Background Ethics committees and their system of research protocol peer-review are currently used worldwide. To ensure an international standard for research ethics and safety, however, data is needed on the quality and function of each nation's ethics committees. The purpose of this study was to describe the characteristics and developments of ethics committees established at medical schools and general hospitals in Japan. Methods This study consisted of four national surveys sent twice over a period of eight years to two separate (...) samples. The first target was the ethics committees of all 80 medical schools and the second target was all general hospitals with over 300 beds in Japan (n = 1457 in 1996 and n = 1491 in 2002). Instruments contained four sections: (1) committee structure, (2) frequency of annual meetings, (3) committee function, and (4) existence of a set of guidelines for the refusal of blood transfusion by Jehovah's Witnesses. Results Committee structure was overall interdisciplinary. Frequency of annual meetings increased significantly for both medical school and hospital ethics committees over the eight years. The primary activities for medical school and hospital ethics committees were research protocol reviews and policy making. Results also showed a significant increase in the use of ethical guidelines, particularly those related to the refusal of blood transfusion by Jehovah's Witnesses, among both medical school and hospital ethics committees. Conclusion Overall findings indicated a greater recognized degree of responsibilities and an increase in workload for Japanese ethics committees. (shrink)
Background In Japan, discussion concerning advance directives (ADs) has been on the rise during the past decade. ADs are one method proposed to facilitate the process of communication among patients, families and health care providers regarding the plan of care of a patient who is no longer capable of communicating. In this paper, we report the results of the first in-depth survey on the general population concerning the preferences and use of ADs in Japan. Method A self-administered questionnaire was sent (...) via mail to a stratified random sampling of 560 residents listed in the residential registry of one district of Tokyo, Japan (n = 165,567). Association between correlating factors and specific preferences toward ADs was assessed using contingency table bivariate analysis and multivariate regression model to estimate independent contribution. Results Of the 560 questionnaires sent out, a total of 425 participants took part in the survey yielding a response rate of 75.9 %. The results of the present study indicate that: 1) the most important components to be addressed are the specifics of medical treatment at the end of life stage and disclosure of diagnosis and prognosis; 2) the majority of participants found it suitable to express their directives by word to family and/or physician and not by written documentation; 3) there is no strong need for legal measures in setting up an AD; 4) it is permissible for family and physician to loosely interpret one's directives; 5) the most suitable proxy is considered to be a family member, relative, or spouse. Multivariate analysis found the following five factors as significantly associated with preferences: 1) awareness regarding living wills, 2) experience with the use of ADs, 3) preferences for end-of-life treatment, 4) preferences for information disclosure, and 5) intentions of creating a will. Conclusions Written ADs might be useful in the Japanese setting when the individual either wishes: 1) to not provide a lot of leeway to surrogates and/or caregivers, and/or 2) to ensure his or her directives in the cases of terminal illness, brain death, and pain treatment, as well as regarding information disclosure. (shrink)
Background Japanese people have become increasingly interested in the expression and enhancement of their individual autonomy in medical decisions made regarding medical treatment at and toward the end of life. However, while many Western countries have implemented legislation that deals with patient autonomy in the case of terminal illness, no such legislation exists in Japan. The rationale for this research is based on the need to investigate patient's preferences regarding treatment at the end of life in order to re-evaluate advance (...) directives policy and practice. Methods We conducted a cross-sectional survey with 418 members of the general middle-aged and senior adults (aged between 40 and 65) in Tokyo, Japan. Respondents were asked about their attitudes toward advance directives, and preferences toward treatment options. Results Over 60% of respondents agreed that it is better to express their wishes regarding advance directives (treatment preferences in writing, appointment of proxy for care decision making, appointment of legal administrator of property, stating preferences regarding disposal of one's property and funeral arrangements) but less than 10% of them had already done so. About 60% of respondents in this study preferred to indicate treatment preferences in broad rather than concrete terms. Over 80% would like to decide treatment preferences in consultation with others (22.2% with their proxy, 11.0% with the doctor, and 47.8% with both their proxy and the doctor). Conclusion This study revealed that many Japanese people indicate an interest in undertaking advance directives. This study found that there is a range of preferences regarding how advance directives are undertaken, thus it is important to recognize that any processes put into place should allow flexibility in order to best respect patients' wishes and autonomy. (shrink)
