Background Japanese people have become increasingly interested in the expression and enhancement of their individual autonomy in medical decisions made regarding medical treatment at and toward the end of life. However, while many Western countries have implemented legislation that deals with patient autonomy in the case of terminal illness, no such legislation exists in Japan. The rationale for this research is based on the need to investigate patient's preferences regarding treatment at the end of life in order to re-evaluate advance (...) directives policy and practice. Methods We conducted a cross-sectional survey with 418 members of the general middle-aged and senior adults (aged between 40 and 65) in Tokyo, Japan. Respondents were asked about their attitudes toward advance directives, and preferences toward treatment options. Results Over 60% of respondents agreed that it is better to express their wishes regarding advance directives (treatment preferences in writing, appointment of proxy for care decision making, appointment of legal administrator of property, stating preferences regarding disposal of one's property and funeral arrangements) but less than 10% of them had already done so. About 60% of respondents in this study preferred to indicate treatment preferences in broad rather than concrete terms. Over 80% would like to decide treatment preferences in consultation with others (22.2% with their proxy, 11.0% with the doctor, and 47.8% with both their proxy and the doctor). Conclusion This study revealed that many Japanese people indicate an interest in undertaking advance directives. This study found that there is a range of preferences regarding how advance directives are undertaken, thus it is important to recognize that any processes put into place should allow flexibility in order to best respect patients' wishes and autonomy. (shrink)

In 1997, after long social debates, the Japanese government enacted a law on organ transplantation from brain-dead bodies. Since 1993, on gene therapy, administrative agencies have issued a series of guidelines. This study seeks to elucidate when people became aware of the issues and when they formed their opinions on organ transplant and gene therapy. At the same time, it aims to examine at which point in time experts, those in university ethical committees and in academic societies, consider these technologies (...) became accepted among the public. A self-administered questionnaire was sent by mail to a stratified random sampling of 3000 people nationwide in Japan. Another questionnaire was sent both to the member societies of the Japanese Association of Medical Sciences and to the ethical committees of all the medical schools in Japan. Results of the surveys indicated that many of the public remained undecided on the desirability of organ transplant or gene therapy at the time of enactment of official guidelines. A substantial part of them formed their opinions in subsequent periods, especially around the time of first implementation and thereafter. Experts of the academic societies and of the university ethical committees regarded the time of implementation as an important factor in the acceptance of the technologies in society. Since many people formed their opinion during the period of technological implementation, communications efforts to facilitate public understanding of science and technology, as well as to advance practical discussion on policy alternatives in this period can play a key role in determining the fate of technological innovation and ethical debates in medicine. (shrink)

Public satisfaction with policy process influences the legitimacy and acceptance of policies, and conditions the future political process, especially when contending ethical value judgments are involved. On the other hand, public involvement is required if effective policy is to be developed and accepted.

BackgroundMost medical schools in Japan have incorporated mandatory courses on medical ethics. To this date, however, there is no established means of evaluating medical ethics education in Japan. This study looks 1) To develop a brief, objective method of evaluation for moral sensitivity and reasoning; 2) To conduct a test battery for the PIT and the DIT on medical students who are either currently in school or who have recently graduated (residents); 3) To investigate changes in moral sensitivity and reasoning (...) between school years among medical students and residents.MethodsQuestionnaire survey: Two questionnaires were employed, the Problem Identification Test (PIT) for evaluation of moral sensitivity and a portion of the Defining Issues Test (DIT) for moral reasoning. Subjects consisted of 559 medical school students and 272 residents who recently graduated from the same medical school located in an urban area of Japan.ResultsPIT results showed an increase in moral sensitivity in 4th and 5th year students followed by a decrease in 6th year students and in residents. No change in moral development stage was observed. However, DIT results described a gradual rising shift in moral decision-making concerning euthanasia between school years. No valid correlation was observed between PIT and DIT questionnaires.ConclusionThis study's questionnaire survey, which incorporates both PIT and DIT, could be used as a brief and objective means of evaluating medical students' moral sensitivity and reasoning in Japan. (shrink)

