自己決定概念は、患者の自律やインフォームド・コンセント、プライバシー概念等の基礎にあり、生命倫理において核となる重要な概念である。しかし、その歴史的由来について、またその概念の意味するところについて、 これまで本巻のように主題的に扱われることはほとんどなかった。ここでの諸論考は、「自己決定権」や「自律」概念の理解にも大いに役立つはずである。.

In Japan, few studies and ethical debates have addressed medical futility, but articles suggesting the practice of such treatment exist. The present study aimed to explore attitudes about this by examining personal practical experiences of those who have been involved in judging treatments as futile. We employed a qualitative descriptive design with content analysis of semi-structured and focus group interviews with 11 Japanese physicians and 9 nurses of a university hospital in Japan. The interviews mined their practical experience to identify (...) why they provided treatment that was regarded futile, factors for determining futility, and attitudes toward foregoing futile treatments. All participants had provided treatments judged as futile for various reasons, such as patient request, inadequate decision-making processes, request from another physician, and the lack of standards with which to judge futility, among others. In addition to medical science factors , participants also considered non-medical science factors to determine if a treatment was futile. Almost all participants agreed that futility should be defined and that such treatments should be foregone, but they did not take a proactive stance towards this due to factors related to the healthcare worker‟s situation or the patient. Although the implications of the present study are somewhat limited, our results indicate that futile treatments are provided at multiple treatment departments. Health-care workers employ a variety of factors to determine futility, including non-medical science factors. As provision of such treatment is not always performed for reasons of patient autonomy, diverse approaches should be employed to cope with situations regarding futile treatments. (shrink)

Self-compassion, sharing some commonalities with positive psychology 2.0 approaches, is associated with better mental health outcomes in diverse populations, including workers. Due to the COVID-19 pandemic, there is heightened awareness of the importance of self-care for fostering mental health at work. However, evidence regarding the applications of self-compassion interventions in work-related contexts has not been systematically reviewed to date. Therefore, this systematic review aimed to synthesize and evaluate the utility of self-compassion interventions targeting work-related well-being, as well as assess the (...) methodological quality of relevant studies. Eligible articles were identified from research databases including ProQuest, PsycINFO, Science Direct, and Google Scholar. The quality of non-randomized trials and randomized controlled trials was assessed using the Newcastle-Ottawa Scale and the Quality Assessment Table, respectively. The literature search yielded 3,387 titles from which ten studies met the inclusion criteria. All ten studies reported promising effects of self-compassion training for work-related well-being. The methodological quality of these studies was medium. All ten studies recruited workers in a caring field and were mostly conducted in Western countries. The Self-Compassion Scale or its short-form was used in almost all instances. Findings indicate that self-compassion training can improve self-compassion and other work-related well-being outcomes in working populations. However, in general, there is need for greater methodological quality in work-related self-compassion intervention studies to advance understanding regarding the applications and limitations of this technique in work contexts. Furthermore, future studies should focus on a broader range of employee groups, including non-caring professions as well as individuals working in non-Western countries. (shrink)

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)

A psycho-historical framework for the science of art appreciation will be an experimental discipline that may shed new light on the highest capacities of the human brain, yielding new scientific ways to talk about the art appreciation. The recent findings of the contextual information processing in the human brain make the concept of the art-historical context clear for empirical experimentation.

Nevin & Grace's primary argument against theory and research on behavioral momentum is that preference and resistance to change may not covary. The method for evaluating preference and resistance to change seems problematic. Moreover, the theory fails to account convincingly for effects of average overall time to primary reinforcement on choice and preference for unsegmented schedules.

