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)
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, various arguments regarding brain death and organ transplantation were offered. An amazing variety of opinions continue to be offered, even after more than 40 years have elapsed since the first heart organ transplant in Japan. Some are of the opinion that with the passage of the revised law, Japan will finally become capable of performing transplants according to global standards. Contrarily, there are assertions that organ transplants from brain- dead donors are unacceptable because they result in organs being taken from living human beings.Considering the current conditions, we will organize and introduce the arguments for and against organ transplants from brain- dead donors in contemporary Japan. Subsequently, we will discuss the primary arguments against organ transplants from brain- dead donors from the perspective of contemporary Japanese views on life and death. After introducing the recent view that brain death should not be regarded as equivalent to the death of a human being, we would like to probe the deeply-rooted views on life and death upon which it is based. (shrink)
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.
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)
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)
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 (...) produce the desired physiological effect. Also, the physicians were asked about their practical frequency and important reasons for futile treatments.Results1134 laypeople and 401 (80%) physicians responded. In all vignettes, the laypeople were more affirmative in providing treatments in question significantly. As the factors for judging futility, medical information and quality of life (QOL) of the patient were rather stressed by the physicians. Treatment wish of the family of the patient and psychological impact on patient side due to the treatment were rather stressed by laypeople. There were wide variations in the threshold of judging quantitative futility in both groups. 88.3% of the physicians had practical experience of providing futile treatment. Important reasons for it were communication problem with patient side and lack of systems regarding futility or foregoing such treatment.ConclusionLaypeople are more supportive of providing potentially futile treatments than physicians. The difference is explained by the importance of medical information, the patient family’s influence to decision-making and QOL of the patient. The threshold of qualitative futility is suggested to be arbitrary. (shrink)
The use of single-use items is now ubiquitous in medical practice. Because of the high costs of these items, the practice of reusing them after sterilisation is also widespread especially in resource-poor economies. However, the ethics of reusing disposable items remain unclear. There are several analogous conditions, which could shed light on the ethics of reuse of disposables. These include the use of restored kidney transplantation and the use of generic drugs etc. The ethical issues include the question of patient (...) safety and the possibility of infection. It is also important to understand the role of informed consent before reuse of disposables. The widespread practice of reuse may bring down high healthcare costs and also reduce the huge amount of hospital waste that is generated. The reuse of disposables can be justified on various grounds including the safety and the cost effectiveness of this practice. (shrink)
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 (...) (HCPs) and 37% were non-healthcare professionals (Non-HCPs).ResultsThe majority of respondents (67.6 %) believed that a physician's refusal to provide or continue a treatment on the ground of futility judgment could never be morally justified but 22.2% approved such refusal with conditions. In the case of physiologically futile care, three-quarters believed that a physician should inform the patient/family of his futility judgment and it would be the patient who could decide what should be done next, based on his/her value judgment. However more than 10% said that a physician should ask about a patient's value and goals, but the final decision was left to the doctor not the patient. There was no statistically significant difference between HCPs and Non-HCPs (p = 0.676). Of respondents 67.6% believed that practical guidelines set up by the health authority would be helpful in futility judgment.ConclusionThe results show that there is no support for the physicians' unilateral decision- making on futile care. This survey highlights medical futility as an emerging issue in Japanese healthcare and emphasizes on the need for public discussion and policy development. (shrink)
