police investigations. Although ministerial guidelines were announced regarding the decision process for end-of-life care in 2007, a consensus could not be reached on the definition of end-of-life and conditions for withholding treatment. We established a forum for extended discussions and consensus building on this topic.
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  5. Atsushi Asai & Hiroko Ishimoto (2013). Should We Maintain Baby Hatches in Our Society? BMC Medical Ethics 14 (1):1-7.
    BackgroundA baby hatch called the “Stork’s Cradle” has been in place at Jikei Hospital in Kumamoto City, Japan, since May 10, 2007. Babyklappes were first established in Germany in 2000, and there are currently more than 90 locations. Attitudes regarding baby hatches are divided in Japan and neither opinions for nor against baby hatches have thus far been overwhelming. To consider the appropriateness of baby hatches, we present and examine the validity of each major objection to establishing baby hatches.DiscussionThere are (...)
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  6. Atsushi Asai & Yasuhiro Kadooka (2013). Reexamination of the Ethics of Placebo Use in Clinical Practice. Bioethics 27 (4):186-193.
    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 (...)
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  7. Atsushi Asai & Kenji Miki (2013). Case Study Concerning Privacy in the Care of Patients with HIV. Eubios Journal of Asian and International Bioethics 23 (1):13-16.
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  8. Sakiko Masaki & Atsushi Asai (2013). Seeing-Off of Dead Bodies at Death Discharges in Japan. Medical Humanities 39 (2):131-136.
    For most death discharge patients, hospitals in Japan offer seeing-off services, a practice characteristic of Japanese culture. When a patient dies, nurses usually perform after-death procedures before transferring the body to the mortuary, where the nurses and doctors gather to provide the seeing-off service. This study was carried out to determine differences between the nurses’ and bereaved families’ opinions and thoughts regarding the seeing-off service. Semi-structured interviews were conducted with 17 nurses and 6 bereaved families . The interviews assessed: the (...)
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  9. Yasuhiro Kadooka, Atsushi Asai & Seiji Bito (2012). Can Physicians' Judgments of Futility Be Accepted by Patients?: A Comparative Survey of Japanese Physicians and Laypeople. BMC Medical Ethics 13 (1):7.
    Back groundEmpirical 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.MethodsA 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 (...)
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  10. Sakiko Maki & Atsushi Asai (2012). Should Japan Abolish the Death Penalty? No Definite Answer Exists Yet. Eubios Journal of Asian and International Bioethics 22 (1):27-32.
    How should the Japanese death penalty system stand in the future? While banning the death penalty has become a global trend, Japanese public opinion still supports it, and the government continues to strongly insist retention of the system. Despite worldwide criticism towards Japanese opinion, until very recently have been no reductions in death penalty sentences or executions. Both abolitionist and retentionist countries have strong arguments to support their opinions, thus there is no decisive argument that overwhelmingly refutes others. Consideration for (...)
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  11. Atsushi Asai (2011). A Question In End-of-Life Medicine In Japan: Three Levels Structure Analysis Of The Ethics Of Provision Of Permanent And Active Artificial Nutrition And Hydration For Elderly Who Cannot Eat. Eubios Journal of Asian and International Bioethics 21 (1-2):37-40.
    This article will focus on issues concerning the provision of artificial nutrition and hydration to patients who are extremely old, completely bedridden, and totally dependent on others. These patients have no advance directives, no malignancy, suffer from persistent but unstable disturbance of consciousness as well as severe cognitive impairment, and cannot eat sufficient amounts of food to maintain their lives. Should ANH be provided? Some would agree while others would maintain otherwise. The underlying values and normative theory behind each argument (...)
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  12. Atsushi Asai & Sakiko Maki (2011). An Ethical and Social Examination of the Death Penalty as Depicted in Two Current Films Made in a ―Pro-Death Penalty Society‖. Eubios Journal of Asian and International Bioethics 21 (3):95-98.
    In Japan, although various arguments exist regarding the appropriateness of the death penalty, nationwide public opinion polls regarding the death penalty revealed that 85.6% of respondents supported maintaining the death penalty in 2009. Under these circumstances, it is worthwhile to deliberate the ethical and social issues surrounding the death penalty as depicted in Japanese films from medical humanities perspectives. In the present paper, we discuss two recent films concerning the death penalty, 13 kaidan directed by Masahiro Nagasawa, 2005 and Kyuka (...)
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  13. Atsushi Asai, Yasuhiro Kadooka & Kuniko Aizawa (2010). Arguments Against Promoting Organ Transplants From Brain-Dead Donors, and Views of Contemporary Japanese on Life and Death. Bioethics 26 (4):215-223.
