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)

BackgroundFew comparative studies of clinical ethics consultation practices have been reported. The objective of this study was to explore how American and Japanese experts analyze an Alzheimer's case regarding ethics consultation.MethodsWe presented the case to physicians and ethicists from the US and Japan (one expert from each field from both countries; total = 4) and obtained their responses through a questionnaire and in-depth interviews.ResultsEstablishing a consensus was a common goal among American and Japanese participants. In attempting to achieve consensus, the (...) most significant similarity between Japanese and American ethics consultants was that they both appeared to adopt an "ethics facilitation" approach. Differences were found in recommendation and assessment between the American and Japanese participants. In selecting a surrogate, the American participants chose to contact the grandson before designating the daughter-in-law as the surrogate decision-maker. Conversely the Japanese experts assumed that the daughter-in-law was the surrogate.ConclusionOur findings suggest that consensus building through an "ethics facilitation" approach may be a commonality to the practice of ethics consultation in the US and Japan, while differences emerged in terms of recommendations, surrogate assessment, and assessing treatments. Further research is needed to appreciate differences not only among different nations including, but not limited to, countries in Europe, Asia and the Americas, but also within each country. (shrink)

This research examines the current status of clinical ethics consultation (CEC) in Japan through a nationwide study conducted with chairs of ethics committees and clinical ethics committees among 1028 post-graduate clinical teaching hospitals. We also qualitatively analyzed their viewpoints of the CEC’s benefits and problems related to hospital consultation services to identify the critical points for CEC and inform the development of a correctly functioning system. The questionnaire included structured questions about hospital CEC organization and service purpose and operation and (...) open-ended questions about the benefits and problems of initiating CEC. The questionnaire comprised the presence/absence of an ethics committee, CEC services and membership when services were implemented, users, and the number of cases handled since inception. In addition, the respondents also provided their impressions of the CEC system’s impact on their hospital by describing (a) the benefits of CEC services and (b) the ineffectual or harmful aspects of the CEC system. Qualitative data were examined using qualitative content analysis to determine the impact of establishing a CEC and the difficulties of practice. One hundred twenty-five questionnaires were returned from either the chair of the ethics committee or clinical ethics committee in teaching hospitals. Of these, 90 (72%) reported they provided CEC services. Additionally, 36 respondents (34.6%) reported that their existing research and clinical ethics committees had conducted CEC services, and 35 (33.7%) reported having a newly established clinical ethics committee conducting CEC services. Three positive effects of establishing and four challenges in managing CEC were also identified. (shrink)

Hospital ethics committees (HECs) are expected to play extremely broad and pivotal roles such as case consultation, education of staffs on healthcare ethics, and institutional policy formation. Despite the growing importance of HECs, there are no standards for setup and operation of HECs, and composition and activities of HECs at each institution are rarely disclosed in Japan. In addition, there is also a lack of information sharing and collaboration among HECs. Therefore, the authors established the Consortium of Hospital Ethics Committees (...) (CHEC) in October 2020, which has been regularly hosting a couple of core activities. One is the Healthcare Ethics Forum, held monthly online for CHEC members to freely discuss HECs and healthcare ethics consultation. The other is the Collaboration Conference of Hospital Ethics Committees, intended to provide a place for HEC members and administrative officers from across Japan to exchange information of their HECs, learn from each other, and cooperate to operate HECs appropriately. In this paper, the authors introduced CHEC as well as reported the results of a questionnaire survey conducted at the first conference among participating facilities, suggesting the diverse structures and activities of HECs in Japan. (shrink)

In the past few years, a second phase of biomedical ethics in Japan has begun to surface with a succession of governmental guidelines and laws regulating biomedical technology. Although this rush of guidelines exemplifies a heightened awareness concerning ethical standards for healthcare research, it also invites several practical, political, and procedural problems.