Empirical surveys about medical futility are scarce relative to its theoretical assumptions. We aimed to evaluate the difference of attitudes between laypeople and physicians towards the issue. A questionnaire survey was designed. Japanese laypeople (via Internet) and physicians with various specialties (via paper-and-pencil questionnaire) were asked about whether they would provide potentially futile treatments for end-of-life patients in vignettes, important factors for judging a certain treatment futile, and threshold of quantitative futility which reflects the numerical probability that an act will (...) produce the desired physiological effect. Also, the physicians were asked about their practical frequency and important reasons for futile treatments. 1134 laypeople and 401 (80%) physicians responded. In all vignettes, the laypeople were more affirmative in providing treatments in question significantly. As the factors for judging futility, medical information and quality of life (QOL) of the patient were rather stressed by the physicians. Treatment wish of the family of the patient and psychological impact on patient side due to the treatment were rather stressed by laypeople. There were wide variations in the threshold of judging quantitative futility in both groups. 88.3% of the physicians had practical experience of providing futile treatment. Important reasons for it were communication problem with patient side and lack of systems regarding futility or foregoing such treatment. Laypeople are more supportive of providing potentially futile treatments than physicians. The difference is explained by the importance of medical information, the patient family’s influence to decision-making and QOL of the patient. The threshold of qualitative futility is suggested to be arbitrary. (shrink)

Dai 1-bu. Kindai no tachiage : chishikijintachi -- dai 2-bu. Kindai no katarinaoshi : Watsuji Tetsurō -- dai 3-bu. Nishimura Shigeki bunken kaidai.

Ethics is a device which is produced by the human consciousness to regulate the human behaviour or society in a sound manner. Organisms are manipulated by techniques of molecular biology these days. Then, it is so difficult to recognize the problems of life manipulation by the ethical principle raised by our sensing level. To regulate the society greatly influenced by modern life sciences, it is time to utilize the mechanistic knowledge about organisms as a basic principle of ethics (Molecular ethics). (...) Molecular ethics is not an ethics produced only by the humane logic, but adopts the property of genome operating system (OS) as a core principle clarified by the molecular biology. It is substantiated by life sciences, but is not a simple scientific decision-making means. It promotes scientific experiments with the integrity to knowledge. Scientific knowledges are projections of the rule of life. Molecular ethics is an ethics which seeks for the rules of evolution; i.e. rules for transcending human being. On the other hand, traditional ethics (individual ethics; ethics based on indivisualism) is an ethics which regards present human being as a terminus of evolution. In this respect, this is against the principle of genome OS (system of evolution). Life sciences and technologies has been developing to meet our wants, however, those activities nowadays seem to be against those rules of genome OS. Therefore, it is extremely important for us to consider the ethics applicable for the life manipulation era. (shrink)

A murder case that had some features in common with the Tarasoff case occurred in Sasebo City, Japan, in 2014. A 15-year-old high school girl was murdered and her 16-year-old classmate was arrested on suspicion of homicide. One and a half months before the murder, a psychiatrist who had been examining the girl called a prefectural child consultation centre to warn that she might commit murder, but he did not reveal her name, considering it his professional duty to keep it (...) confidential. Article 134 of the Japanese Criminal Law states that doctors should not disclose patient information obtained in clinical practice without a legitimate reason, but the Japanese Supreme Court has not specified what constitutes a legitimate reason. Mass media and commentators suggested that the murder could have been prevented if the psychiatrist had disclosed the girl's name to the authorities or had isolated her coercively in a psychiatric ward. However, the authors disagree with such claims. This article discusses obligations imposed on concerned individuals and third party members in cases involving ethical dilemmas regarding patient confidentiality and information disclosure. It is concluded that everyone should fulfill their obligations to prevent such tragedies and one should judge the appropriateness of others’ actions based not on the consequences of their actions, but on the processes used to decide on a course of action and their commitment. It is necessary for us to establish a society in which concerned parties can do what they think is ethically best without fearing ungrounded charges. (shrink)

In the issue of futile treatments, patients and healthcare professionals tend to disagree. We conducted an Internet questionnaire survey and explored the Japanese nurses’ attitude toward this topic, comparing with that of laypeople. In total, 522 nurses and 1134 laypeople completed the questionnaire. Nurse respondents were significantly less in favor of providing potentially futile treatments in hypothetical vignettes and stressed quality of life of the patient for judging the futility of a certain treatment. Of them, 85.4% reported having experienced providing (...) such treatments. Reasons for providing them included factors related to not only patients but also healthcare teams. Our results indicate that attitudes among Japanese nurses toward the issue of futile treatments are different from patients and that their actual practice is influenced by several situational factors. (shrink)

Reprinted From Abstracts Of Theses, The University Of Chicago, Humanistic Series, V6, 1927-1928.