BackgroundHealthcare professionals use the ethics of justice and care to construct moral reasoning. These ethics are conflicting in nature; different value systems and orders of justice and care are applied to the cause of actual moral conflict. We aim to clarify the structure and factors of healthcare professionals’ moral conflicts through the lens of justice and care to obtain suggestions for conflict resolutions.MethodSemi-structured interviews about experiences of moral conflict were conducted with Japanese nurses recruited using the snowball sampling method. Interviews (...) were conducted based on the real-life moral conflict and choice interview. Interviews were recorded and transcribed verbatim, then analyzed based on the interpretive method of data analysis. Verbatim transcripts were read four times, first to get an overall sense of the conflict, then to understand the person’s thoughts and actions that explain the conflict, and third and fourth to identify perspectives of justice and care, respectively. Each moral perspective was classified into categories according to Chally’s taxonomy.ResultsAmong 31 responses, 2 that did not mention moral conflict were excluded, leaving 29 responses that were analyzed. These responses were classified into six cases with conflict between both justice and care perspectives or within one perspective, and into two cases without conflict between perspectives. The “rules” category of justice and the “welfare of others” category of care were included in many cases of conflict between two perspectives, and they frequently occurred in each perspective.ConclusionsThe nurses in this study suggest that they make moral judgments based on moral values that are intertwined with justice and care perspectives complex manner.Organizational, professional, and patient-related factors influenced conflicts between justice and care. Additionally, multiple overlapping loyalties created conflicts within justice perspectives, and multifaceted aspects of care-provider’s responsibility and patient need created conflicts within care. Decision-making biased towards one perspective can be distorted. It is important to consider ethical issues from both perspectives to resolve conflicts, especially the effective use of the ethics of care is recommended. (shrink)

This study aimed to: (1) develop and evaluate the Moral Distress Scale for Psychiatric nurses (MDS-P); (2) use the MDS-P to examine the moral distress experienced by Japanese psychiatric nurses; and (3) explore the correlation between moral distress and burnout. A questionnaire on the intensity and frequency of moral distress items (the MDS-P: 15 items grouped into three factors), a burnout scale (Maslach Burnout Inventory — General Survey) and demographic questions were administered to 391 Japanese psychiatric nurses in 2007—2008. These (...) nurses experienced relatively low levels of moral distress despite the fact that they were commonly confronted by morally distressing situations. All the circumstances in which the participants experienced moral distress were included in the ‘low staffing’ factor, which reflects the characteristics of Japanese psychiatric care. The frequency score of the low staffing factor was a significant predictor of burnout. (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)

La présente étude se propose d’examiner la conception tout à fait originale de Bentham concernant une éducation démocratique fondée sur des intellectuels qui visent à établir une société libérale, contrairement à l’éducation civique d’aujourd’hui. Tout d’abord, j’examine les recherches récentes sur l’éducation civique, qui sont liées à un tournant délibératif, en montrant en quoi elles diffèrent des objectifs que Bentham s’assignait pour l’éducation. Ensuite, en évoquant l’évolution des travaux de recherche concernant les relations entre Bentham et Foucault, je souligne que (...) Foucault appréhendait l’aspect démocratique du panoptique de Bentham et le liait à la gouvernementalité libérale. En troisième lieu, j’analyse les idées de Bentham sur l’éducation. Cette analyse comprend deux volets : ses idées concernant l’éducation de bons citoyens dotés d’intelligence, et sa conception de l’éducation comme expérimentation. Bentham considérait l’éducation intellectuelle de l’école chrestomatique comme une protection contre les illusions pernicieuses. Les idées de Bentham sur l’éducation, d’une part, visaient à favoriser l’émergence de bons citoyens pouvant participer au Tribunal de l’opinion publique, et de dirigeants compétents ayant les qualités intellectuelles voulues pour diriger ou suivre l’opinion publique. D’autre part, Bentham souhaitait ardemment que l’éducation fût une expérimentation destinée à établir une société libérale entièrement recréée depuis ses fondements. Il exprima ce souhait dans la dernière partie de ses lettres sur Le Panoptique, qui traitait de l’application des principes du panoptique aux écoles et de son plan de contrôle des pauvres. Afin de réformer la société existante gouvernée par un petit nombre de dirigeants uniquement soucieux de leurs intérêts dévoyés, il chercha à promouvoir la publicité et l’éducation intellectuelle pour contrer cette mauvaise gestion. Si, par contre, la société pouvait être établie de manière idéale dès ses débuts, alors une société entièrement nouvelle pourrait émerger sur la base des principes utilitaristes, qui donneraient corps à l’identification artificielle des intérêts entre chaque individu et l’ensemble de la communauté. La pensée éducative de Bentham était une entreprise à double face, qui s’adressait à la fois au présent et à l’avenir. (shrink)

There are two ways of preventing induced cellular mutagenesis. In the first, mutagens are inactivated by ‘desmutagens’ before they can attack the DNA. In the second, ‘bio‐antimutagens’ interfere with cellular fixation processes working on damage in DNA. Examples of modes of action are shown for these inhibitors of induced mutations and implications for reducing genetic damage in man are discussed.

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 (Type 1), patient interest-oriented factor (Type 2), family preference-oriented factor (Type 3), and balanced patient/family preference-oriented factor (Type 4). 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)

On April 5 2000, the Diet elected Yoshiro Mori as Japan's 55th prime minister. His predecessor, Keizo Obuchi, had suffered a stroke and became unable to carry out his official responsibility. Mori, who was the former Secretary General of the ruling Liberal Democratic Party (LDP), inherited the three party coalition between the LDP, the new Komei Party and the Conservative Party, and reappointed all of Obuchi's cabinet members. Yohei Kono was reposted as the Minister of Foreign Affairs; Hideo Usui as (...) Justice; Kiichi Miyazawa as Finance; Hirofumi Nakasone as Education, Science and Technology; Yuya Niwa as Health and Welfare; Tokuichiro Tanazawa as Agriculture, Forestry and Fisheries; Takeshi Fukaya as International Trade and Industry; Toshihiro Nikai as Transport; Eita Yashiro as Posts and Telecommunications; Takamori Makino as Labor; Masaaki Nakayama as Construction; Kosuke Hori as Home Affairs, Mikio Aoki as Chief Cabinet Secretary; Kunihiro Tsuzuki as Management and Coordination; Tsutomu Kawara as Defense; Taichi Sakaiya as Economic Planning; Kayoko Shimizu as environment; and Sadakazu Tanigaki as Financial Reconstruction. (shrink)