Currently in Japan, it is extremely difficult to realize the basic wish of protecting personal dignity at the end of life. A patient’s right to refuse life-sustaining treatment has not been substantially warranted, and advance directives have not been legally enforceable. Unfortunately, it is not until the patient is moribund that all concerned parties start to deliberate on whether or not death with dignity should be pursued. Medical intervention is often perceived as a worthwhile goal to not only preserve life, (...) but also provide psychological benefit to the family, regardless of its effect on the patient. To feel they are doing something, family members tend to act against the imperative “Do not inflict on others what you would not wish done to you,” and permit extraordinary measures they would not want themselves. Another complication in Japanese culture is the necessity of unanimous decisions for end-of-life care. If there is conflict between a patient and his/her family on accepting medical intervention, the view of the latter is more likely to prevail due to different perceptions of human dignity. As a result, incapacitated patients in Japanese clinical settings often suffer through extraneous medical procedures, particularly during end-of-life care. Patient dignity is in danger from a national refusal to accept major bioethical principles such as having respect for patient autonomy, serving the best interests of the patient, doing no harm, and ensuring fairness at the end of life. We argue that more education about human dignity and legislation for death with dignity are necessary. Peace of mind for patients during end-of-life care will never be achieved in this society unless drastic changes take place in medical ethics and law. (shrink)

In Japan, few studies and ethical debates have addressed medical futility, but articles suggesting the practice of such treatment exist. The present study aimed to explore attitudes about this by examining personal practical experiences of those who have been involved in judging treatments as futile. We employed a qualitative descriptive design with content analysis of semi-structured and focus group interviews with 11 Japanese physicians and 9 nurses of a university hospital in Japan. The interviews mined their practical experience to identify (...) why they provided treatment that was regarded futile, factors for determining futility, and attitudes toward foregoing futile treatments. All participants had provided treatments judged as futile for various reasons, such as patient request, inadequate decision-making processes, request from another physician, and the lack of standards with which to judge futility, among others. In addition to medical science factors , participants also considered non-medical science factors to determine if a treatment was futile. Almost all participants agreed that futility should be defined and that such treatments should be foregone, but they did not take a proactive stance towards this due to factors related to the healthcare worker‟s situation or the patient. Although the implications of the present study are somewhat limited, our results indicate that futile treatments are provided at multiple treatment departments. Health-care workers employ a variety of factors to determine futility, including non-medical science factors. As provision of such treatment is not always performed for reasons of patient autonomy, diverse approaches should be employed to cope with situations regarding futile treatments. (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)

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)

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.

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)

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)

OBJECTIVES: Life-sustaining treatment at the end of life gives rise to many ethical problems in Japan. Recent surveys of Japanese physicians suggested that they tend to treat terminally ill patients aggressively. We studied why Japanese physicians were reluctant to withhold or withdraw life-support from terminally ill patients and what affected their decisions. DESIGN AND PARTICIPANTS: A qualitative study design was employed, using a focus group interview with seven physicians, to gain an in-depth understanding of attitudes and rationales in Japan regarding (...) medical care at the end of life. RESULTS: Analysis revealed that physicians and patients' family members usually make decisions about life-sustaining treatment, while the patients' wishes are unavailable or not taken into account. Both physicians and family members tend to consider withholding or withdrawing life-sustaining treatment as abandonment or even killing. The strongest reason to start cardiopulmonary resuscitation- and to continue it until patients' family members arrive-seems to be the family members' desire to be at the bedside at the time of death. All physicians participating in our study regarded advance directives that provide information as to patients' wishes about life-sustaining treatment desirable. All expressed concern, however, that it would be difficult to forego or discontinue life-support based on a patient's advance directive, particularly when the patient's family opposed the directive. CONCLUSION: Our group interview suggested several possible barriers to death with dignity and the appropriate use of advance directives in Japan. Further qualitative and quantitative research in this regard is needed. (shrink)

Clinical ethics support, including ethics consultation, has become established in the field of medical practice throughout the world. This practice has been regarded as useful, most notably in the UK and the USA, in solving ethical problems encountered by both medical practitioners and those who receive medical treatment. In Japan, however, few services are available to respond to everyday clinical ethical issues, although a variety of difficult ethical problems arise daily in the medical field: termination of life support, euthanasia and (...) questions about patient autonomy. In light of these conditions, a group of 17 volunteer educators and researchers from the area of biomedical ethics, including the authors, have formed the Clinical Ethics Support and Education Project, and began providing Japan’s first small team clinical ethics consultation service in October, 2006. Members include scholars of biomedical ethics, scholars of philosophy and ethics, legal professionals and legal scholars, nurses and doctors, consisting of five women and 12 men. Consultation teams, made up of a small number of members, were organised each time a request for consultation was received. Over approximately 15 months (October 2006–December 2007), the programme received 22 consultation requests from medical practitioners and medical institutions, and three from the families of patients. In this paper, we will discuss the status of our consultation service and examples of consultation cases we have handled. In addition, we will examine the process of evaluating small team clinical ethics consultation services, as well as the strengths and weakness of such programmes. (shrink)