Background Ethics committees and their system of research protocol peer-review are currently used worldwide. To ensure an international standard for research ethics and safety, however, data is needed on the quality and function of each nation's ethics committees. The purpose of this study was to describe the characteristics and developments of ethics committees established at medical schools and general hospitals in Japan. Methods This study consisted of four national surveys sent twice over a period of eight years to two separate (...) samples. The first target was the ethics committees of all 80 medical schools and the second target was all general hospitals with over 300 beds in Japan (n = 1457 in 1996 and n = 1491 in 2002). Instruments contained four sections: (1) committee structure, (2) frequency of annual meetings, (3) committee function, and (4) existence of a set of guidelines for the refusal of blood transfusion by Jehovah's Witnesses. Results Committee structure was overall interdisciplinary. Frequency of annual meetings increased significantly for both medical school and hospital ethics committees over the eight years. The primary activities for medical school and hospital ethics committees were research protocol reviews and policy making. Results also showed a significant increase in the use of ethical guidelines, particularly those related to the refusal of blood transfusion by Jehovah's Witnesses, among both medical school and hospital ethics committees. Conclusion Overall findings indicated a greater recognized degree of responsibilities and an increase in workload for Japanese ethics committees. (shrink)

Compared to institutional and area-based ethics committees, little is known about the structure and activities performed by ethics committees at national medical organizations and societies. This five year follow-up study aimed to determine (1) the creation and function of ethics committees at medical organizations in Japan, and (2) their general strategies to deal with ethical problems. The study sample included the member societies of the Japanese Association of Medical Sciences (n=92 in 1998, n=96 in 2003). Instruments consisted of two sections: (...) (1) the structure, function and activities of ethics committees, and (2) the strategies for dealing with ethical problems. Response rates were 84.4% in 1998 and 64.4% in 2003. Findings showed a significant increase of ethics committees at medical organizations between 1998 (25.6%) and 2003 (50.0%). Members were mostly male, medical doctors in clinical or basic medicine, and members of the organization. The major functions of ethics committees were ethical reviews of research protocols, policy making and ethical reviews of manuscripts submitted for journal publication. Among organizations that did not have an ethics committee, a significant decrease was found in organizations that replied that they had never experienced an ethical problem which needed further investigation (p<0.01). Findings suggested an overall rise in awareness of the importance of ethical issues and also highlighted an increase in recognition of responsibility regarding ethical problems. (shrink)

Background In Japan, discussion concerning advance directives (ADs) has been on the rise during the past decade. ADs are one method proposed to facilitate the process of communication among patients, families and health care providers regarding the plan of care of a patient who is no longer capable of communicating. In this paper, we report the results of the first in-depth survey on the general population concerning the preferences and use of ADs in Japan. Method A self-administered questionnaire was sent (...) via mail to a stratified random sampling of 560 residents listed in the residential registry of one district of Tokyo, Japan (n = 165,567). Association between correlating factors and specific preferences toward ADs was assessed using contingency table bivariate analysis and multivariate regression model to estimate independent contribution. Results Of the 560 questionnaires sent out, a total of 425 participants took part in the survey yielding a response rate of 75.9 %. The results of the present study indicate that: 1) the most important components to be addressed are the specifics of medical treatment at the end of life stage and disclosure of diagnosis and prognosis; 2) the majority of participants found it suitable to express their directives by word to family and/or physician and not by written documentation; 3) there is no strong need for legal measures in setting up an AD; 4) it is permissible for family and physician to loosely interpret one's directives; 5) the most suitable proxy is considered to be a family member, relative, or spouse. Multivariate analysis found the following five factors as significantly associated with preferences: 1) awareness regarding living wills, 2) experience with the use of ADs, 3) preferences for end-of-life treatment, 4) preferences for information disclosure, and 5) intentions of creating a will. Conclusions Written ADs might be useful in the Japanese setting when the individual either wishes: 1) to not provide a lot of leeway to surrogates and/or caregivers, and/or 2) to ensure his or her directives in the cases of terminal illness, brain death, and pain treatment, as well as regarding information disclosure. (shrink)

Background This study aimed to ask a sample of the general population about their preferences regarding doctors holding discretionary powers in relation to disclosing cancer diagnosis and prognosis. Methods The researchers mailed 443 questionnaires to registered voters in a ward of Tokyo which had a socio-demographic profile similar to greater Tokyo's average and received 246 responses (response rate 55.5%). We describe and analysed respondents' attitudes toward doctors and family members holding discretionary powers in relation to cancer diagnoses disclose. Results Amongst (...) respondents who wanted full disclosure about the diagnosis without delay, 117 (69.6 %) respondents agreed to follow the doctor's discretion, whilst 111 (66.1 %) respondents agreed to follow the family member's decision. For respondents who preferred to have the diagnosis and prognosis withheld, 59 (26.5 %) agreed to follow the doctor's decision, and 79 (35.3 %) of respondents agreed with following family member's wishes. Conclusions The greater proportion of respondents wants or permits disclosure of cancer diagnosis and prognosis. In patients who reveal negative attitudes toward being given a cancer disclosure directly, alternative options exist such as telling the family ahead of the patient or having a discussion of the cancer diagnosis with the patient together with the family. It is recommended that health professionals become more aware about the need to provide patients with their cancer diagnosis and prognosis in a variety of ways. (shrink)

