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.

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 (...) the feelings of the murder victim’s family is significant, and there are certain actions perpetrated by the criminal which seem unforgivable and for which nothing can compensate. At the same time, homicide is a violence that should never be acceptable and therefore cannot be justified, and human error will always allow for the possibility of wrongful convictions. The authors argue that the death penalty should be abolished in principle, but we cannot deny the existence of a criminal for whom the death penalty would be appropriate. Ethically, it would be questionable to accept life imprisonment without parole as an alternative. We are of the position that there is no definite conclusion concerning the ethicality of the death penalty. (shrink)

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

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 (...) reasons why nurses provided seeing-off services; thoughts during the seeing-off service; impressions of the mortuary rituals; and the necessity for the seeing-off service. The results indicated that nurses expressed their courtesy and sense of appreciation during the seeing-off service, which was recognised as an important nursing role. In contrast, bereaved families felt thankful but also doubtful, particularly as regards the mortuary rituals. In light of the differences in perspective between nurses and families, it may be that the level of satisfaction with the seeing-off service is largely affected by the relationship between the family and the medical professionals before the patient's death. Our study also notes that Japanese people respect the dead body and treat it with care, reflecting the unique culture and customs of Japan. (shrink)

Previous work suggests that Asians allocate more attention to configuration information than Caucasian Americans do. Yet this cultural variation has been found only with stimuli such as natural scenes and objects that require both feature- and configuration-based processing. Here, we show that the cultural variation also exists in face perception—a domain that is typically viewed as configural in nature. When asked to identify a prototypic face for a set of disparate exemplars, Japanese were more likely than Caucasian Americans to use (...) overall resemblance rather than feature matching. Moreover, in a speeded identity-matching task, Japanese were more accurate than Americans in identifying the spatial configuration of features (e.g., eyes). Together, these findings underscore the robustness of culture’s influences on cognition. (shrink)

Destination therapy is the permanent implantation of a left ventricular assist device in patients with end-stage, severe heart failure who are ineligible for heart transplantation. DT improves both the quality of life and prognosis of patients with end-stage heart failure. However, there are also downsides to DT such as life-threatening complications and the potential for the patient to live beyond their desired length of life following such major complications. Because of deeply ingrained cultural and religious beliefs regarding death and the (...) sanctity of life, Japanese society may not be ready to make changes needed to enable patients to have LVADs deactivated under certain circumstances to avoid needless suffering. Western ethical views that permit LVAD deactivation based mainly on respect for autonomy and dignity have not been accepted thus far in Japan and are unlikely to be accepted, given the current Japanese culture and traditional values. Some healthcare professionals might regard patients as ineligible for DT unless they have prepared advance directives. If this were to happen, the right to prepare an advance directive would instead become an obligation to do so. Furthermore, patient selection for DT poses another ethical issue. Given the predominant sanctity of life principle and lack of cost-consciousness regarding medical expenses, medically appropriate exclusion criteria would be ignored and DT could be applied to various patients, including very old patients, the demented, or even patients in persistent vegetative states, through on-site judgment. There is an urgent need for Japan to establish and enact a basic act for patient rights. The act should include: respect for a patient’s right to self-determination; the right to refuse unwanted treatment; the right to prepare legally binding advance directives; the right to decline to prepare such directives; and access to nationally insured healthcare. It should enable those concerned with patient care involving DT to seek ethical advice from ethics committees. Furthermore, it should state that healthcare professionals involved in the discontinuation of life support in a proper manner are immune to any legal action and that they have the right to conscientiously object to LVAD deactivation. (shrink)

Background Destination therapy is the permanent implantation of a left ventricular assist device in patients with end-stage, severe heart failure who are ineligible for heart transplantation. DT improves both the quality of life and prognosis of patients with end-stage heart failure. However, there are also downsides to DT such as life-threatening complications and the potential for the patient to live beyond their desired length of life following such major complications. Because of deeply ingrained cultural and religious beliefs regarding death and (...) the sanctity of life, Japanese society may not be ready to make changes needed to enable patients to have LVADs deactivated under certain circumstances to avoid needless suffering. Main text Western ethical views that permit LVAD deactivation based mainly on respect for autonomy and dignity have not been accepted thus far in Japan and are unlikely to be accepted, given the current Japanese culture and traditional values. Some healthcare professionals might regard patients as ineligible for DT unless they have prepared advance directives. If this were to happen, the right to prepare an advance directive would instead become an obligation to do so. Furthermore, patient selection for DT poses another ethical issue. Given the predominant sanctity of life principle and lack of cost-consciousness regarding medical expenses, medically appropriate exclusion criteria would be ignored and DT could be applied to various patients, including very old patients, the demented, or even patients in persistent vegetative states, through on-site judgment. Conclusion There is an urgent need for Japan to establish and enact a basic act for patient rights. The act should include: respect for a patient’s right to self-determination; the right to refuse unwanted treatment; the right to prepare legally binding advance directives; the right to decline to prepare such directives; and access to nationally insured healthcare. It should enable those concerned with patient care involving DT to seek ethical advice from ethics committees. Furthermore, it should state that healthcare professionals involved in the discontinuation of life support in a proper manner are immune to any legal action and that they have the right to conscientiously object to LVAD deactivation. (shrink)

