This paper investigates the stabilization and trajectory tracking problem of wheeled mobile robot with a ceiling-mounted camera in complex environment. First, an adaptive visual servoing controller is proposed based on the uncalibrated kinematic model due to the complex operation environment. Then, an adaptive controller is derived to provide a solution of uncertain dynamic control for a wheeled mobile robot subject to parametric uncertainties. Furthermore, the proposed controllers can be applied to a more general situation where the parallelism requirement between the (...) image plane and operation plane is no more needed. The overparameterization of regressor matrices is avoided by exploring the structure of the camera-robot system, and thus, the computational complexity of the controller can be simplified. The Lyapunov method is employed to testify the stability of a closed-loop system. Finally, simulation results are presented to demonstrate the performance of the suggested control. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 37.4 (2003) 107-114 [Access article in PDF] A Comparative Study of Artistic Play and Zoukei-Asobi[Tables] "Artistic Play" and "Zoukei-Asobi" Recently, I found an article in Art Education which led me to believe that "artistic play" is not as popular among North America art educators as it is in Japan. 1 For Japanese art educators, especially at the elementary level, this word is well-known as (...) a key term. In Japanese we say "zoukei-asobi." "Zoukei" means "plastic arts activities" and "Asobi" means "playing." I recognized that the basic concept of "artistic play" has something in common with that of "zoukei-asobi." In this article I will identify this as "J-artistic play." The aim of this essay is to compare the meaning of "J-artistic play" by studying its use in Japan and the United States. The Curriculum Guidelines for Art Education in Japan Before considering J-artistic play, I should explain the national guideline for art education in Japan, since the objectives and contents of J-artistic play are prescribed by this guideline. We have had a national guideline since 1872 though this has changed drastically to resemble the American model after World War II. The subject corresponding to "Visual Art" in the elementary school is "Art and Handicraft (Zuga-Kousaku)." "Zuga" means drawing and painting, "Kousaku" means design and craft. The current guideline is divided into three parts (I-III) as shown in Table 1.The first shows a general goal of art education in the elementary school. The second describes the objectives and contents of each grade. The third indicates some key points of teaching for teachers. In the elementary school the curriculum sequence falls into three steps. The content is divided into the two areas ("Hyougen" and appreciation), and Hyougen is divided further into "artistic play" and "art-making." [End Page 107] [Begin Page 110]I should make some comments on Hyougen. In this guideline, Hyougen is used both as expression and representation. In traditional Japanese aesthetic consciousness, "expression, representation, and decoration" constitute a kind of trinity. The concept of J-artistic play was introduced into the national guidelines for art education in1977. 2 At first, this was available only for grades 1 and 2 in the elementary school, but since 1998 the concept has been extended to grades 1 and 6, as shown in Table 1. About the Property of J-artistic Play The activities in J-artistic play do not refer to any traditional art forms, such as painting, sculpture, or handicraft, nor are they derived from any specific art forms. In fact, the purpose for the introduction of this concept into the national guideline is to protect children from falling into conventional ways of representation as found in the traditional art forms. The promoters of J-artistic play thought that the preconceived ideas found in such existing art forms, such as painting might depress children's spontaneous and free expression. Some concepts from contemporary art, such as performance art, have also influenced J-artistic play.As Eliza Pitri said, "Play is spontaneous and voluntary. It is not obligatory but is freely chosen by the player." Though schooling is compulsory and a student cannot choose it independently, advocates of J-artistic insist that the character of "play" in the school curriculum should be an original and undifferentiated form of learning. One of the advocates of J-artistic play explains the significance of artistic play as an operation of integrated intelligence. 3 Artistic play is different in function from ordinary expressing activities. Ordinary expressing activity works with a blank drawing paper as sterile space, conditioned, virtual...laboratory. Contrarily artistic play works with raw materials, living places, and real environments, and is composed of organized and integrated formative activity by working on the subjects that make conditions for human, objective, and phenomenal interaction. Reorganization of intelligence and the opportunity for acquiring new intelligence are embedded in the activities that work interactively. Here we note that children will learn a reality from the interaction between the person and his... (shrink)

We should seek to justify, from a moral perspective, policies associated with serious and irreversible risks to the health of human beings, their societies, and the environment for these risks may have great impacts on the autonomy of both existing and future persons. The ideal of discursive democracy provides a way of morally justifying such policies to both existing and future persons. It calls for the inclusive, informed, and uncoerced deliberation toward an agreement of both existing and future persons, which (...) can serve as a justificatory basis for such public policies. This agreement best protects their fundamental interests and basic needs, and garners their general acceptance. It does so by upholding their agency in decision-making processes and, more specifically, by counseling a maxim of precaution in their public reasoning. The aim of this maxim is to protect the social and environmental conditions that will enable members of existing and future generations to review and, if necessary, revise decisions made in the past but that impact upon them in the present. Precautionary public reasoning thus serves to uphold the decisional agency of existing and future persons, which is a necessary condition of their democratic involvement in the policies that affect them and thus of their autonomous existence defined by their conceptions of the good. (shrink)

This review analyzes the social perspective of patient safety and how pharmacists should consider these elements when adopting health information technology (HIT) into their practice.