Cet article se demande si un dialogue entre la civilisation chinoise et Leo Strauss est possible et à quelles conditions. Il décrit le contexte d’introduction de Strauss en Chine, en se concentrant sur Liu Xiaofeng, l’un des straussiens les plus influents de la Chine contemporaine. L’analyse de son interprétation de la critique straussienne de la modernité occidentale fait ressortir deux distorsions fondamentales : là où Strauss considérait l’« enseignement tyrannique » comme quelque chose de théorique, Liu en fait un plan (...) d’action politique ; au lieu de reconnaître la modernité des bases idéologiques de l’État fondé par Mao Zedong, il les interprète au crible de la tradition. Cette double déformation contredit l’intention de Strauss en tant que philosophe zététique et socratique. (shrink)

It is well known that the Neo-Confucian thinker Zhu Xi particularly emphasizes the role of emotions in human life. This paper shows that the four ‘moral emotions’ are central to Zhu's thinking, insofar as only their genuine actualization enables the individual to achieve spiritual freedom. Moreover, I discuss the crucial notions of ‘awareness’/‘perception’ and ‘knowledge’/‘wisdom’, in order to reveal the complex dynamic that moral emotions are said to create in the moral agent. I also analyse two important passages from the (...) Mencius and examine how Zhu Xi, in his exegetical glosses, defines the conditions of virtuous agency as based on the moral emotions. Finally, I explain the reasons why Neo-Confucians like Zhu Xi have sometimes been described as Kantian thinkers avant la lettre. (shrink)

This paper engages with the longstanding debate over whether being exposed to a risk of harm amounts to harm itself (what I call ‘risk-harm’). The dominant view has been that those exposed to risks of harm do not suffer harm. In this paper, I defend the widely unpopular subjectivist account of risk-harm – according to which those exposed to unwanted risks of harm can suffer harm – against prominent objections that have been levied against it. The first section sets out (...) to renew and strengthen the appeal of the account in light of recent developments in the surrounding literature. The second section defends the account against arguably its most formidable objection, namely the claim that there is no such thing as risk-harm. The third section wraps up by parrying some prominent general objections, which highlight potentially undesirable upshots to accepting the existence of risk-harm. (shrink)

This paper defends what I call the ‘wellbeing conception of harm’, according to which the relevant criterion for determining whether one has suffered harm is whether they have been made worse off in terms of their wellbeing. Firstly, I explain why it is that one might find the wellbeing conception of harm appealing to begin with. Then, I respond to two sets of concerns that have been levied against the wellbeing conception of harm. The first set of concerns relate to (...) the implausible moral/political consequences that would allegedly follow from adopting the wellbeing conception of harm. The second set of concerns challenge the practical significance of adopting the wellbeing conception of harm. I conclude with some remarks on how the wellbeing conception of harm can help to answer, or at least navigate, some controversial issues related to harm. (shrink)

In recent years, there has been a growing jurisprudential and philosophical literature on the concept of harm, in particular, what it means to suffer harm. This paper defends the most unpopular acc...

Whereas previous research on ego depletion and ethics suggests that employees who are depleted of their self-control resources are more likely to engage in unethical behavior, our current research focuses on how observers perceive and react to depleted employees’ unethical behavior. Integrating ego depletion and attribution theories, we hypothesize and find that observers judge depleted employees’ unethical behavior more leniently than non-depleted employees as a result of lower levels of perceived intentionality. These perceptions in turn lead to lower levels of (...) punishment. Results further suggest that not all types of depletion lead to the same effects on observers’ lenient moral judgments—depletion due to externally imposed reasons are more likely to result in lenient moral judgment, compared to depletion due to internally imposed reasons. (shrink)

Posing the question ‘How diverse is philosophy of education in the West?’ this paper responds to two recent defences of African philosophy of education which endorse its communitarianism and oppose individualism in Western philosophy of education. After outlining Thaddeus Metz's argument that Western philosophy of education should become more African by being more communitarian, and Yusef Waghid's defence of communitarianism in African philosophy of education, we develop a qualified defence of aspects of individualism in education. Our reservations about some aspects (...) of communitarianism lead us to argue for a role for some forms of individualism in African as well as Western education. Finally, reflecting on what is at stake in this kind of comparative philosophy of education, we argue that an over-emphasis on cultural differences can distract philosophers of education from the attention they should pay to the common dangers posed across continents by the influence of global capitalism on education. (shrink)

