Background Japanese people have become increasingly interested in the expression and enhancement of their individual autonomy in medical decisions made regarding medical treatment at and toward the end of life. However, while many Western countries have implemented legislation that deals with patient autonomy in the case of terminal illness, no such legislation exists in Japan. The rationale for this research is based on the need to investigate patient's preferences regarding treatment at the end of life in order to re-evaluate advance (...) directives policy and practice. Methods We conducted a cross-sectional survey with 418 members of the general middle-aged and senior adults (aged between 40 and 65) in Tokyo, Japan. Respondents were asked about their attitudes toward advance directives, and preferences toward treatment options. Results Over 60% of respondents agreed that it is better to express their wishes regarding advance directives (treatment preferences in writing, appointment of proxy for care decision making, appointment of legal administrator of property, stating preferences regarding disposal of one's property and funeral arrangements) but less than 10% of them had already done so. About 60% of respondents in this study preferred to indicate treatment preferences in broad rather than concrete terms. Over 80% would like to decide treatment preferences in consultation with others (22.2% with their proxy, 11.0% with the doctor, and 47.8% with both their proxy and the doctor). Conclusion This study revealed that many Japanese people indicate an interest in undertaking advance directives. This study found that there is a range of preferences regarding how advance directives are undertaken, thus it is important to recognize that any processes put into place should allow flexibility in order to best respect patients' wishes and autonomy. (shrink)

BackgroundMost medical schools in Japan have incorporated mandatory courses on medical ethics. To this date, however, there is no established means of evaluating medical ethics education in Japan. This study looks 1) To develop a brief, objective method of evaluation for moral sensitivity and reasoning; 2) To conduct a test battery for the PIT and the DIT on medical students who are either currently in school or who have recently graduated (residents); 3) To investigate changes in moral sensitivity and reasoning (...) between school years among medical students and residents.MethodsQuestionnaire survey: Two questionnaires were employed, the Problem Identification Test (PIT) for evaluation of moral sensitivity and a portion of the Defining Issues Test (DIT) for moral reasoning. Subjects consisted of 559 medical school students and 272 residents who recently graduated from the same medical school located in an urban area of Japan.ResultsPIT results showed an increase in moral sensitivity in 4th and 5th year students followed by a decrease in 6th year students and in residents. No change in moral development stage was observed. However, DIT results described a gradual rising shift in moral decision-making concerning euthanasia between school years. No valid correlation was observed between PIT and DIT questionnaires.ConclusionThis study's questionnaire survey, which incorporates both PIT and DIT, could be used as a brief and objective means of evaluating medical students' moral sensitivity and reasoning in Japan. (shrink)

Public satisfaction with policy process influences the legitimacy and acceptance of policies, and conditions the future political process, especially when contending ethical value judgments are involved. On the other hand, public involvement is required if effective policy is to be developed and accepted.

In Japan, discussion concerning advance directives (ADs) has been on the rise during the past decade. ADs are one method proposed to facilitate the process of communication among patients, families and health care providers regarding the plan of care of a patient who is no longer capable of communicating. In this paper, we report the results of the first in-depth survey on the general population concerning the preferences and use of ADs in Japan. A self-administered questionnaire was sent via mail (...) to a stratified random sampling of 560 residents listed in the residential registry of one district of Tokyo, Japan (n = 165,567). Association between correlating factors and specific preferences toward ADs was assessed using contingency table bivariate analysis and multivariate regression model to estimate independent contribution. Of the 560 questionnaires sent out, a total of 425 participants took part in the survey yielding a response rate of 75.9 %. The results of the present study indicate that: 1) the most important components to be addressed are the specifics of medical treatment at the end of life stage and disclosure of diagnosis and prognosis; 2) the majority of participants found it suitable to express their directives by word to family and/or physician and not by written documentation; 3) there is no strong need for legal measures in setting up an AD; 4) it is permissible for family and physician to loosely interpret one's directives; 5) the most suitable proxy is considered to be a family member, relative, or spouse. Multivariate analysis found the following five factors as significantly associated with preferences: 1) awareness regarding living wills, 2) experience with the use of ADs, 3) preferences for end-of-life treatment, 4) preferences for information disclosure, and 5) intentions of creating a will. Written ADs might be useful in the Japanese setting when the individual either wishes: 1) to not provide a lot of leeway to surrogates and/or caregivers, and/or 2) to ensure his or her directives in the cases of terminal illness, brain death, and pain treatment, as well as regarding information disclosure. (shrink)