    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, (...)
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  14. Atsushi Asai & Yasuhiro Kadooka Aizawa (2009). The Role of Religious and Non-Religious Beliefs in Medical Decisions. Eubios Journal of Asian and International Bioethics 19 (6):162-165.
    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 (...)
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  15. Miki Fukuyama & Atsushi Asai (2008). How Can We Make the Best Use of the Universal Declaration on Bioethics and Human Rights? Eubios Journal of Asian and International Bioethics 18 (4):110-111.
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  16. Kayoko Ohnishi, Yumiko Hayama, Atsushi Asai & Shinji Kosugi (2008). The Process of Whistleblowing in a Japanese Psychiatric Hospital. Nursing Ethics 15 (5):631-642.
    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 (...)
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  17. Atsushi Asai & Sayaka Sakamoto (2007). Self-Determination of Death in Japan: A Review & Discussion. Eubios Journal of Asian and International Bioethics 17 (2):35-40.
    Self-determination is a central concept in the field of bioethics and the most critical decision among the myriad of decisions concerning medical care is the decision to choose to die; “self-determination of death.” The purpose of this paper is to clarify the basic positions on self-determination of death held by present Japanese people and we tentatively sorted these positions into 10 arguments. We discuss the problems and implications of these positions revealed within our present review and conclude that a society (...)
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  18. Seiji Bito & Atsushi Asai (2007). Attitudes and Behaviors of Japanese Physicians Concerning Withholding and Withdrawal of Life-Sustaining Treatment for End-of-Life Patients: Results From an Internet Survey. BMC Medical Ethics 8 (1):1-9.
    Background Evidence concerning how Japanese physicians think and behave in specific clinical situations that involve withholding or withdrawal of medical interventions for end-of-life or frail elderly patients is yet insufficient. Methods To analyze decisions and actions concerning the withholding/withdrawal of life-support care by Japanese physicians, we conducted cross-sectional web-based internet survey presenting three scenarios involving an elderly comatose patient following a severe stroke. Volunteer physicians were recruited for the survey through mailing lists and medical journals. The respondents answered questions concerning (...)
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  19. Takao Takahashi & Atsushi Asai (eds.) (2007). Nihon No Seimei Rinri: Kaiko to Tenbō. Kyūshū Daigaku Shuppankai.
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  20. Alireza Bagheri, Atsushi Asai & Ryuichi Ida (2006). Experts' Attitudes Towards Medical Futility: An Empirical Survey From Japan. [REVIEW] BMC Medical Ethics 7 (1):1-7.
    BackgroundThe current debate about medical futility is mostly driven by theoretical and personal perspectives and there is a lack of empirical data to document experts and public attitudes towards medical futility.MethodsTo examine the attitudes of the Japanese experts in the fields relevant to medical futility a questionnaire survey was conducted among the members of the Japan Association for Bioethics. A total number of 108 questionnaires returned filled in, giving a response rate of 50.9%. Among the respondents 62% were healthcare professionals (...)
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  21. Atsushi Asai, Yugo Narita, Etsuyo Nishigaki, Seiji Bito & Taishu Masano (2005). Perceptions of Interpersonal Relationships Held by Patients with Obstinate Disease. Eubios Journal of Asian and International Bioethics 15 (1):32-34.
    The objective of this study was to reveal the problems related to interpersonal relationships which patients with obstinate diseases face, and consider the behavior, attitude and medical intervention that healthcare and healthcare-related professions should take in regards to these problems. Semi-structured individual interviews were conducted with patients with obstinate neurological diseases and observation of outpatient care was also conducted. Data were analyzed by qualitative content analysis. Patient diseases included Parkinson Disease , Amyotrophic Lateral Sclerosis , myasthenia gravis, spinocerebellar ataxia , (...)
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  22. Atsushi Asai & O. E. Sachi (2005). A Valuable Up-to-Date Compendium of Bioethical Knowledge. Developing World Bioethics 5 (3):216–219.
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  23. Atsushi Asai & Koichiro Itai (2004). Clinical Ethics Discussion 4: Urgent "Lifesaving" Clinical Research. Eubios Journal of Asian and International Bioethics 14 (2):52-57.
    No matter how far medicine advances, incurable disease will inevitably exist; and the dying patient's last resort will likewise look to medical research. In this report, we examine a case concerning the use of experimental medical therapy on a critically ill child. We discuss the ethical argument pertaining to the recommending of experimental medical therapy to the family of a dying patient.Under the circumstances of having to face the impending death of one's own child, parents of a terminally ill child (...)
     