Der Lehrstuhl für Christentumswissenschaft (Kirisutokyōgaku) an der Kaiserlichen Universität Kyoto wurde 1922 als Stiftungslehrstuhl gegründet. Die Gründung der Christentumswissenschaft in Kyoto erfolgte in einer spezifischen bildungspolitischen Konstellation: Es ging um die spannungsreichen Beziehung zwischen staatlichen Hochschulen und den Religionsgemeinschaften sowie um die Ansprüche einer dezidiert nationalen Politik. Der erste Inhaber des Lehrstuhls war einer der prominentesten japanischen Ideenhistoriker und Philosophen, Seiichi Hatano (1877–1950). Für Hatano gab es keinen Unterschied zwischen Theologie und Christentumswissenschaft. Er wandte die historische Methode auf die Forschung (...) zum frühen Christentum an, die er von deutschen Theologen gelernt hatte. Besonders stark hatte ihn die Religionsgeschichtliche Schule beeinflusst. Als Philosoph entwickelte Hatano eine Religionsphilosophie, die auf der Idee der Persönlichkeit basierte. Das starke Interesse am Thema “Persönlichkeit” hatte er auch mit den deutschen Theologen gemeinsam. Andererseits kritisierte Hatano den liberalen Protestantismus in Deutschland scharf. Dennoch wurde seine Haltung, mit der er die Vorgänger und Zeitgenossen “voraussetzungslos” kritisiert hatte, von führenden Vertretern des liberalen Protestantismus in Deutschland angenommen. (shrink)

Many normative political theorists have engaged in the systematic collection and/or analysis of empirical data to inform the development of their arguments over the past several decades. Yet, the approach they employ has typically not been treated as a distinctive mode of theorizing. It has been mostly overlooked in surveys of normative political theory methods and methodologies, as well as by those critics who assert that political theory is too abstracted from actual political contestation. Our aim is to unearth this (...) grounded normative theory (GNT) approach – to identify its definitive practices and highlight its potential significance. We detail four overlapping commitments characteristic of GNT. These include commitments to expanding the comprehensiveness of input for normative arguments through original empirical research and/or analysis, recursivity in the development of normative claims, attentiveness to the systematic inclusion of a range of voices and ways of knowing, and accountability to those engaged by the theorist in empirical contexts. We discuss methodological distinctions within GNT, including between more- and less-solidaristic approaches. We discuss how GNT answers calls for theorists to engage more closely with empirical political dynamics and we consider responses to possible critiques. (shrink)

Why are diagrams sometimes so useful, while other times unhelpful and even misguiding? There are systematic reasons for this. Drawing on modern research in logic, Artificial Intelligence, cognitive psychology, and graphic design, "Semantic Properties of Diagrams and their Cognitive Potentials" shows that diagrams' cognitive functions are rooted in the characteristic ways they carry information about their targets. The analysis leads to an answer for the deeper question of What makes a diagram a diagram?, which is of crucial importance to the (...) foundation of a collective science of diagrams. ". (shrink)

We can easily discriminate self-produced from externally generated sensory signals. Recent studies suggest that the prediction of the sensory consequences of one’s own actions made by forward model can be used to attenuate the sensory effects of self-produced movements, thereby enabling a differentiation of the self-produced sensation from the externally generated one. The present study showed that attenuation of sensation occurred both when participants themselves performed a goal-directed action and when they observed experimenter performing the same action, although they clearly (...) reported that the tones were produced by other during action observation and by themselves during their own action. These results suggest that sensory prediction of action modulates ongoing auditory processing irrespective of who produces the sounds and that the explicit judgment of agency does not necessarily rely on the same mechanisms on which implicit perceptual measures such as sensory attenuation rely. (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)

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)

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)

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)

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)

In everyday medical settings in Japan, physicians occasionally tell an elderly patient that their symptoms are “due to old age,” and there is some concern that patient care might be negatively impacted as a result. That said, as this phrase can have multiple connotations and meanings, there are certain instances in which the use of this phrase may not necessarily be indicative of ageism, or prejudice against the elderly. One of the goals in medical care is to address pain and (...) suffering that develops with age in elderly individuals, and whether or not aging is a disease is inconsequential. However, assuming that an individualized and thorough examination has been performed, there are some conditions that can be attributed only to age. Accordingly, physicians must acknowledge the merits and drawbacks of using the phrase “due to old age,” and exercise caution when using it. Both physicians and their elderly patients must share a common awareness of the incomplete and limited nature of modern medicine and its scope, and physicians must help their elderly patients accept and live with the aging phenomenon. (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)