In 1997, after long social debates, the Japanese government enacted a law on organ transplantation from brain-dead bodies. Since 1993, on gene therapy, administrative agencies have issued a series of guidelines. This study seeks to elucidate when people became aware of the issues and when they formed their opinions on organ transplant and gene therapy. At the same time, it aims to examine at which point in time experts, those in university ethical committees and in academic societies, consider these technologies (...) became accepted among the public. A self-administered questionnaire was sent by mail to a stratified random sampling of 3000 people nationwide in Japan. Another questionnaire was sent both to the member societies of the Japanese Association of Medical Sciences and to the ethical committees of all the medical schools in Japan. Results of the surveys indicated that many of the public remained undecided on the desirability of organ transplant or gene therapy at the time of enactment of official guidelines. A substantial part of them formed their opinions in subsequent periods, especially around the time of first implementation and thereafter. Experts of the academic societies and of the university ethical committees regarded the time of implementation as an important factor in the acceptance of the technologies in society. Since many people formed their opinion during the period of technological implementation, communications efforts to facilitate public understanding of science and technology, as well as to advance practical discussion on policy alternatives in this period can play a key role in determining the fate of technological innovation and ethical debates in medicine. (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)

BackgroundThis study aimed to ask a sample of the general population about their preferences regarding doctors holding discretionary powers in relation to disclosing cancer diagnosis and prognosis.MethodsThe researchers mailed 443 questionnaires to registered voters in a ward of Tokyo which had a socio-demographic profile similar to greater Tokyo's average and received 246 responses (response rate 55.5%). We describe and analysed respondents' attitudes toward doctors and family members holding discretionary powers in relation to cancer diagnoses disclose.ResultsAmongst respondents who wanted full disclosure (...) about the diagnosis without delay, 117 (69.6 %) respondents agreed to follow the doctor's discretion, whilst 111 (66.1 %) respondents agreed to follow the family member's decision. For respondents who preferred to have the diagnosis and prognosis withheld, 59 (26.5 %) agreed to follow the doctor's decision, and 79 (35.3 %) of respondents agreed with following family member's wishes.ConclusionsThe greater proportion of respondents wants or permits disclosure of cancer diagnosis and prognosis. In patients who reveal negative attitudes toward being given a cancer disclosure directly, alternative options exist such as telling the family ahead of the patient or having a discussion of the cancer diagnosis with the patient together with the family. It is recommended that health professionals become more aware about the need to provide patients with their cancer diagnosis and prognosis in a variety of ways. (shrink)

Background In Japan, discussion concerning advance directives (ADs) has been on the rise during the past decade. ADs are one method proposed to facilitate the process of communication among patients, families and health care providers regarding the plan of care of a patient who is no longer capable of communicating. In this paper, we report the results of the first in-depth survey on the general population concerning the preferences and use of ADs in Japan. Method A self-administered questionnaire was sent (...) via mail to a stratified random sampling of 560 residents listed in the residential registry of one district of Tokyo, Japan (n = 165,567). Association between correlating factors and specific preferences toward ADs was assessed using contingency table bivariate analysis and multivariate regression model to estimate independent contribution. Results Of the 560 questionnaires sent out, a total of 425 participants took part in the survey yielding a response rate of 75.9 %. The results of the present study indicate that: 1) the most important components to be addressed are the specifics of medical treatment at the end of life stage and disclosure of diagnosis and prognosis; 2) the majority of participants found it suitable to express their directives by word to family and/or physician and not by written documentation; 3) there is no strong need for legal measures in setting up an AD; 4) it is permissible for family and physician to loosely interpret one's directives; 5) the most suitable proxy is considered to be a family member, relative, or spouse. Multivariate analysis found the following five factors as significantly associated with preferences: 1) awareness regarding living wills, 2) experience with the use of ADs, 3) preferences for end-of-life treatment, 4) preferences for information disclosure, and 5) intentions of creating a will. Conclusions Written ADs might be useful in the Japanese setting when the individual either wishes: 1) to not provide a lot of leeway to surrogates and/or caregivers, and/or 2) to ensure his or her directives in the cases of terminal illness, brain death, and pain treatment, as well as regarding information disclosure. (shrink)

Das Problem der Intersubjektivitiit Intersubjektivität ist Husserl schon seit der Darstellung der Ideen I in Zusammenhang mit dem Problem der phiinomenologischen phänomenologischen Reduk tion sehr stark bewusst und wird, wie die neue VerOffentlichung Veröffentlichung 'Zur Phänome Phiinome nologie der Intersubjektivität'l Intersubjektivitiit'l ausdrücklich ausdrucklich zeigt, zeit seines Lebens in seinem Denken mit mehr oder weniger Intensitiit Intensität behandelt. Bekanntlich hat Husserl Hussed die Einfühlungslehre EinfUhlungslehre in seinem spiiten späten Versuch mit der 'Selbstobjektivation' 'Selbstobjektivation',, 'Selbstauslegung' des absoluten, anonymen, transzen 2 dentalen ego (...) erkliirt. erklärt. Gerade auf diesen Punkt konzentriert sich zutreffende Kritik und zeigt die Unvermeidbarkeit des transzendentalen Solipsismus; was als Grund für fUr echte echte Intersubjektivitiit Intersubjektivität gesucht gesucht wird, wird, niimlich nämlich die die Gleichursprunglich Gleichursprünglich keit keit von von Subjekten, Subjekten, fUhrt führt schliesslich schliesslich auf auf den den Weg der Radikalisierung der trans zendentalen Reduktion und der Erklärung Erkliirung mit der immanenten Zeitigung des transzendentalen ego in die 'einseitige Verlagerung des Gewichts auf ein konsti tuierendes Ur-Ich, dem kein ebenso ursprungliches ursprüngliches Du gegenübersteht, gegeniibersteht,...'3. (shrink)