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  24. Atsushi Asai, Motoki Ohnishi, Etsuyo Nishigaki, Miho Sekimoto, Shunichi Fukuhara & Tsuguya Fukui (2004). Focus Group Interviews Examining Attitudes Towards Medical Research Among the Japanese: A Qualitative Study. Bioethics 18 (5):448–470.
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  25. Atsushi Asai, Takeo Nakayama & Mariko Naito (2003). Ethics In Questionnaire-Based Research. Eubios Journal of Asian and International Bioethics 13 (4):147-151.
    This study is aimed to address the problems associated with questionnaire-based research. Twelve hypothetical cases are presented and checked for ethical validity. The problems are categorized under seven headings: Whether the participation of the subject is truly voluntary; whether consent to participate in the study has been obtained or proxy consent is required; whether consent to participate has been obtained from "authentic" participants and their privacy is protected; whether participants are fully informed before they consent to participate; whether the validity (...)
     
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  26. Seiji Bito, Kazuki Chiba & Atsushi Asai (2003). Clinical Ethical Discussion 2: Should A Physician Withdraw Ventilation Support From A Patient With Respiratory Failure When The Patient Prefers Not To Undergo Tracheotomy? Eubios Journal of Asian and International Bioethics 13 (4):147-151.
     
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  27. Yukari Take & Atsushi Asai (2003). Clinical Ethics Discussion 2: The Family And Assisted Reproductive Technology. Eubios Journal of Asian and International Bioethics 13 (2):61-63.
     
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  28. Atsushi Asai (2002). Commentary by Atsushi Asai. Eubios Journal of Asian and International Bioethics 12 (1):23-24.
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  29. Atsushi Asai (2002). Unknowability and Humility in Clinical Ethical Decisions. Eubios Journal of Asian and International Bioethics 12 (4):133-136.
    The purpose of this paper is to show problems encountered in the clinical setting by analyzing a case of a senile demented patient and to reexamine the validity of existing ethical principles and procedures. It will be argue that although existing ethical guidelines and procedures are ordinarily quite useful, ethical decisions based on them could sometimes be inconclusive because unknowabililty and uncertainty inherent to real life situations such as the care of the demented elderly patient exist. It will also be (...)
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  30. Atsushi Asai, Motoki Ohnishi, Etsuyo Nishigaki, Miho Sekimoto, Shunichi Fukuhara & Tsuguya Fukui (2002). Attitudes of the Japanese Public and Doctors Towards Use of Archived Information and Samples Without Informed Consent: Preliminary Findings Based on Focus Group Interviews. [REVIEW] BMC Medical Ethics 3 (1):1-10.
    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 (...)
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  31. Noritoshi Tanida, Atsushi Asai, Motoki Ohnishi, Shizuko K. Nagata, Tsuguya Fukui, Yasuji Yamazaki & Helga Kuhse (2002). Voluntary Active Euthanasia and the Nurse: A Comparison of Japanese and Australian Nurses. Nursing Ethics 9 (3):313-322.
    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 (...)
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  32. Atsushi Asai (2001). Some Fundamental Questions About Human Life: Ethicalcomments of Japanese Physicians in Terms of the Appropriate Care of Patients in Persistent Vegetative State. Eubios Journal of Asian and International Bioethics 11 (3):66-67.
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  33. Atsushi Asai, Motoki Ohnishi, Shizuko K. Nagata, Noritoshi Tanida & Yasuji Yamazaki (2001). Doctors' and Nurses' Attitudes Towards and Experiences of Voluntary Euthanasia: Survey of Members of the Japanese Association of Palliative Medicine. Journal of Medical Ethics 27 (5):324-330.
    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% (...)
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  34. Atsushi Asai & Motoki Onishi (2001). Reasons for Discontinuation of Treatments for Severely Demented Patients: A Japanese Physician’s View. Eubios Journal of Asian and International Bioethics 11 (5):141-143.
    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 (...)
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  35. Teresa Chikako Maruyama & Atsushi Asai (2001). Book Reviews-Hospice Care and Culture: A Comparison of the Hospice Movement in the West and Japan. Bioethics 15 (2):157-159.
     
