Eubios journal of Asian and international bioethics : EJAIB最新文献

Objective: To investigate the knowledge, attitudes and practice of Japanese students regarding brain death and organ transplantation.

Methods: A 22-item questionnaire was handed out among 383 Japanese students during the 2002 academic year. The data was finally analyzed using a statistical package for social sciences, SPSS.

Results: Most students knew that organ transplantation can save a life 97%, while only 38% of the students were aware that there is no treatment for brain dead patients. Overall, 60% of the respondents believed brain death is equal to human death and 63% believed that organ removal from brain dead donors is mutilation of the body. There was a negative association between the students who reported positive attitudes toward the idea that removing an organ is mutilation of the body with their willingness to be a donor. Of the students 27% were opposed to the necessity of family agreement for organ donation. Although 66% expressed their wish to be a donor, less than half of them, 31% had a donor card; and 40% did not even know how to get a donor card.

Conclusion: Granting a veto power to the family as well as the mistaken idea that there is recovery from brain death, can be considered as obstacles to organ procurement from the brain dead in Japan. The high value of life among Japanese society and the willingness to be a donor, bring hope that giving correct medical information and proper public education can increase social acceptance of organ transplantation from the brain dead in Japan.

Why has the law on euthanasia in the Netherlands caused such an upheaval both at home and abroad? In this paper I explore some bioethical issues in the decriminalisation of euthanasia in the Netherlands. The regulatory role of legal and state institutions in the process of decision-making by patients, physicians and other people concerned plays a central role in these discussions. I argue, first, that the limited scope of the Dutch legislation on euthanasia cannot be a solution to end-of-life issues in general, and, second, that it is inadequate as a model for dealing with problems related to 'death-on-request' abroad. Moreover, the confusion around the meaning of the term euthanasia would make its adaptation in other institutional environments capricious. Legal changes in the Netherlands was accompanied by cultural changes, expressed in the use of terms such as individual autonomy and personal choice. In the last section of this article I argue that the social and political environment may be crucial in defining the meaning of free choice. The contending views on the decriminalisation of euthanasia seem to develop as a reaction to change in medical technology in a particular socio-political environment rather than from a unique cultural ethic.

The philosophical and ethical concept of autonomy is herein examined, ex post facto, using an existential lens to examine the process of a personal friend's dying. Anagogy, defined as interpretation of a word, passage, or text that finds beyond the literal, allegorical, and moral senses a fourth and ultimate spiritual or mystical sense, is intended to enlarge the understanding of the use of autonomy in this case. The idea of personhood linked inextricably to reason is, therefore, understood as empowering an individual to choose among various actions, to define and redefine life goals, and to give priority to selected values and moral tenants, which reveal a moral hermeneutic. Conditions and circumstances, existentially exposed, limit choice in unexpected ways, such that the predicted value of autonomy is vulnerable to misuse or misunderstanding. The intent to respect the dignity of every person is central to the philosophy of Respect for Persons ethics, and assumes that autonomy, as freedom of the moral agent, is a moral duty. Implicit reality of freedom is, in a practical sense, essential to being rational agents who can thereby exercise informed choice. The moral law, law of freedom, involves the autonomy of the will and an ultimate end to which all action is directed. Defined as the highest good, morality unites virtue and happiness by ascribing the ultimate end sought as God. The freedom to use rational will finds principles within its own rational nature. The ability to create maxims is autonomy of the will, which equates with the dignity of persons. My recent experience as a companion to a personal friend with a terminal illness inspired me to re-evaluate the concept of autonomy as it is too often interpreted in modern ethical discourse as a individualistic right of choice as opposed to the hermeneutic of dignity of person. This paper describes a shift of position in understanding the paradox of autonomy in this existential context.

This survey on biotechnology and bioethics was carried out on national random samples of the public and scientists in November 2000-January 2000 [sic]throughout Japan, and attendees at the Novartis Life Science Forum held on 29 September 1999 in Tokyo. The sample size was 297, 370, and 74 respectively. While there is a better awareness of GMOs in 2000 compared to 1991; the trend shows an increase in the perceived risks of GMOs followed by growing resistance in Japan. While a majority of persons believed genetic engineering would make life better over the next twenty years (57%), the proportion of respondents who thought genetic engineering would make life worse over the next twenty years doubled from 1997 to 2000 (from 12% to 25%). Respondents were asked whether they had heard about applications in several areas and the order of familiarity (high-low) was: pest-resistant crops, human genes in bacteria, mouse to develop cancer, food and drinks, pigs with human hearts and pre-implantation diagnosis. A divide of opinion can be seen when the results on benefit, risk and moral acceptability of applications of biotechnology by the public are compared to the forum and scientist samples. A significant change in the acceptance of the public occurred in 2000 where only 22% agreed on the moral acceptability of GM food compared to 41% in 1997. In 2000 fewer people said they are willing (20%) to buy genetically modified fruits that taste better compared to 1997 (36%). The results show less public support for use of gene therapy than 1993 and twice as many scientists rejected gene therapy than they did in 1991. When asked who is best placed to regulate modern biotechnology, the respondents were overwhelmingly in favor of international regulatory bodies, such as the United Nations and the World Health Organization (72%), rather than national bodies. The comparison between scientists and public is interesting, however the more enthusiastic sample were participants from the Novaritis Life Science Forum with its mixed occupations.

On the surface, it would appear that patients would welcome the opportunity to relinquish their traditional subordination to doctors in therapeutic decision making, and that doctors would be pleased to have partners with whom to share the burden involved in making such fateful decisions. We investigated the attitudes and practices of patients and physicians towards "patient autonomy" in an outpatient clinic of an internal medicine department prior to the enactment of the Patient's Rights Bill in Israel. There were 81 patients randomly chosen from those attending the study clinic and 21 physicians randomly selected from among the physicians treating them. They were all administered the Krantz, the Abramson Health Index, and the Christie Ethical Decision Making pre-tested questionnaires. They were also queried on demographic and background material. The results indicated that the patient sample was neither particularly interested in participating in medical decision making (average score of 3 out of 9 in the Krantz behavioral involvement sub-scale) nor in receiving medical information (average score of 4 out of 7 in the Krantz preference of information sub-scale). The physicians exhibited a willingness to establish equal relations with their patients, and claimed to prefer their taking an active role in decision making. However, when presented with ethical dilemmas, the physicians were not consistent in their attitude in terms of respecting "patient autonomy." The findings of an Israeli survey conducted three years after the bill's passage showed that only one-third of the studied physicians had read the Israel Medical Association booklet's explaining the new law and most of them claimed that the new law had no affect on their daily encounter with patients, meaning that the law did not affect any change in these physicians' pattern of behavior. We concluded that if the Patient's Rights Bill is to achieve its goals, it will have to be accompanied by a widespread educational campaign to encourage the public to appreciate the value and the importance of the autonomy granted to them, and to guide them in exercising this autonomy to its best advantage. In parallel, the medical profession will need to be aware of the importance of achieving the therapeutic goals while upholding ethical and moral values in health care.