In Japan, where a prominent gap exists in what is considered a patient’s best interest between the medical and patient sides, appropriate decision-making can be difficult to achieve. In Japanese clinical settings, decision-making is considered an act of choice-making from multiple potential options. With many ethical dilemmas still remaining, establishing an appropriate decision-making process is an urgent task in modern Japanese healthcare. This paper examines ethical issues related to shared decision-making (SDM) in clinical settings in modern Japan from the psychocultural-social (...) perspective and discusses the ideal decision-making process in present Japan. Specifically, we discuss how five psychocultural-social tendencies – “surmise (Sontaku),” “self-restraint (Jishuku),” “air (atmosphere or mood, Kuuki),” “peer pressure (or tuning pressure, Docho-Atsuryoku),” and “community (Seken)”—which have often been referred to as characteristics of present-day Japanese people, may affect the ideal practice of SDM in Japanese clinical settings. We conclude that health care professionals must be aware of the possible adverse effects of the above Japanese psychocultural-social tendencies on the implementation of SDM and attempt to promote autonomous decision-making, thereby allowing patients to make treatment choices that sufficiently reflect their individual and personal views of life, experiences, goals, preferences, and values. (shrink)

Grodzinsky's general approach to the neuroscience of language is interesting, but the evidence currently available has problems with pragmatic infelicity in experiments involving Japanese scrambling and the interpretation of experimental results on Japanese indirect passives. I will suggest a more direct way of testing the Trace-Deletion Hypothesis (TDH).

The famous Japanese novelist offers his personal interpretation of a classic work on samurai ethics, everyday life, and spiritual salvation.

When participants observed a rubber hand being touched, their sense of touch was activated . While this illusion might be caused by multi-modal integration, it may also be related to empathic function, which enables us to simulate the observed information. We examined individual differences in the RHI, including empathic and schizotypal personality traits, as previous research had suggested that schizophrenic patients would be more subject to the RHI. The results indicated that people who experience a stronger RHI might have stronger (...) empathic and schizotypal personalites simultaneously. We discussed these relationships in terms of self-other representations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 20 (2000) 59-69 [Access article in PDF] Buddhist Views on Ritual Pactice Protestant Character of Modern Buddhist Movements Yukio MatsudoUniversity of HeidelbergWhat is the relationship between ritual and ethical activities in Nichiren Buddhism, as practiced in the Soka Gakkai (SG)? SG is a lay Buddhist organization which is, as such, involved extensively in secular affairs, specifically in the field of educational, cultural, social, and peace-promoting programs. (...) The question is, therefore, not at all whether there is a connection of religious practice and ethical activities. Rather it begs an explanation regarding its ideological background. In this respect a further reflection on a metareflection level would be useful to clarify the "modern" character of SG, which may be discussed in relation to Christian Protestantism since it has been regarded as a spiritual background for the formation of modern ethos such as individualism, egalitarianism, and social engagement. Thus, I will depict the fundamental feature of Nichiren Buddhism as "reformative Buddhism," which makes the practice of Buddhism congruent with "modern" understanding of religious roles in daily life as well as social engagement. On the other hand, I will also discuss some problems being inherent to the Western acculturation of the reformed and "engaged Buddhism." 1 The Ethical Activities of the SG in the World Ethical and Social Aspects of the Movement It is generally well known that the lay Buddhist organization, SG, as a whole has initiated wide and multifaceted activities even in an international level in order to transform its religious ideals into social reality, specifically in the field of educational, cultural, social, and peace-promoting programs. For this purpose it established educational institutes ranging from kindergartens to universities as well as research [End Page 59] institutes such as the Institute of Oriental Philosophy (founded 1961), the Boston Research Center for the 21st Century (founded 1993), the Toda Institute for Global Peace and Policy Research (founded 1996), and other centers for ecological researches. For promoting mutual respect and understanding through cultural expressions and exchanges several institutes have been established, like the Min-On Concert Association (founded 1963), the Tokyo Fuji Art Museum (founded 1991), and La Maison Littéraire de Victor Hugo in Bièvre, France (founded 1992). On a global level, its political involvement is, for a large part, situated as a NGO in the frame of the UNO and the UNESCO. With the help of the UNO, SG has organized all over the world expositions translating its concerns for peace, e.g., "Nuclear War: Threat to our World" and "War and Peace." With the Simon Wiesenthal Center it organized an exhibition "The Courage to Remember: Anne Frank and the Holocaust Exhibition." The issue of human rights is another of its major concerns. Commemorating the forty-fifth anniversary of the United Nations' adoption of the Universal Declaration of Human Rights, SG held an exhibition entitled "Toward the Century of Humanity: An Overview of Human Rights in Today's World" at the UN office in Geneva. Also, money received from fund-raising activities has been donated to the Office of the United Nations High Commissioner for Refugees and related agencies to provide medical supplies and food, and to support educational programs in the areas concerned. To expose the horrors of war, SG has also published life histories written by members about their sufferings in war: "Women against War," "Cries for Peace," and "Peace is our Duty." Segmental Differentiation of Organizational Structure To meet the requirements of functional differentiation of today's modern societal life SG is organized in a segmental and hierarchical structure. The basic structure is the regional units, organized in a hierarchical model, and all members are integrated "in each group" in their residence area. At the same time each member belongs to a specific "division" which is organized according to gender, age, and occupation. There are the four divisions of men, women, young men, and young women. Additionally there are divisions for school boys and girls, university students, as well as divisions according to occupation such as artists, lawyers, medical doctors, academics, and so on. These divisional differentiations reflect the need... (shrink)