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  36. Atsushi Asai, Shizuko Nagata & Tsuguya Fukui (2000). What Ought to Be Done Regarding Health Care Ethics Education in Japan? Eubios Journal of Asian and International Bioethics 10 (1):2-4.
     
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  37. Atsushi Asai (1998). Commentary. Can Clinical Ethics Deal With Some "Real" Problems? Eubios Journal of Asian and International Bioethics 8 (1):16-17.
     
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  38. Atsushi Asai (1998). Case Study 3: A Patient with HIV. Eubios Journal of Asian and International Bioethics 8 (1):15-16.
     
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  39. Atsushi Asai (1998). Should Physicians Make Value Judgments Regarding Medical Futility? Eubios Journal of Asian and International Bioethics 8 (5):141-143.
    Medical futility is one of the most controversial concepts in biomedical ethics. Different people have proposed diverse definitions. Nevertheless, decisions about medical futility have tremendous impacts on clinical practice and physician-patient relationships. The most fundamental dispute about medical futility is whether or not value-laden judgments regarding medical futility are acceptable.In this essay, I argue that value-laden judgments of medical futility are necessary in clinical settings because a majority of "futility " debates have focused on medical problems requiring value-laden judgments. Value (...)
     
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  40. Atsushi Asai, Minako Kishino, Tsuguya Fukui, Masahiko Sakai, Masako Yokota, Kazumi Nakata, Sumiko Sasakabe, Kiyomi Sawada & Fumie Kaiji (1998). Choices of Japanese Patients in the Face of Disagreement. Bioethics 12 (2):162–172.
  41. Atsushi Asai & Takuro Shimbo (1998). Commentary by Atsushi Asai & Takuro Shimbo. Eubios Journal of Asian and International Bioethics 8 (4):106-106.
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  42. Atsushi Asai (1997). What Ethical Dilemmas Are Japanese Physicians Faced With? Eubios Journal of Asian and International Bioethics 7 (6):162-165.
    Each country may face some distinctive ethical problems. Little is known about what kind of ethical problems exist and how often physicians are faced with them in clinical settings in Japan. The authors conducted both retrospective and prospective studies to identify ethical dilemmas at a general medical ward of a university hospital in Japan. In the first phase of the study, retrospective chart reviews were conducted for 61 patients who had been admitted to our general medical ward. It revealed that (...)
     
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  43. Atsushi Asai & Tsuguya Fukui (1997). Ethical Issues In Japanese Clinical Settings In 1990's: Attitudes And Experiences Of The Japanese. Eubios Journal of Asian and International Bioethics 7 (2):39-43.
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  44. Atsushi Asai & Masashi Shirahama (1997). Case Study 1: Hemodialysis For A Patient In Persistent Vegetative State. Eubios Journal of Asian and International Bioethics 7 (4):105-107.
     
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  45. Masashi Shirahama & Atsushi Asai (1997). Case Study 2: Disagreement Among Family Members. Call For Comments. Eubios Journal of Asian and International Bioethics 7 (5):135-137.
     
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  46. Atsushi Asai (1996). Barriers To Informed Consent In Japan. Eubios Journal of Asian and International Bioethics 6 (4):91-93.
    In the Japanese clinical setting, informed consent has not been well adopted although the idea is no longer novel and the bioethics movement is well known. There are several barriers to informed consent in Japan.It is possible that both patients and physicians do not know the idea or misunderstand it. Some may think that informed consent can be obtained from a patient who does not know his or her diagnosis or from family members of a competent patient. Because of no (...)
     
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  47. Atsushi Asai (1996). Unanswered Questions About Medical Ethics Education in Japan. Eubios Journal of Asian and International Bioethics 6 (6):160-162.
    Patients and physicians have confronted many ethical dilemmas in Japan and more complete medical ethics education should be developed to cope with them. We have to be cautious, however, when adopting ethical guidelines and decision-making priorities utilized in Western countries and expert ethicists' opinions without critical deliberation. Accepting them as absolute norms would fail to resolve ethical problems deeply rooted in the idiosyncratic Japanese human relationship and value system. Traditional ethical attitudes in Japan should be also criticized because they have (...)
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