What should Japanese doctors do when asked by a patient for active voluntary euthanasia, when the family wants aggressive treatment to continue? In this paper, we present the results of a questionnaire survey of 366 Japanese doctors, who were asked how they would act in a hypothetical situation of this kind, and how they would justify their decision, 23% of respondents said they would act on the patient’s wishes, and provided reasons for their view; 54% said they would not practice (...) VE, either because they were opposed to VE as such, or because they believed that the wishes of the patient’s family should be respected.Analysis of these responses yielded the following results: Doctors willing to respect the patient’s wishes defended their decision by highlighting the significance of patient autonomy and the patient’s exclusive ownership of his or her life; doctors unwilling to act on the patient’s wishes fell into two broad categories — those who based their reasoning on the family’s objections, and those who provided other reasons for refusing VE. Respondents who said they would not comply with the patient’s wishes because of family objections provided the following kinds of rationale: doctors have serious responsibilities not only to the patient, but also to the patient’s family; the importance of the family-doctor relationship; fear of lawsuits for murder and related criminal offences; the need for agreement among all those affected by the decision, and the belief that the patient’s life is not his or her own, but the family’s. Respondents who gave non-family centred reasons for not complying with the patient’s wishes pointed to values such as the sanctity of life, or the importance of a natural deathIn the remainder of this paper, we discuss the implications of a family-centred approach to VE. (shrink)

A review of Dretske's Naturalizing the Mind.

Special Issue: The Material Bases of Cognition Guest Editors: Fred Adams · Kenneth Aizawa -/- Compositional Explanatory Relations and Mechanistic Reduction K.L. Theurer 287 -/- Constitution, and Multiple Constitution, in the Sciences: Using the Neuron to Construct a Starting Framework C. Gillett 309 -/- The Mark of the Cognitive F. Adams · R. Garrison 339 -/- Dynamics and Cognition L.A. Shapiro 353 -/- Causal Parity and Externalisms: Extensions in Life and Mind P. Huneman 377 -/- Did I Do That? (...) Brain–Computer Interfacing and the Sense of Agency P. Haselager 405 . (shrink)

In a recent article in this journal (Adams and Aizawa 1992), Fred Adams and Ken Aizawa argued that Jerry Fodor's proposed naturalistic sufficient condition for meaning is unsatisfactory. In this paper, I respond to Adams and Aizawa, noting that (1) they have overestimated the importance of their “pathologies” objection, perhaps as a consequence of misunderstanding Fodor's asymmetric dependency condition, (2) they have misunderstood Fodor's asymmetric dependency condition in formulating their Twin Earth objection, and (3) they have, in (...) addition to under describing their “clear counterexample” to Fodor's proposal, in fact identified a satisfactory Fodorian rejoiner to their objection. I conclude that Fodor's proposal is, for all Adams and Aizawa have shown, adequate as a naturalistic theory of content. (shrink)

In his discussion of results which I (with Michael Hayward) recently reported in this journal, Kenneth Aizawa takes issue with two of our conclusions, which are: (a) that our connectionist model provides a basis for explaining systematicity within the realm of sentence comprehension, and subject to a limited range of syntax (b) that the model does not employ structure-sensitive processing, and that this is clearly true in the early stages of the network''s training. Ultimately, Aizawa rejects both (a) (...) and (b) for reasons which I think are ill-founded. In what follows, I offer a defense of our position. In particular, I argue (1) that Aizawa adopts a standard of explanation that many accepted scientific explanations could not meet, and (2) that Aizawa misconstrues the relevant meaning of structure-sensitive process. (shrink)

The notion of cognitive system is widely used in explanations in cognitive psychology and neuroscience. Traditional approaches define cognitive systems in an agent-relative way, that is, via top-down functional decomposition that assumes a cognitive agent as starting point. The extended cognition movement challenged that approach by questioning the primacy of the notion of cognitive agent. In response, [Adams, F., and K. Aizawa. 2001. The Bounds of Cognition. Oxford, UK: Wiley-Blackwell.] suggested that to have a clear understanding of what a (...) cognitive system is we may need to solve “the demarcation challenge”: the problem of identifying a reliable way to determine which mechanisms that are causally responsible for the production of a certain cognitive process constitute a cognitive system responsible for such process and which ones do not. Recently, [Rupert, R. 2009. Cognitive Systems and the Extended Mind. Oxford: Oxford University Press.] offered a solution based on the idea that the mechanisms that constitute a cognitive system are integrated in a particular sense. In this paper I critically review Rupert’s solution and argue against it. Additionally, I argue that a successful account of cognitive system must accommodate the fact that the neural mechanisms causally responsible for the production of a cognitive process are diachronically dynamic and yet functionally stable. At the end, I offer a suggestion as to how to accommodate this diachronic dynamicity without losing functional stability. I conclude by drawing some implications for the discussion on cognitive ontologies. (shrink)