A fundamental postulate of statistical mechanics is that all microstates in an isolated system are equally probable. This postulate, which goes back to Boltzmann, has often been criticized for not having a clear physical foundation. In this note, we provide a derivation of the canonical distribution that avoids this postulate. In its place, we impose two axioms with physical interpretations. The first axiom ensures that, as our system of interest comes into contact with different heat baths, the ranking of states (...) of the system by probability is unchanged. Physically, this axiom is a statement that in thermal equilibrium, population inversions do not arise. The second axiom requires that, for any heat bath and any probability distribution on states, there is a universe consisting of a system and heat bath that can achieve this distribution. Physically, this axiom is a statement that energy flows between system and heat bath are unrestricted. We show that our two axioms identify the Boltzmann distribution. (shrink)

According to the causal account of harming, an event harms a person if and only if it causes the person to be worse off. This view has emerged as a popular alternative to the more traditional view, according to which an event harms a person if and only if the person would have been better off had the event not occurred. In this paper, my primary aim is to motivate and defend a certain variant of the causal account of harming. (...) Moreover, I also situate this variant within recent attempts to provide a unified account of harm. (shrink)

It has been proved that total generalized variation can better preserve edges while suppressing staircase effect. In this paper, we propose an effective hybrid regularization model based on second-order TGV and wavelet frame. The proposed model inherits the advantages of TGV regularization and wavelet frame regularization, can eliminate staircase effect while protecting the sharp edge, and simultaneously has good capability of sparsely estimating the piecewise smooth functions. The alternative direction method of multiplier is employed to solve the new model. Numerical (...) results show that our proposed model can preserve more details and get higher image visual quality than some current state-of-the-art methods. (shrink)

When people interact with social robots, they treat them as real social agents. How people depict robots is fun to consider, but when people are confronted with embodied entities that move and talk – whether humans or robots – they interact with them as authentic social agents with minds, and not as mere representations.

The very enterprise of philosophy itself became problematical under Wittgenstein's probing. Rorty, extending Wittgenstein's conception and aligning certain prominent features of Wittgenstein's work with pragmatism, argues that philosophy is only problematic when taken as a disciplinary matrix. Where it is viewed as a non-disciplinary attempt to see how things hang together, it is unproblematic. But Wittgenstein himself in effect argues that philosophy in both senses is problematic even when the synthetic side is taken in a metaphysically innocuous way. This conception (...) is explicated and its underlying rationale is both sympathetically probed and critically inspected. It is l\irther shown that no such seeing how things hang together is articulated in his philosophy of culture and that his cultural commentary finds no grounding in Wittgenstein's powerfully articulated metaphilosophy. The former along with many of Wittgenstein's passionately held attitudes toward life, could be rejected and the latter accepted. (shrink)

I thought the paper by Kai-yee Wong and Chris Fraser was fascinating and insightful. Two things I especially appreciated are the clarity with which they summarize my views. I think they are quite fair and accurate. Second, I appreciate their suggestion that the way to deal with the practical problem of weakness of will has much to do with the role of the Background in shaping our actions. I think they are especially on the right track when they say that (...) the improvement of Background skills may actually narrow the range of real options for action, (p. 21) nonetheless, they do not decrease freedom. As they say, “It is a process of strengthening the self, and the agent is likely to experience the concomitant restriction of ‘live’ options not as a limitation but as strength of character.” (p. 21). That seems to me very much on the right track. What they are suggesting, and it is a powerful addition to my own writings, is that we should not just think of the Background as facilitating languages, games and social practices generally, but for morality as well (p. 23). (shrink)

We propose a new dynamical mechanism for information processing in mind and brain. We emphasize that a hermeneutic process is one of the key processes manifesting the functions of the brain and that it can be formulated as an itinerant motion in ultrahigh dimensional dynamical systems, which may give a new realm of the dynamic information processing. Our discussions are based on the notion of chaotic information processing and the observations of biological chaos.