This study aimed to identify the ethical issues faced by home care physicians and nurses, and the support they require. It was conducted in collaboration with the Japanese Association for Home Care Medicine from November to December 2020. An e-mail was sent to 2785 physicians and 582 nurses who are members of the society, requesting their participation in a web-based survey targeting physicians and nurses with practical experience in home care; 152 physicians and 53 nurses responded. Home care physicians and (...) nurses face ethical issues, some of which are that “the patient’s wishes cannot be reliably understood owing to their impaired decision-making capacity” and “there is disagreement between the patient and their family members over the necessary healthcare.” The respondents sought “experience with, and insight into, healthcare ethics” and “home care” from people with whom they would consult on ethical issues, but at the time of the actual consultation, those individuals were the main healthcare professionals involved with the patient. In addition, the respondents desired to have “multidisciplinary discussions in the community,” “participation of healthcare ethics experts at meetings,” and “meetings held by healthcare ethics experts” to discuss specific cases. Given these results and the history of healthcare ethics education in Japan—which has been implemented mostly for healthcare providers—we conclude that it is important for academic societies that offer healthcare ethics education to healthcare providers and regional core hospitals with ethics support resources to collaborate to provide ethics consultation services in the community. (shrink)

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)

Compared to institutional and area-based ethics committees, little is known about the structure and activities performed by ethics committees at national medical organizations and societies. This five year follow-up study aimed to determine (1) the creation and function of ethics committees at medical organizations in Japan, and (2) their general strategies to deal with ethical problems. The study sample included the member societies of the Japanese Association of Medical Sciences (n=92 in 1998, n=96 in 2003). Instruments consisted of two sections: (...) (1) the structure, function and activities of ethics committees, and (2) the strategies for dealing with ethical problems. Response rates were 84.4% in 1998 and 64.4% in 2003. Findings showed a significant increase of ethics committees at medical organizations between 1998 (25.6%) and 2003 (50.0%). Members were mostly male, medical doctors in clinical or basic medicine, and members of the organization. The major functions of ethics committees were ethical reviews of research protocols, policy making and ethical reviews of manuscripts submitted for journal publication. Among organizations that did not have an ethics committee, a significant decrease was found in organizations that replied that they had never experienced an ethical problem which needed further investigation (p<0.01). Findings suggested an overall rise in awareness of the importance of ethical issues and also highlighted an increase in recognition of responsibility regarding ethical problems. (shrink)

The Pragmatics of Multi-Verb Sequences: The Case of the Verb Go This paper is an empirical investigation into the nature of multi-verb sequences in English. Multi-verb sequences such as V-to-VP and V-and-VP present a natural construction type of investigating recurring patterns of event sequences as conceived situations. This paper focuses on the image-schematic properties of both the go-to-VP construction and the go-and-VP construction to which previous accounts have paid little attention, and it demonstrates that the interpretation of the image-schemas has (...) enhanced research. The go-to-VP and the go-and-VP constructions require different image schemas. With respect to the go-to-VP construction, the SOURCE-PATH-GOAL schema plays an important role; sometimes a compound image schema of that type are necessary. Specifically, the image-schematic properties of the first verb go are incorporated into the event structure of the second verb to allow the speaker to construe the event denoted by the second verb in accordance with the image-schematic meaning of the first verb go. Consequently, this paper offers a pragmatic and cognitive account of the two constructions respectively. Some results in a data-driven analysis in this paper also reinforce selected convincing explanations. (shrink)

The mechanism of chromosome condensation is one of the classic mysteries of mitosis. A number of years ago, it was suggested that nonhistone proteins of the chromosome scaffold fraction might help chromosomes to condense, possibly by constructing a framework for the condensed structure. Recent results have shown that topoisomerase II and the SMC proteins, two abundant members of the scaffold fraction, are required for chromosome condensation and segregation during mitosis. Topoisomerase II is a well‐characterized enzyme. In contrast, nothing is yet (...) known about the function of the SMC proteins. We summarize evidence suggesting that these proteins may be enzymes whose activity is somehow involved in the establishment and maintenance of mitotic chromosome morphology. (shrink)

Resolution and cut-free LK are the most popular propositional systems used for logical automated reasoning. The question whether or not resolution and cut-free LK have the same efficiency on the system of CNF formulas has been asked and studied since 1960 425–467). It was shown in Cook and Reckhow, J. Symbolic Logic 44 36–50 that tree resolution has super-polynomial speed-up over cut-free LK. Naturally, the current issue is whether or not resolution and cut-free LK expressed as directed acyclic graphs have (...) the same efficiency. In this paper, we introduce a new algorithm to eliminate atomic cuts and show that cut-free LK polynomially simulates resolution when the input formula is expressed as a k-CNF formula. As a corollary, we show that regular resolution does not polynomially simulate cut-free LK . We also show that cut-free LK polynomially simulates regular resolution. (shrink)