In "Representations without Rules, Connectionism and the Syntactic Argument'', Kenneth Aizawa argues against the view that connectionist nets can be understood as processing representations without the use of representation-level rules, and he provides a positive characterization of how to interpret connectionist nets as following representation-level rules. He takes Terry Horgan and John Tienson to be the targets of his critique. The present paper marshals functional and methodological considerations, gleaned from the practice of cognitive modelling, to argue against Aizawa's (...) characterization of how connectionist nets may be understood as making use of representation-level rules. (shrink)

In recent years the science-and-religion/spirituality/theology dialogue has flourished, but the impact on the minds of the general public, on society as a whole, has been less impressive. Also, religious believers and outspoken atheists face each other without progressing toward a common understanding. The view taken here is that achieving a more marked impact of the dialogue would be beneficial for a peaceful survival of humanity. I aim to argue the why and how of that task by analyzing three possible purposes (...) of the dialogue and their logical interdependence, suggest conceivable improvements of the quality and extent of the current efforts toward a negotiated action plan, and consider an enlargement of the circle of the actors involved. The dialogue that has been carried on between science and religion/spirituality/theology could be expanded and usefully applied to some major problems in the present world. (shrink)

大阪大学大学院文学研究科が所蔵する、会沢正志斎書簡を活字翻刻。会沢正志斎は、後期水戸学を代表する儒学者の一人。本書簡群は、会沢が、弟子で甥でもある寺門政次郎およびその父喜太平に対して宛てた書簡を主とし 、江戸に滞在していた寺門が水戸の会沢に対して定期的に府下の情報を送り続けた、その返答としての性格をもっている。また、会沢著作の書肆とのやりとりに関する記述が多く存在するのも特徴。緊迫する幕末の情勢と、 そのなかで行われた思想の営為を解明するための一級史料。.

Written by leading researchers in educational and social psychology, learning science, and neuroscience, this edited volume is suitable for a wide-academic readership. It gives definitions of key terms related to motivation and learning alongside developed explanations of significant findings in the field. It also presents cohesive descriptions concerning how motivation relates to learning, and produces a novel and insightful combination of issues and findings from studies of motivation and/or learning across the authors' collective range of scientific fields. The authors provide (...) a variety of perspectives on motivational constructs and their measurement, which can be used by multiple and distinct scientific communities, both basic and applied. (shrink)

There are important ethical issues to be examined before launching any public health intervention, particularly when targeting vulnerable groups. The aim of this article is to identify and discuss ethical concerns that may arise when intervening for health behavior change among adolescents identified as overweight. These concerns originate from an intervention designed to capacitate adolescents to increase self-determined physical activity. Utilizing an ethical framework for prevention of overweight and obesity, we identified three ethical aspects as particularly significant: the attribution of (...) responsibility for health behavior, liberty to choose, and the effect on the participants’ psychosocial well-being. It is discussed whether and how measures can be taken to deal with these aspects. It seems evident that the ethical aspects are mainly concerned with the vulnerability of adolescents identified as overweight. However, we claim that when individual feedback and counseling is provided, tailored interventions have a unique potential to empower adolescents to make ethically anchored decisions about their own health behavior. (shrink)

This paper attempts to argue for the theory-ladenness of evidence. It does so by employing and analysing an episode from the history of eighteenth century chemistry. It delineates attempts by Joseph Priestley and Antoine Lavoisier to construct entirely different kinds of evidence for and against a particular hypothesis from a set of agreed upon observations or (raw) data. Based on an augmented version of a distinction, drawn by J. Bogen and J. Woodward, between data and phenomena it is shown that (...) the role of theoretical auxiliary assumptions is very important in constructing evidence for (or against) a theory from observation or (raw) data. In revolutionary situations, rival groups hold radically different theories and theoretical auxiliary assumptions. These are employed to construct very different evidence from the agreed upon set of observations or (raw) data. Hence, theory resolution becomes difficult. It is argued that evidence construction is a multi-layered exercise and can be disputed at any level. What counts as unproblematic observation or (raw) data at one level may become problematic at another level. The contingency of these constructions and the (un)problematic nature of evidence are shown to be partially dependent upon the scientific knowledge that the scientific community possesses. (shrink)

Sexual objectification, in the broadest terms, involves treating people as things. Philosophers have offered different accounts of what, more precisely, this involves. According to the conjoint view of Catherine Mackinnon and Sally Haslanger, sexual objectification is necessarily morally objectionable. According to Martha Nussbaum, it is not: there can be benign instances of it, in the course of a healthy sexual relationship, for instance. This is taken to be a serious disagreement, both by Nussbaum and by recent commentators such as Lina (...) Papadaki. However it isn't a serious disagreement, for the two theories have different aims and methodology, and are not rivals. They both could be apt, simultaneously. (shrink)