ABSTRACT Objectives: the purpose of this study is to explore laypersons’ attitudes towards and experiences of medical research, and to compare them with those of physicians in Japan. Designs and Participants: fourteen Japanese adults from the general public and seven physicians participated in one of three focus interviews. Setting: Osaka, Japan. Results: trust and distrust in the physician by whom the participants were invited to participate in research played a considerable role in their decisions about participation. That the participants felt (...) an obligation to participate was also expressed. The lay participants perceived medical research as something entirely outside of their world. A greater willingness to volunteer for research was expressed if there were direct benefits to themselves or their families. Research methods such as use of placebos, double blinds, and randomisations seemed to cause negative attitudes to medical research. All physicians were convinced of the need for medical research, including double‐blinded randomised control trials, and its significant role in medical progress. Most physicians thought that the greater awareness of the need for medical research in the community and a better understanding of the psychology of potential research participants were necessary and urgent. Conclusions: there is a good possibility that the lay public and medical professionals have sharply different beliefs about and attitudes towards every aspect of medical research. Building up a better and equal patient‐doctor relationship based on trust is a key issue in medical research, and it is mandatory to fill the gap in perception regarding medical research between them through fully informed debates. (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)

Semantic studies on diagrammatic notations (Barwise & Etchemendy, ; Shimojima, ; Stenning & Lemon, ) have revealed that the “non-deductive,” “emergent,” or “perceptual” effects of diagrams (Chandrasekaran, Kurup, Banerjee, Josephson, & Winkler, ; Kulpa, ; Larkin & Simon, ; Lindsay, ) are all rooted in the exploitation of spatial constraints on graphical structures. Thus, theoretically, this process is a key factor in inference with diagrams, explaining the frequently observed reduction of inferential load. The purpose of this study was to examine (...) the empirical basis for this theoretical suggestion, focusing on the reality of the constraint-exploitation strategy in actual practices of diagrammatic reasoning. Eye movements were recorded while participants used simple position diagrams to solve three- or four-term transitive inference problems. Our experiments revealed that the participants could exploit spatial constraints on graphical structures even when (a) they were not in the position of actually manipulating diagrams, (b) the semantic rule for the provided diagrams did not match their preferences, and (c) the constraint-exploitation strategy invited a partly adverse effect. These findings indicate that the hypothesized process is in fact robust, with the potential to broadly account for the inferential advantage of diagrams. (shrink)

Eye contact plays a critical role in many aspects of face processing, including the processing of smiles. We propose that this is achieved by a subcortical route, which is activated by eye contact and modulates the cortical areas involve in social cognition, including the processing of facial expression. This mechanism could be impaired in individuals with autism spectrum disorders.

In medical ethics, an appropriate national healthcare system that meets the requirements of justice in healthcare resource allocation is a major concern. Japan is no exception to this trend, and the pros and cons of introducing a two-tier healthcare system, which permits insured medical care services to be provided along with services not covered by social health insurance, have been the subject of debate for many years. The Supreme Court ruled in 2011 that it was valid for the government to (...) ban mixing medical treatments and both the Ministry of Health, Labour and Welfare and Japanese Medical Association oppose the introduction of such a system. In this paper, we examine the main arguments against the introduction of a two-tier healthcare system and ideas that form their basis, which can be broadly divided into opinions based on the importance of equality and those derived from the logical conclusion that the outcomes would be detrimental. We point out issues and shortcomings of each standpoint and argue that the introduction of the system would not necessarily threaten equality and social solidarity in Japanese society, and that abuses of a self-pay tier would be controllable to a certain extent. Then, the authors—who do not actively promote the introduction of a two-tier healthcare system—conclude that the allegation that is completely devoted to one side and the theory that social healthcare is collapsing, which makes the public excessively nervous, cannot be accepted. (shrink)

Self-determination is a central concept in the field of bioethics and the most critical decision among the myriad of decisions concerning medical care is the decision to choose to die; “self-determination of death.” The purpose of this paper is to clarify the basic positions on self-determination of death held by present Japanese people and we tentatively sorted these positions into 10 arguments. We discuss the problems and implications of these positions revealed within our present review and conclude that a society (...) needs to deny unnecessary intrusion and tolerance for different views might be a keyword in our oncoming society. (shrink)

ABSTRACT In this brief article, we examine the document entitled Universal Draft Declaration on Bioethics and Human Rights, published by UNESCO in June 2005. We examine it in terms of its content and its appropriate role in global bioethics movements in the future. We make clear our view on the Declaration: the Declaration, despite a variety of serious problems, remains a valuable bioethical document and can contribute in substantial ways to the happiness of people throughout the world.