Background: An external locus of control is associated with poorer psychopathology in individualist cultures, but associations are reported to be weaker in collectivist cultures where an external style is less maladaptive. We investigated the prospective association between externality and psychotic-like experiences and depressive symptoms and compared the strength of associations between a UK and a Japanese cohort.Method: Cross-cultural cohort study of a UK and a Japanese cohort. Externality was assessed using the Children's Nowicki and Strickland Internal, External Scale and DS (...) using the Short Moods and Feelings Questionnaire in both cohorts, PLE were assessed with the Psychosis-Like Experiences Questionnaire, and the Adolescent Psychotic-Like Symptom Screener. Associations were investigated using multivariable regression models and bivariate regression models to compare the strength of associations.Results: Mean externality in both childhood and adolescence was higher in ALSPAC than in the TTC. Childhood externality was associated with PLE in late childhood and adolescence in both cohorts and adolescent externality was associated with PLE in young adulthood in the ALSPAC cohort. There was a more mixed pattern of association between externality and DS scores. There was little evidence of any differences in the strength of associations between externality and different psychopathologies, or between cohorts. In ALSPAC adolescent externality and early adult psychopathology were more strongly associated than childhood externality and adolescent and early adult psychopathology. There was no evidence that change in externality between childhood and adolescence was associated with new onset PLE or DS in early adulthood.Conclusion: An external locus of control is associated with poor mental health regardless of cultural context. (shrink)

In the present super-aging society, issues concerning what treatment should be given for incapacitated patients have become more important than ever before. This paper discusses whether or not an incapacitated patient’s refusal of treatment should be respected. The authors present a complete hypothetical scenario involving a 75-year-old moderately demented man suffering from malignant lymphoma. Of primary importance are the respect for patient dignity and the protection of human rights. Acts such as coercion, disregard, restriction, and surveillance can be unethical in (...) many situations. The effectiveness of chemotherapy for malignant lymphoma and its adverse outcomes could offset each other, leaving no net benefits for the patient. The patient is vulnerable and this very vulnerability requires the utmost protection and care. However, protection must be sensitive and comprehensive and the protection of his life at the expense of many other valuable factors is not justifiable. Coercing unwanted treatment would be intrusion, not protection, because of the physical and psychological suffering. When the refusal is explicit, consistent, and stable enough, it should to be viewed as true and current desire. Due to moderate dementia, the patient has lost his rational capacity, but his emotional capacity remains. If the remaining portion of his personality is rooted in his feelings, these feelings should be respected as much as possible. Those involved in the care of the patients who refuse treatment should not force them to undergo it simply on the grounds that it may be an established standard in their own country. What must be asked first is whether or not forced treatment would promote the patient’s subjective well-being. Additionally, treatment decisions should not be distorted due to the selfishness or discriminatory feelings of those involved in his care. In situations in which patients lack decisionmaking capacities, overriding the patients’ refusals of treatment should be regarded as an exception, rather than a standard course of action. Even in patients who are incapacitated, treatment refusal could stem from the feelings of the individual. Their subjective wellbeing would not be improved through close observation, restraint, denial, and coercion, the purpose of which they does not understand. (shrink)

Ainu artists were invited to make “replicas” of traditional Ainu arts held in an important museum collection and describe their choices, process and results. The resulting Ainu aesthetics challenges—and changes—our understanding of aesthetics and the philosophy of art, on four levels: descriptive aesthetics, categorical aesthetics (the categories through which the Ainu understand aesthetic value), implications of these aesthetics for a variety of human activities such as museum practice and daily life, and the implications of the first three for our broader (...) understanding of aesthetics and the philosophy of art. Preliminary analysis of Ainu aesthetics suggests it is interested in it not only as the creation and appreciation of pleasure, but also as the creation and appreciation of meaning, of sacrality, of community, and of knowledge. These latter become especially important given the threats to Ainu culture presented first by incorporation into the Japanese polity and culture and then by modernization and commercialization. Ainu works of art, therefore, carry special significance as means of conveying to current and future generations not only the aesthetic experiences of the past, but their sacred relations, sense of community, and knowledge. This suggests new roles for arts and for museums as they strive to present the works in their full physicality to contemporary audiences, especially those of Ainu artists. (shrink)

