This study examines public health nurses’ perceptions and concerns about the implications of Japan’s new long-term care insurance law concerning care provision for elderly people and their families. Respondents voiced their primary concern about this law as access to services for all elderly people needing care, and defined their major responsibility as strengthening health promotion and illness prevention programmes. Although wanting to expand their roles to meet the health care, social and public policy advocacy needs of elderly persons and their (...) families, respondents also stated their concern for the possible lack of enough resources for this expansion to support family caregivers adequately. They viewed their first function as developing collaborative relationships with local government officials to help to assure sufficient resources to provide the necessary foundation for long-term care programmes to deliver services to all those in need. These concerns fall within the larger ethical issue of distributive justice in a society based on the obligations of the state to citizens and the family to its members, especially elderly relatives, who, according to traditional Japanese values, retain respect. (shrink)

Background: Patients in different countries have different attitudes toward self‐determination and medical information. Little is known how much respect Japanese patients feel should be given for their wishes about medical care and for medical information, and what choices they would make in the face of disagreement. Methods: Ambulatory patients in six clinics of internal medicine at a university hospital were surveyed using a self‐administered questionnaire. Results: A total of 307 patients participated in our survey. Of the respondents, 47% would accept (...) recommendations made by physicians, even if such recommendations were against their wishes; 25% would try to persuade their physician to change their recommendations; and 14% would leave their physician to find a new one. Seventy‐six percent of the respondents thought that physicians should routinely ask patients if they would want to know about a diagnosis of cancer, while 5% disagreed; 59% responded that physicians should inform them of the actual diagnosis, even against the request of their family not to do so, while 24% would want their physician to abide by their family's request and 14% could not decide. One‐third of the respondents who initially said they would want to know the truth would yield to the desires of the family in a case of disagreement. Interpretations: In the face of disagreement regarding medical care and disclosure, Japanese patients tend to respond in a diverse and unpredictable manner. Medical professionals should thus be prudent and ask their patients explicitly what they want regarding medical care and information. (shrink)

What is the communicative value of negative polarity? That is, why do so many languages maintain a stock of special indefinites that occur only in a proper subset of the contexts in which ordinary indefinites can appear? Previous answers include: marking the validity of downward inferences; marking the invalidity of veridical inferences; or triggering strengthening implications. My starting point for exploring a new answer is the fact that an NPI must always take narrow scope with respect to its licensing context. (...) In contrast, ordinary indefinites are notorious for taking wide scope. So whatever other functions NPIs may have, they at least serve as an utterly reliable signal that an indefinite is taking narrow scope. As also proposed in recent work of Kusumoto and Tancredi, I will show that NPIs are only licensed in contexts in which the wide scope construal of an indefinite fails to entail the narrow scope. In other words, weak NPIs occur only in contexts in which taking narrow scope matters for interpretation. Thus one part of the explanation for the ubiquity and robust stability of negative polarity is that it signals scope relations. (shrink)

Next SectionLanguages that are classified as non-Sequence-of-Tense come in more than one variety (e.g., Arregui & Kusumoto 1998): some of these languages allow a past tense in before-clauses while others do not. We propose that some languages have quantificational (existential) tenses, while others have pronominal (referential/bound) tenses. The past tense in before-clauses is ill-formed in a language that has quantificational tenses, because the semantics of before is incompatible with existential quantification over times. A language with pronominal tenses does not (...) have this problem. The pronominal/quantificational tense distinction interacts with the Sequence-of-Tense parameter, providing a general theory of possible and impossible languages. (shrink)