To understand the public opinion concerning the genethics in culturally different populations, we conducted two focus groups in Japan, with one focus group each in China and Panama between April 2008 and August 2009. Generally, the participants in Japan were more cautious to disclose their personal thinking in a clear manner. Most participants in China and Panama hoped to have children free from any genetic disease if at all possible. The major difference between China and Panama seems to be whether (...) or not they will accept the issue of genetic abortion. Compared to China and Panama, fewer participants accepted a reprogenetics procedure in Japan. ―A goal of genetic counseling is to reduce the number of patients of genetic disease‖ is supported to a greater degree in China and Panama than in Japan. Most participants in China as well as Panama, and fewer participants in Japan accepted the concept of sharing genetic information with relatives, even though it is useful for preventing a possible genetic risk. The difference of the answers for the questions is depending on the cultural and value diversity in each country, while some of them are related into a paucity of knowing the principle of biogenetics. Education as to medical genetics and the principle of bioethics is most important to make genetics more accessible to the general public. (shrink)

Using the concepts of chaotic dynamical systems, we present an interpretation of dynamic neural activity found in cortical and subcortical areas. The discovery of chaotic itinerancy in high-dimensional dynamical systems with and without a noise term has motivated a new interpretation of this dynamic neural activity, cast in terms of the high-dimensional transitory dynamics among “exotic” attractors. This interpretation is quite different from the conventional one, cast in terms of simple behavior on low-dimensional attractors. Skarda and Freeman (1987) presented evidence (...) in support of the conclusion that animals cannot memorize odor without chaotic activity of neuron populations. Following their work, we study the role of chaotic dynamics in biological information processing, perception, and memory. We propose a new coding scheme of information in chaos-driven contracting systems we refer to as Cantor coding. Since these systems are found in the hippocampal formation and also in the olfactory system, the proposed coding scheme should be of biological significance. Based on these intensive studies, a hypothesis regarding the formation of episodic memory is given. Key Words: Cantor coding; chaotic itinerancy; dynamic aspects of the brain; dynamic associative memory; episodic memory; high-dimensional dynamical systems; SCND attractors. (shrink)

Das Problem der Intersubjektivitiit Intersubjektivität ist Husserl schon seit der Darstellung der Ideen I in Zusammenhang mit dem Problem der phiinomenologischen phänomenologischen Reduk tion sehr stark bewusst und wird, wie die neue VerOffentlichung Veröffentlichung 'Zur Phänome Phiinome nologie der Intersubjektivität'l Intersubjektivitiit'l ausdrücklich ausdrucklich zeigt, zeit seines Lebens in seinem Denken mit mehr oder weniger Intensitiit Intensität behandelt. Bekanntlich hat Husserl Hussed die Einfühlungslehre EinfUhlungslehre in seinem spiiten späten Versuch mit der 'Selbstobjektivation' 'Selbstobjektivation',, 'Selbstauslegung' des absoluten, anonymen, transzen 2 dentalen ego (...) erkliirt. erklärt. Gerade auf diesen Punkt konzentriert sich zutreffende Kritik und zeigt die Unvermeidbarkeit des transzendentalen Solipsismus; was als Grund für fUr echte echte Intersubjektivitiit Intersubjektivität gesucht gesucht wird, wird, niimlich nämlich die die Gleichursprunglich Gleichursprünglich keit keit von von Subjekten, Subjekten, fUhrt führt schliesslich schliesslich auf auf den den Weg der Radikalisierung der trans zendentalen Reduktion und der Erklärung Erkliirung mit der immanenten Zeitigung des transzendentalen ego in die 'einseitige Verlagerung des Gewichts auf ein konsti tuierendes Ur-Ich, dem kein ebenso ursprungliches ursprüngliches Du gegenübersteht, gegeniibersteht,...'3. (shrink)

It has long been thought that transmembrane cell‐surface receptors, such as receptor tyrosine kinases and cytokine receptors, among others, are activated by ligand binding through ligand‐induced dimerization of the receptors. However, there is growing evidence that prior to ligand binding, various transmembrane receptors have a preformed, yet inactive, dimeric structure on the cell surface. Various studies also demonstrate that during transmembrane signaling, ligand binding to the extracellular domain of receptor dimers induces a rotation of transmembrane domains, followed by rearrangement and/or (...) activation of intracellular domains. The paper here describes transmembrane cell‐surface receptors that are known or proposed to exist in dimeric form prior to ligand binding, and discusses how these preformed dimers are activated by ligand binding. (shrink)

Drawing on insights of thinkers in the natural rights tradition, Draper analyzes numerous hypothetical cases including those involving a runaway trolley, then seeks to determine if killing civilians in war is ever justified. In his consideration of this issue he avoids appealing to the principle of double effect. Having considered hypothetical cases at length, he leaves it to others to decide if any option to go to war is justifiable. In this regard he himself is sceptical.