No laws or official guidelines govern medical assistance for dying in Japan. However, over the past several years, cases of assisted suicide or voluntary euthanasia, rarely disclosed until recently, have occurred in close succession. Inspired by these events, ethical, legal, and social debates on a patient’s right to die have arisen in Japan, as it has in many other countries. Several surveys of Japanese people’s attitudes towards voluntary assisted dying suggest that a certain number of Japanese prefer active euthanasia. Against (...) this background, it is important to discuss voluntary assisted dying cases in Japan and the Japanese views on them and to consider their implications. We review three recent Japanese voluntary assisted dying cases and discuss the various objections to voluntary assisted dying that have been published in response to these in various media outlets. Our counterarguments include the double suffering of people who are unable to give up their desire to die, individuality of death, variability of culture, problem of being an annoyance to (burden on) others, a slippery slope argument supporting voluntary assisted dying, and unfair claims about responsibility and excessive burden on people who are unable to give up their desire to die. We also point out the psychocultural and social problems in Japanese society that these objections reflect, and argue that voluntary assisted dying can be ethically acceptable under certain conditions. We conclude that Japanese society must change in order to enable those who sincerely wish to die to do so in a better way. (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)

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)

Background A baby hatch called the “Stork’s Cradle” has been in place at Jikei Hospital in Kumamoto City, Japan, since May 10, 2007. Babyklappes were first established in Germany in 2000, and there are currently more than 90 locations. Attitudes regarding baby hatches are divided in Japan and neither opinions for nor against baby hatches have thus far been overwhelming. To consider the appropriateness of baby hatches, we present and examine the validity of each major objection to establishing baby hatches. (...) Discussion There are various objections to baby hatches as follows: It violates a child’s right to know the identity of his or her biological parents by allowing anonymous birth; it neglects fulfillment of the biological parents’ basic obligation to raise their child and its very availability induces abandonment of infants; some people abuse it for very selfish reasons; it cannot save babies’ lives; the rights of one parent can be ignored if the other surrenders a child without his or her consent; it puts a baby in medical jeopardy; and it has no clear legal basis. The authors would argue that there are many plausible refutations for each objection mainly based on priority of child’s right to life, pregnant women’s vulnerability and necessity of anonymity, social responsibility to protect and raise children, differences between dropping a child off at a baby hatch and child neglect, limited function of social childcare center, inevitability of abuse by a minority of people, necessary distinction between outcomes that occur only because baby hatches exist and those that occur regardless of their existence, important local direct and upmost measures for women in trouble, and difference between ambiguous legality and illegality. Summary We argue that a certain number of baby hatches should continue to be established as a last resort, in a form that can maintain anonymity if the parent dropping the child off so desires. It should be supported if it is initiated with good intentions; if the maximum possible effort is made at said facility to protect the interests, rights, and safety of the child; and if no clear evidence of harm exists. (shrink)

Free will in intentional consciousness is exposed to skeptics since it was found that subconscious neural activities, what is called readiness potential, precedes the intention to an action. The question of whether free will is an authentic illusion has been argued not only in psychology but physics and philosophy. Most of scientists, however, think that the intentional consciousness who believes to have his/her own free will, is determined by readiness potential in advance, and that free will cannot coexist with determinism. (...) We here point out that knowing to be determined in advance cannot be verified till local event at a local site can be known from a different local site without disturbing the event. That is the assumption of locality. We here show that determinism, free will and locality are three essential elements in consciousness, and show that they constitute trilemma. The fact that one of three elements must be abandoned can lead to three types of consciousness. Absence of free will can constitute type I consciousness which is consistent with symptoms in autism spectrum disorder such as weakened theory of mind. Absence of determinism can constitute type II consciousness which is consistent with symptoms in schizophrenia such as thought insertion, self-other integration. Absence of locality can constitute type III consciousness which is consistent with typical people. We can find the entanglement of intentional consciousness with unconsciousness including readiness potential only in type III consciousness. Finally, we show that sense of agency and free will cannot be established until consciousness as an entanglement is implemented. (shrink)

Floridi’s infosphere consisting of informational reality is estimated and delineated by introducing the new notion of Typ-Ken, an undifferentiated amalgam of type and token that can be expressed as either type or token dependent on contingent ontological commitment. First, we elaborate Floridi’s system, level of abstraction (LoA), model, and structure scheme, which is proposed to reconcile ontic with epistemic structural reality, and obtain the duality of type and token inherited in the relationship between LoA and model. While we focus on (...) the ontological commitment that can negotiate and emphasize the discrepancy between type and token, we show that most research focusing on different hierarchical layers (type and token) has converged onto the flattened perspective of type and token to clarify the role of ontological commitment. We propose the idea of Typ-Ken to avoid this flattening. In addition, we elaborate Taddeo and Floridi’s criticism of approaches to the symbol grounding problem and show that their criticism based on the zero semantical commitment condition is specific to the agents affected by the flattening. We then take bird flocks as a metaphor for the living infosphere as if it had one mind. The knowledge recently yielded by image analysis indicates that it is difficult for previous flock models based on agents equipped with the flattening of local (token) and global (type) to show the special feature of a flock of the scale-free proportion (SFP). We show here that agents based on the Typ-Ken can reveal the SFP, which is the essential characteristic of the living infosphere. In other words, Typ-Ken is an expression for informational reality (LoA and model with ontological commitment) that can reveal seamless local and global interactions in the functioning of a flock or infosphere. (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)

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)

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)

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)

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)