A murder case that had some features in common with the Tarasoff case occurred in Sasebo City, Japan, in 2014. A 15-year-old high school girl was murdered and her 16-year-old classmate was arrested on suspicion of homicide. One and a half months before the murder, a psychiatrist who had been examining the girl called a prefectural child consultation centre to warn that she might commit murder, but he did not reveal her name, considering it his professional duty to keep it (...) confidential. Article 134 of the Japanese Criminal Law states that doctors should not disclose patient information obtained in clinical practice without a legitimate reason, but the Japanese Supreme Court has not specified what constitutes a legitimate reason. Mass media and commentators suggested that the murder could have been prevented if the psychiatrist had disclosed the girl's name to the authorities or had isolated her coercively in a psychiatric ward. However, the authors disagree with such claims. This article discusses obligations imposed on concerned individuals and third party members in cases involving ethical dilemmas regarding patient confidentiality and information disclosure. It is concluded that everyone should fulfill their obligations to prevent such tragedies and one should judge the appropriateness of others’ actions based not on the consequences of their actions, but on the processes used to decide on a course of action and their commitment. It is necessary for us to establish a society in which concerned parties can do what they think is ethically best without fearing ungrounded charges. (shrink)
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 (...) mutual trust between patients and healthcare professionals. Issues concerning the clinical use of placebo are thus intimately related to patient-provider relationships, the public's trust in medicine, and medical education. A review of recent survey studies suggests that the clinical use of placebo appears to be fairly well accepted among healthcare professionals and is common in clinical settings in various countries. However, we think that an ethical discussion is urgently needed because of its controversial nature. If judged to be ethically wrong, the practice should end. In the present paper, we discuss the ethicality of the clinical use of placebo with deception and argue against it, concluding that it is unethical and should be banned. We will show that most arguments in favor of the clinical use of placebo can be refuted and are therefore incorrect or weak. These arguments will be presented and examined individually. Finally, we will briefly consider issues relevant to the clinical use of placebo without deception. (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, patient interest-oriented factor, family preference-oriented factor, and balanced patient/family preference-oriented factor. 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)
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)
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)
This article presents a critique of the health promotion policy of Japan, which is based on an examination of the social importance of and justification for health promotion. This is done to suggest the proper direction that the future Japanese policy could take, and to question the adequacy of the term of ‘health promotion’. We find the ‘social progress’ characterization of the ‘Second Term of National Health Promotion Movement in the Twenty-First Century - Health Japan 21 ’ to be problematic. (...) While there are clear restraints found in terms of social costs related to the policy, the aims toward social justice provided by the policy are not clear. Considering the social importance and justification of health promotion, and the present conditions seen in Japan, we believe that it is necessary clearly to position health promotion as a form of social justice. Having said this, the term ‘health promotion’ is in itself misleading and can belie the range of activities required to action these policies. Therefore, we propose considering the selection of a different and more appropriate term for health promotion that concretely defines policies that actively work toward definitive health equity. (shrink)
In medical ethics, an appropriate national healthcare system that meets the requirements of justice in healthcare resource allocation is a major concern. Japan is no exception to this trend, and the pros and cons of introducing a two-tier healthcare system, which permits insured medical care services to be provided along with services not covered by social health insurance, have been the subject of debate for many years. The Supreme Court ruled in 2011 that it was valid for the government to (...) ban mixing medical treatments and both the Ministry of Health, Labour and Welfare and Japanese Medical Association oppose the introduction of such a system. In this paper, we examine the main arguments against the introduction of a two-tier healthcare system and ideas that form their basis, which can be broadly divided into opinions based on the importance of equality and those derived from the logical conclusion that the outcomes would be detrimental. We point out issues and shortcomings of each standpoint and argue that the introduction of the system would not necessarily threaten equality and social solidarity in Japanese society, and that abuses of a self-pay tier would be controllable to a certain extent. Then, the authors—who do not actively promote the introduction of a two-tier healthcare system—conclude that the allegation that is completely devoted to one side and the theory that social healthcare is collapsing, which makes the public excessively nervous, cannot be accepted. (shrink)
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 (...) needs to deny unnecessary intrusion and tolerance for different views might be a keyword in our oncoming society. (shrink)
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)
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.