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)

In recent years, the global need for clinical ethics consultation services (CECS) has increased to address ethical challenges, dilemmas, and moral distress in clinical environments. In Japan, many hospitals have introduced CECS over the past decade, but few such services work effectively because of the small number of consultations. To address this, we propose two proactive ethics consultation methods: inter-professional ethics rounds and patient note reviews. This paper provides a detailed explanation of these methods, complete with scenarios based on actual (...) cases. These methods can make CECS ‘well-functioning’ by shifting the starting points of consultation from consultees to CECS providers. We then examine the impact and value of proactive ethics consultation as well as four critical factors for its success including attitude, positioning, and competency of proactive consultation teams. We believe our suggestions will provide valuable insights for future clinical ethics consultations and stimulate academic debate about what constitutes a ‘well-functioning’ CECS. (shrink)

In Japan, although various arguments exist regarding the appropriateness of the death penalty, nationwide public opinion polls regarding the death penalty revealed that 85.6% of respondents supported maintaining the death penalty in 2009. Under these circumstances, it is worthwhile to deliberate the ethical and social issues surrounding the death penalty as depicted in Japanese films from medical humanities perspectives. In the present paper, we discuss two recent films concerning the death penalty, 13 kaidan directed by Masahiro Nagasawa, 2005 and Kyuka (...) directed by Hajime Kadoi, 2007. The two films describe the impact of execution on the executioners, secrecy of executions, rehearsal of the execution, and voluntary participation in execution. They depict the current situation surrounding the death penalty and execution, as well as everyday life on death row, in detail. Serious concerns about current execution procedures were also described. The two films seem to try to tell the audience that there is something strange in killing people in perfect order with good will in the name of law and justice. They show the officer‘s instinctive aversion provoked by the execution and make us think about what it means to kill a human. (shrink)

This article will focus on issues concerning the provision of artificial nutrition and hydration to patients who are extremely old, completely bedridden, and totally dependent on others. These patients have no advance directives, no malignancy, suffer from persistent but unstable disturbance of consciousness as well as severe cognitive impairment, and cannot eat sufficient amounts of food to maintain their lives. Should ANH be provided? Some would agree while others would maintain otherwise. The underlying values and normative theory behind each argument (...) are quite different. In this paper, I will present opinions, comments, and arguments concerning the provision of PANH to such patients and examine each using the Takahashi‘s three levels structure analysis. Utilitarianism is a fitting ethical theory for the third level in arguments against the provision of PANH to patients in question, and the non-religious sanctity of life doctrine covers the opposite position. (shrink)

In the Japanese clinical setting, informed consent has not been well adopted although the idea is no longer novel and the bioethics movement is well known. There are several barriers to informed consent in Japan.It is possible that both patients and physicians do not know the idea or misunderstand it. Some may think that informed consent can be obtained from a patient who does not know his or her diagnosis or from family members of a competent patient. Because of no (...) history to develop informed consent, the ethical principle of patient self-determination can be lost in Japan. Paternalistic physicians and protective family members would counteract informed consent and try to make medical decisions to promote their patients' well being independent of their wishes and values. Dependent attitudes of some patients who never ask medical information and expect their physicians to consider all they need would make the idea of self-determination irrelevant in Japan. (shrink)

No matter how far medicine advances, incurable disease will inevitably exist; and the dying patient's last resort will likewise look to medical research. In this report, we examine a case concerning the use of experimental medical therapy on a critically ill child. We discuss the ethical argument pertaining to the recommending of experimental medical therapy to the family of a dying patient.Under the circumstances of having to face the impending death of one's own child, parents of a terminally ill child (...) are extremely vulnerable to suggestion and often loose the ability to make a composed decision._Moreover, there exists the possibility of not only patients, but also medical staff and researchers, to fall into therapeutic misconception. Likewise, for the terminal patient and his/her family though, experimental medical therapy is often the only hope, which is, however, always accompanied by a factor of uncertainty and is considered to be merely an unapproximated gamble. The proposing of experimental medical therapy can result in being cruel by shattering the parent's expectations of saving their child._We examine the issues involved in proposing an experimental medical therapy to patients who are in dire need of a last hope; and conclude that, in times of emergency, we must take great consideration in recommending an experimental medical therapy as an "innovative treatment." In extreme circumstances where an individual's life is on the line, doing nothing can be quite trying; yet, what is right is not necessarily doing something, but rather making the right decision. (shrink)