We propose a new dynamical mechanism for information processing in mind and brain. We emphasize that a hermeneutic process is one of the key processes manifesting the functions of the brain and that it can be formulated as an itinerant motion in ultrahigh dimensional dynamical systems, which may give a new realm of the dynamic information processing. Our discussions are based on the notion of chaotic information processing and the observations of biological chaos.

Im vorliegenden Buch wird das Verhaltnis zwischen den Problematiken der Zeit und des Anderen durchdacht. Die Genese der Zeit wird inhaltlich hinsichtlich der Entwicklung der drei Schichten des Werdeprozesses des Subjekts untersucht. Die erste Schicht wird als die ursprungliche, vor-ichliche Zeitigung durch die Triebintentionalitat zwischen dem Kleinkind und den Eltern angesehen. In der zweiten Schicht wird der Ursprung der messbaren, objektiven Zeitlichkeit und Raumlichkeit durch das Auftreten der aktiven Synthesen des Wahrnehmens, des Sprechens, des Urteilens, des Rechnens usw. intersubjektiv grundgelegt. (...) Dadurch wird die Integration der neurowissenschaftlichen Untersuchung des Bewusstseins durch B. Libet oder jener Spiegelneuronen durch G. Rizzolatti in die genetische Phanomenologie Husserls begrundet. Die dritte Schicht bezieht sich auf den Ursprung der Zeit aus dem Du der Ich-Du-Beziehung beim Erwachsenen. Dabei werden die Ich-Du-Beziehung und die selbstlose, nicht-ichliche Zuwendung zur Welt im Buddhismus in den folgenden Fragestellungen der genetischen Phanomenologie weiter vertieft: zum einen die Frage nach der Entstehung der einzelnen Empfindungsfelder aus der Ursynasthese, zum anderen die nach der Entstehung der Ethik aus dem vorsprachlichen und ubersprachlichen Schweigen der selbstlosen Zuwendung zur Welt. (shrink)

Using the concepts of chaotic dynamical systems, we present an interpretation of dynamic neural activity found in cortical and subcortical areas. The discovery of chaotic itinerancy in high-dimensional dynamical systems with and without a noise term has motivated a new interpretation of this dynamic neural activity, cast in terms of the high-dimensional transitory dynamics among “exotic” attractors. This interpretation is quite different from the conventional one, cast in terms of simple behavior on low-dimensional attractors. Skarda and Freeman (1987) presented evidence (...) in support of the conclusion that animals cannot memorize odor without chaotic activity of neuron populations. Following their work, we study the role of chaotic dynamics in biological information processing, perception, and memory. We propose a new coding scheme of information in chaos-driven contracting systems we refer to as Cantor coding. Since these systems are found in the hippocampal formation and also in the olfactory system, the proposed coding scheme should be of biological significance. Based on these intensive studies, a hypothesis regarding the formation of episodic memory is given. Key Words: Cantor coding; chaotic itinerancy; dynamic aspects of the brain; dynamic associative memory; episodic memory; high-dimensional dynamical systems; SCND attractors. (shrink)

歴史の中で生み出された時代や人々の思想を「事項編」で、個別思想家128人の人と思想を「人物編」で解説し、日本思想史の流れを、わかりやすく鳥瞰する。.

L’avocat japonais a été institué en 1872 à l’image de l’avocat français, au cours du mouvement de modernisation qui a suivi l’ouverture du pays. Mais l’état d’esprit y était et reste celui de la bureaucratie judiciaire. L’avocat n’a obtenu son indépendance qu’en 1949. Malgré les apparences, son rôle ne semble pas suffisamment développé pour permettre à la Justice d’avancer pleinement dans le sens de la protection des droits et libertés. Après avoir dressé un aperçu général de l’évolution et de l’état (...) actuel de la profession d’avocat, nous examinerons la possibilité d’étendre ses fonctions à de nouvelles activités. (shrink)