Background Public satisfaction with policy process influences the legitimacy and acceptance of policies, and conditions the future political process, especially when contending ethical value judgments are involved. On the other hand, public involvement is required if effective policy is to be developed and accepted. Methods Using the data from a large-scale national opinion survey, this study evaluates public appraisal of past government efforts to legalize organ transplant from brain-dead bodies in Japan, and examines the public's intent to participate in future (...) policy. Results A relatively large percentage of people became aware of the issue when government actions were initiated, and many increasingly formed their own opinions on the policy in question. However, a significant number (43.3%) remained unaware of any legislative efforts, and only 26.3% of those who were aware provided positive appraisals of the policymaking process. Furthermore, a majority of respondents (61.8%) indicated unwillingness to participate in future policy discussions of bioethical issues. Multivariate analysis revealed the following factors are associated with positive appraisals of policy development: greater age; earlier opinion formation; and familiarity with donor cards. Factors associated with likelihood of future participation in policy discussion include younger age, earlier attention to the issue, and knowledge of past government efforts. Those unwilling to participate cited as their reasons that experts are more knowledgeable and that the issues are too complex. Conclusions Results of an opinion survey in Japan were presented, and a set of factors statistically associated with them were discussed. Further efforts to improve policy making process on bioethical issues are desirable. (shrink)
I thought the paper by Kai-yee Wong and Chris Fraser was fascinating and insightful. Two things I especially appreciated are the clarity with which they summarize my views. I think they are quite fair and accurate. Second, I appreciate their suggestion that the way to deal with the practical problem of weakness of will has much to do with the role of the Background in shaping our actions. I think they are especially on the right track when they say that (...) the improvement of Background skills may actually narrow the range of real options for action, (p. 21) nonetheless, they do not decrease freedom. As they say, “It is a process of strengthening the self, and the agent is likely to experience the concomitant restriction of ‘live’ options not as a limitation but as strength of character.” (p. 21). That seems to me very much on the right track. What they are suggesting, and it is a powerful addition to my own writings, is that we should not just think of the Background as facilitating languages, games and social practices generally, but for morality as well (p. 23). (shrink)
Wang, Kai 王楷, Naturalistic Human Nature and Cultivation of the Self: The Spirit of Xunzi’s Virtue Philosophy 天然與修為—荀子道德哲學的精神. Beijing 北京: Peking University Press, 2011, 206 pages Content Type Journal Article Pages 115-118 DOI 10.1007/s11712-011-9252-z Authors Elizabeth Woo Li, Department of Philosophy, Peking University, Beijing, China Journal Dao Online ISSN 1569-7274 Print ISSN 1540-3009 Journal Volume Volume 11 Journal Issue Volume 11, Number 1.
Kai Nielsen’s recent book Philosophy and Atheism is discussed here. The main point is that Nielsen’s arguments against Christianity can be turned against his own rationalist atheism with similar results, namely that the position seems incoherent from its own point of view. Christianity is unempirical and irrational by certain arguments, but the position assumed underneath those arguments does not survive treatment by those same arguments. Nielsen’s dependence on arguments that undermine the position assumed in these arguments should make him open (...) to the suggestion that these arguments may not be relevant to the assessment of the validity of a religious position. (shrink)
In assessing the veridicality of utterances, we normally seem to assess the satisfaction of conditions that the speaker had been concerned to get right in making the utterance. However, the debate about assessor-relativism about epistemic modals, predicates of taste, gradable adjectives and conditionals has been largely driven by cases in which seemingly felicitous assessments of utterances are insensitive to aspects of the context of utterance that were highly relevant to the speaker’s choice of words. In this paper, we offer an (...) explanation of why certain locutions invite insensitive assessments, focusing primarily on ’tasty’ and ’might’. We spell out some reasons why felicitous insensitive assessments are puzzling and argue briefly that recent attempts to accommodate such assessments (including attempts by John MacFarlane, Kai von Fintel and Anthony Gillies) all fail to provide more than hints at a solution to the puzzle. In the main part of the paper, we develop an account of felicitous insensitive assessments by identifying a number of pragmatic factors that influence the felicity of assessments. Before closing, we argue that the role of these factors extend beyond cases considered in the debate about assessor-relativism and fit comfortably with standard contextualist analyses of the relevant locutions. (shrink)
In this essay I trace the terms empeiria and tribē throughout the Platonic corpus in order to expose their central position within Plato’s critique of the sophists and rhetoricians. I find that these two terms—both of which indicate a knack or habitude that has been developed through experiential familiarity with certain causal tendencies—are regularly deployed in order to account for the effectiveness of these speakers even in the absence of a technē; for, what Plato identifies with these terms is the (...) sophists’ and rhetoricians’ near masterful familiarity with and ability to manipulate the doxa and the dogma of the many, hoi poloi. (shrink)