This contribution explores the reciprocal links between the organisational transformation of Western European Green parties and the access of some of these parties to national government participation. On the one hand, a series of hypotheses with regard to the possible link between prior organisational adaptation and eventual access to governmental participation are examined. On the other hand, the opposite question is addressed : that of the potential impact of governmental participation on further organisational adaptation. Following both a qualitative and Qualitative (...) Comparative Analysis, one does ultimately identify a link between prior organisational adaptation and eventual access to government, but a much more indirect and contrasted link between governmental participation and further organisational adaptation. (shrink)

The use of the axial vector representing a three-dimensional rotation makes the rotation representation much more compact by extending the trigonometric functions to vectorial arguments. Similarly, the pure Lorentz transformations are compactly treated by generalizing a scalar rapidity to a vector quantity in spatial three-dimensional cases and extending hyperbolic functions to vectorial arguments. A calculation of the Wigner rotation simplified by using the extended functions illustrates the fact that the rapidity vector space obeys hyperbolic geometry. New representations bring a Lorentz-invariant (...) fundamental equation of motion corresponding to the Galilei-invariant equation of Newtonian mechanics. (shrink)

Complex systems can be characterized by classes of equivalency of their elements defined according to system specific rules. We propose a generalized preferential attachment model to describe the class size distribution. The model postulates preferential growth of the existing classes and the steady influx of new classes. According to the model, the distribution changes from a pure exponential form for zero influx of new classes to a power law with an exponential cut-off form when the influx of new classes is (...) substantial. Predictions of the model are tested through the analysis of a unique industrial database, which covers both elementary units (products) and classes (markets, firms) in a given industry (pharmaceuticals), covering the entire size distribution. The model's predictions are in good agreement with the data. The paper sheds light on the emergence of the exponent tau approximately 2 observed as a universal feature of many biological, social and economic problems. (shrink)

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 (...) directed by Hajime Kadoi, 2007. The two films describe the impact of execution on the executioners, secrecy of executions, rehearsal of the execution, and voluntary participation in execution. They depict the current situation surrounding the death penalty and execution, as well as everyday life on death row, in detail. Serious concerns about current execution procedures were also described. The two films seem to try to tell the audience that there is something strange in killing people in perfect order with good will in the name of law and justice. They show the officer‘s instinctive aversion provoked by the execution and make us think about what it means to kill a human. (shrink)

When building personal relationships, it is important to select optimal partners, even based on the first meeting. This study was inspired by the idea that people who smile are considered more trustworthy and attractive. However, this may not always be true in daily life. Previous studies have used a relatively simple method of judging others by presenting a photograph of one person’s face. To move beyond this approach and examine more complex situations, we presented the faces of two people confronted (...) with each other to participants and asked them to judge them from a third-person perspective. Through three experiments, participants were asked to judge which of the two persons was more appropriate for forming alliances, more trustworthy, or more attractive, respectively. In all experiments, images were shown for a short or a long time. In all three experiments, the results showed that participants were more likely to choose persons with happy faces than those with neutral, sad, or angry faces when the image presentation was short. Contrarily, the facial expressions did not affect those judgments when the image presentation was long. Instead, judgments were correlated with personality estimated from the model’s neutral face in a single-person presentation. These results suggest that although facial expressions can affect the judgments of others when observing two-person confrontations from a third-person perspective, when participants have more time to elaborate their judgments, they go beyond expressions. (shrink)

The Millennium Development Goals were criticised for failing to address the issue of governance, and the associated notions of responsibility and accountability. The Sustainable Development Goals, we argue, need to recognise the structural constraints facing poor countries – the power imbalances in the global economic system that limit their ability to promote the prosperity and well-being of their people, as was clearly brought out by the Commission on Global Governance for Health, of which we were both members [Ottersen, O. P., (...) J. Dasgupta, C. Blouin, Paulo Buss, Virasakdi Chongsuvivatwong, Julio Frenk, Sakiko Fukuda-Parr, et al. 2014. “The Political Origins of Health Inequality: Prospects for Change.” Lancet 383: 630–667]. This article is divided into three parts. We begin by making the case for a global justice perspective which emphasises the responsibility – and hence also accountability – of international organisations and rule-making bodies. We next demonstrate the limitations of accountabi.. (shrink)

Previous long-term memory research found that angry faces were more poorly recognised when encoded with averted vs. direct gaze, while memory for happy faces was unaffected by gaze. Contrasti...