1. Hōriron -- 2. Hōshisō -- 3. Jitteihō no kiso riron.

In the circular sphere around the Pacific Ocean many volcanos have erupted, and, because of tectonic plates, numerous earthquakes have occurred. In Tonga, especially, the resulting devastation has been beyond our wildest imagination. Regarding such natural phenomena, we could not predict anything. Likewise, the Covid-19 pandemic appeared suddenly, and no one can say when its destruction will end. Protective measures against infection have affected the nature of our social interactions: masking has changed our spatial consciousness; observing social distancing has made (...) us less dependent on one another and has influenced us to seek solitude. As a result, inter-subjectivity—the foundation of ethics—has been broken. All of these effects on our interpersonal relationships have instilled in us a new attitude towards nature, because the human being is a part of nature. This new attitude with nature opens up a new paradigm: dialogues with nature and their co-operative activities must be demanded, and we must wait for nature’s movement and ask for its help. It is, in a way, the traditional artistic attitude toward nature. (shrink)

Avec et après la pandémie, notre conscience de l’espace et du temps a subi un changement radical : les individus ont expérimenté l’oisiveté forcée, les gestes barrières et la distanciation physique qui redouble l’éloignement induit par les nouvelles technologies ayant substitué la communication à l’échange. Or, les progrès techniques n’ont de progrès que le nom et ne cherchent que l’efficacité assurée par la vitesse qui fait violence aux cycles de la nature. Pourtant, seule cette dernière est capable de nous réconcilier (...) avec nous-mêmes en nous extrayant de la domination de la machine et en nous enseignant la patience de laquelle peut surgir la beauté : beauté du geste artistique qui défie le temps, accès à la transcendance à travers la contemplation du vivant. C’est dans ce rapport d’interdépendance avec la nature que nous pouvons échapper à la déshumanisation de la société moderne et renouer avec la beauté du monde. (shrink)

The method of analytic tableaux is employed in many introductory texts and has also been used quite extensively as a basis for automated theorem proving. In this paper, we discuss the complexity of the system as a method for refuting contradictory sets of clauses, and resolve several open questions. We discuss the three forms of analytic tableaux: clausal tableaux, generalized clausal tableaux, and binary tableaux. We resolve the relative complexity of these three forms of tableaux proofs and also resolve the (...) relative complexity of analytic tableaux versus resolution. We show that there is a quasi-polynomial simulation of tree resolution by analytic tableaux; this simulation is close to optimal, since we give a matching lower bound that is tight to within a polynomial. (shrink)

In the case of Japan, we accepted the Chinese philosophy of morality when we received the Chinese character Yi: it means responsibility to Heaven (vertical) and, at the same time, responsibility to community (horizontal). An act having this structure might be our responsibility as human beings: yi means “justice”, keeping balance between Heaven and Earth. The Japanese people had such a balance until the Edo era. In 1868, when the Meiji Restoration occurred, the Japanese government tried to accept Western ideas. (...) Cyoumin Nakae introduced the Western philosophy of law and the constitutional system. He translated Rousseau’s The Social Contract into Japanese and gave a series of lectures on the social contract. The fundament of his thought is concentrated in the “rights of Liberty”. He emphasized transcendental liberty beyond personal, phenomenal liberty and found the same structure in Mencius. His idea of ft suggests the way of justice. Unfortunately, this idea was crushed with the death of his talented disciple in prison. After the book of Bushido, ft was only translated as “duty” for the community (horizontal), and we lost the vertical perspective: transcendental liberty. (shrink)

The *Kāśyapaparivarta, an early Mahāyāna sūtra, has a complex history. Sanskrit and Tibetan versions, and some of its Chinese translations, have been available to scholars for almost a century, thanks to Staël-Holstein’s 1926 editio princeps. Yet no comprehensive survey of available sources, or critical appraisal of their antecedants, has been published, and most importantly, essential Chinese materials have long been overlooked. The present contribution focuses most centrally on the Chinese translations of the scripture. In addition, the relation of the sūtra (...) to the Mahāratnakūṭa collection of forty-nine texts and the possible Indic origins of the latter are explored. (shrink)