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)
The year 2010 marked the centenary of the birth of Akira Kurosawa (1910–1998), whose works have been reassessed favourably in the last couple of years in Japan. During his lifetime, Kurosawa directed and produced three films whose chief characters are medical doctors: Drunken Angel (1948), The Quiet Duel (1949) and Red Beard (1965). This paper discusses these three films and examines the thoughts and lives of the three protagonists from the perspective of modern medical ethics. The films depict contemporary ethical (...) and social problems, and deal with paternalism, a healthy professional life and the proper place for human reason in medicine, all of which still give rise to debate in modern medical settings. They are very impressive in their portrayal of extreme paternalism, excessively professional lives and disproportionate reliance on rationality. The doctors are role models in certain situations and are examples of how not to behave in other situations. On the one hand, they are devoted to helping their patients, with their self-sacrifice firmly based on humanity and medical ethics. On the other hand, they perform unwelcome favours and are unhealthy role models who might harm others through narrow-minded attitudes about human beings, a fixed view of life and inflexible ideas about medicine. In this sense, they can be regarded as a rather mixed blessing. These films provide us with an opportunity to simultaneously recognise the importance of modern ethical principles and the significance of ‘old’ ethical values. (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)
The global increase in patients with chronic conditions has led to increased interest in ethical issues regarding such conditions. A basic biomedical principle—respect for autonomy—is being reexamined more critically in its clinical implications. New accounts of this basic principle are being proposed. While new accounts of respect for autonomy do underpin the design of many public programs and policies worldwide, addressing both chronic disease management and health promotion, the risk of applying such new accounts to clinical setting remain understudied. However, (...) the application of new accounts of respect for autonomy to clinical settings could support disrespectful attitudes toward or undue interference with patients with chronic conditions. Reconsidering autonomy and respect using Kantian accounts, this paper proposes respect for persons as an alternative basic bioethical principle to respect for autonomy. Unlike the principle of respect for persons in the Belmont Report, our principle involves respecting any patient’s decisions, behaviors, emotions, or life-style regardless of his or her “autonomous” capabilities. Thus, attitudes toward patients should be no different irrespective of the assessment of their decisional or executive capabilities. (shrink)
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 (...) are extremely vulnerable to suggestion and often loose the ability to make a composed decision._Moreover, there exists the possibility of not only patients, but also medical staff and researchers, to fall into therapeutic misconception. Likewise, for the terminal patient and his/her family though, experimental medical therapy is often the only hope, which is, however, always accompanied by a factor of uncertainty and is considered to be merely an unapproximated gamble. The proposing of experimental medical therapy can result in being cruel by shattering the parent's expectations of saving their child._We examine the issues involved in proposing an experimental medical therapy to patients who are in dire need of a last hope; and conclude that, in times of emergency, we must take great consideration in recommending an experimental medical therapy as an "innovative treatment." In extreme circumstances where an individual's life is on the line, doing nothing can be quite trying; yet, what is right is not necessarily doing something, but rather making the right decision. (shrink)
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 (...) of questionnaire-based research has been determined in terms of its possible harm; how the roles of the research ethics committee are defined; and what content should be presented in reports and articles. It is important that the ethics of questionnaire-based research should be reviewed with consideration to maintaining a balance between the protection of a subject's human rights and the promotion of research for the improvement of medical science and health care. (shrink)
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 , (...) and progressive supranuclear palsy . Findings highlighted that patients’ disease and suffering was not understood fully by patients’ families, that patients feel a lack of family support and cooperation, and that society’s level of understanding of their disease was also insufficient. Again, findings revealed that patients recognized their inability to perform personal activities and to behave competently within the contexts of family and society. This lowered their self evaluation. These findings highlight three needs: “the need for empathy,” “the need for self the “the need for empathy” and “the need for self esteem.”This study was supported by a great-in-aid by Ministry of Health, Labor and Welfare in Japan, “Outcomes Research of Specific Diseases”（PI:S.Fukuhara）（Grand no: H14-44）. (shrink)