It has long been thought that transmembrane cell‐surface receptors, such as receptor tyrosine kinases and cytokine receptors, among others, are activated by ligand binding through ligand‐induced dimerization of the receptors. However, there is growing evidence that prior to ligand binding, various transmembrane receptors have a preformed, yet inactive, dimeric structure on the cell surface. Various studies also demonstrate that during transmembrane signaling, ligand binding to the extracellular domain of receptor dimers induces a rotation of transmembrane domains, followed by rearrangement and/or (...) activation of intracellular domains. The paper here describes transmembrane cell‐surface receptors that are known or proposed to exist in dimeric form prior to ligand binding, and discusses how these preformed dimers are activated by ligand binding. (shrink)

To understand the public opinion concerning the genethics in culturally different populations, we conducted two focus groups in Japan, with one focus group each in China and Panama between April 2008 and August 2009. Generally, the participants in Japan were more cautious to disclose their personal thinking in a clear manner. Most participants in China and Panama hoped to have children free from any genetic disease if at all possible. The major difference between China and Panama seems to be whether (...) or not they will accept the issue of genetic abortion. Compared to China and Panama, fewer participants accepted a reprogenetics procedure in Japan. ―A goal of genetic counseling is to reduce the number of patients of genetic disease‖ is supported to a greater degree in China and Panama than in Japan. Most participants in China as well as Panama, and fewer participants in Japan accepted the concept of sharing genetic information with relatives, even though it is useful for preventing a possible genetic risk. The difference of the answers for the questions is depending on the cultural and value diversity in each country, while some of them are related into a paucity of knowing the principle of biogenetics. Education as to medical genetics and the principle of bioethics is most important to make genetics more accessible to the general public. (shrink)

The sense of agency is a basic feature of our subjective experience. Experimental studies usually focus on either its attributional aspects or on its motoric aspects. Here, we combine both aspects and focus on the subjective experience of the time between action and effect. Previous studies [Haggard, P., Aschersleben, G., Gehrke, J., & Prinz, W.. Action, binding and awareness. In W. Prinz, & B. Hommel, Common mechanisms in perception and action: Attention and performance. Oxford: Oxford University Press] have shown a (...) temporal attraction in the perceived times of actions and effects, but did directly not study the relation between them. In three experiments, time estimates of an interval between an action and its subsequent sensory effect were obtained. The actions were either voluntary key press actions performed by the participant or kinematically identical movements applied passively to the finger. The effects were either auditory or visual events or a passive movement induced to another finger. The results first indicated a shortening of the interval between one’s own voluntary action and a subsequent effect, relative to passive movement conditions. Second, intervals initiated by observed movements, either of another person or of an inanimate object, were always perceived like those involving passive movements of one’s own body, and never like those involving active movements. Third, this binding effect was comparable for auditory, somatic and visual effects of action. Our results provide the first direct evidence that agency involves a generalisable relation between actions and their consequences, and is triggered by efferent motor commands. (shrink)

This book, first published in 2002, is a systematic critical overview of German aesthetics from 1750 to the present. It begins with the work of Baumgarten and covers all the major writers on German aesthetics that follow, including Kant, Schiller, Schelling, Hegel, Nietzsche, Heidegger, Gadamer and Adorno. The book offers a clear and non-technical exposition of ideas, placing these in a wider philosophical context where necessary. Such is the importance of German aesthetics that the market for this book will extend (...) far beyond the domain of philosophy to such fields as literary studies, fine art and music. (shrink)

Social epidemiology has made a powerful case that health determined not just by individual-level factors such as our genetic make-up, access to medical services, or lifestyle choices, but also by social conditions, including the economy, law, and culture. Indeed, at the level of populations, evidence suggests that these “structural” factors are thepredominantinfluences on health. Legal scholars in public health, including those in the health and human rights movement, have contended that human rights, laws, and legal practices are powerfully linked to (...) health. Social epidemiology and health-oriented legal scholarship are complementary in their focus and their research needs. Legal scholarship has identified plausible ways in which legal and human rights factors could be influencing health, but empirical evidence has been limited. (shrink)

Social epidemiology has made a powerful case that health determined not just by individual-level factors such as our genetic make-up, access to medical services, or lifestyle choices, but also by social conditions, including the economy, law, and culture. Indeed, at the level of populations, evidence suggests that these “structural” factors are the predominant influences on health. Legal scholars in public health, including those in the health and human rights movement, have contended that human rights, laws, and legal practices are powerfully (...) linked to health. Social epidemiology and health-oriented legal scholarship are complementary in their focus and their research needs. Legal scholarship has identified plausible ways in which legal and human rights factors could be influencing health, but empirical evidence has been limited. (shrink)

Explains the ethical principles of the ancient Greek philosophy known as Stoicism and shows how it can change our understanding of contemporary issues such as environmental sustainability, social justice, and global capitalism.