Should a patient in a persistent vegetative state live? Is the life of a patient in a mere biological state worthwhile maintaining? I would argue that the life of a PVS patient is instrumentally valuable in so far as it can satisfy the family’s preference to keep it alive. A PVS patient should live if the patient’s family desires it Conversely, the PVS patient should be allowed to die or be actively killed if no one desires him or her to (...) live. Mere biological life has no value at all when no one finds it valuable and it is morally permissible to destroy something valueless to everyone.Under what circumstances should the desires of a PVS patient’s family be disregarded? Their desire to keep the patient alive should not be unlimited if that would evidently harm other patients. The objection based on just resource allocation could set the limits of a family’s desire to keep the patient in a certain condition. I would argue that when only one bed is available in intensive care unit, the life and interests of conscious patient should override these of PVS patients and preferences of the family to keep the PVS patient alive. This is because harm that the conscious patient suffers is much more serious than that suffered by the family.Whether to use organs of PVS patients is also discussed. Is the family’s donating the patients’ organs a minimum duty of no harm or an act of beneficence? It is uncertain. It might be a supererogatory action for the family to do so in a certain situation. (shrink)
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 (...) judgments made by physicians can be used in the form of recommendation given in the process of informed consent. Physicians' value judgments might be well informed and calm.I believe that imposing one's value on others is one thing and having a certain position about value is the other. Physicians should establish their ethical attitudes in physician-patient relationships, but I strongly object to physicians' imposing their value judgments on patients and their family in any situation. In most "futility" cases, physicians must not withhold information about medical interventions that they believe are futile. It is essential for physicians to openly discuss their beliefs regarding what makes a human life valuable and what constitutes benefits with their patients and patients' families. There are many barriers to a physicians making sound value judgments. Therefore, it is mandatory for physicians to be aware that they are making value judgments about medical interventions and recognize that value judgments could be biased by self-interest. It is also important for them to admit that physicians have no expertise in value judgments about individual cases. (shrink)
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 (...) assess the uniqueness and validity of religious beliefs, as well as the rationality of beliefs. We concluded that decisions based on religious and non-religious beliefs shouldbe treated in the same way and that the distinguishing features of valid beliefs are deeply held and do not cause harm to others. In addition, we stated that the root beliefs we hold, whether religious or secular, cannot necessarily be explained logically, and that patient decisions should be judged by the logical consistency of their reasoning with their beliefs as starting points. (shrink)
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 (...) claimed that in the face of uncertainty and unknowability all we can do is try to be a virtuous person on behalf of the patient although it is unknown about what the virtuous clinician who are imaginative, compassionate, benevolent, empathic, trustworthy, fair, altruistic, moderate, and modest would do for the demented patient. In the situation where we cannot surely know what is right or what is good, arrogance could be the worst character that clinicians, ethicists, and philosophers could have. Therefore, what is left to us is, I would argue, keeping listening to others, keep thinking what is good with humility and keep questioning the ethical validity of what we have done and what we will do in the name of the patient’s benefits. No one can be modest without recognizing unknowability in reality and one’s own limitations in ability to judge about what is good for patients. (shrink)
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 (...) apparently failed to deal with present ethically difficult situations.We have to, therefore, start our consideration regarding appropriate medical ethics education by asking the following questions: What is an ethical problem in Japan, what kind of decision-making process should be used, and what is ethically right in this country? We would obtain valid answers only through recognition of present situation in this regard. (shrink)
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 (...) ethical dilemmas were recorded in 17 cases. In the subsequent period, as the second phase of the study, 6-month prospective case findings were conducted, showing that 22 of 47 patients had ethical dilemmas that attending physicians were concerned about. Ethical dilemmas frequently identified included refusal of or unnecessary requests for diagnostic procedures or treatment by patients, issues concerning truth-telling to patients with a serious illness, and disagreement regarding plans for patient care between patients' family and physicians in charge. The prospective case findings identified a significantly higher frequency of ethical dilemmas than did retrospective chart reviews . Demographics were not significantly different for the two patient groups. The data suggests that ethical dilemmas are not uncommon in general medical wards in Japan. The patients' family played a significant role in clinical decision making, leading on some occasions to complicated ethical dilemmas. (shrink)
