This research examines the current status of clinical ethics consultation (CEC) in Japan through a nationwide study conducted with chairs of ethics committees and clinical ethics committees among 1028 post-graduate clinical teaching hospitals. We also qualitatively analyzed their viewpoints of the CEC’s benefits and problems related to hospital consultation services to identify the critical points for CEC and inform the development of a correctly functioning system. The questionnaire included structured questions about hospital CEC organization and service purpose and operation and (...) open-ended questions about the benefits and problems of initiating CEC. The questionnaire comprised the presence/absence of an ethics committee, CEC services and membership when services were implemented, users, and the number of cases handled since inception. In addition, the respondents also provided their impressions of the CEC system’s impact on their hospital by describing (a) the benefits of CEC services and (b) the ineffectual or harmful aspects of the CEC system. Qualitative data were examined using qualitative content analysis to determine the impact of establishing a CEC and the difficulties of practice. One hundred twenty-five questionnaires were returned from either the chair of the ethics committee or clinical ethics committee in teaching hospitals. Of these, 90 (72%) reported they provided CEC services. Additionally, 36 respondents (34.6%) reported that their existing research and clinical ethics committees had conducted CEC services, and 35 (33.7%) reported having a newly established clinical ethics committee conducting CEC services. Three positive effects of establishing and four challenges in managing CEC were also identified. (shrink)

BackgroundFew comparative studies of clinical ethics consultation practices have been reported. The objective of this study was to explore how American and Japanese experts analyze an Alzheimer's case regarding ethics consultation.MethodsWe presented the case to physicians and ethicists from the US and Japan (one expert from each field from both countries; total = 4) and obtained their responses through a questionnaire and in-depth interviews.ResultsEstablishing a consensus was a common goal among American and Japanese participants. In attempting to achieve consensus, the (...) most significant similarity between Japanese and American ethics consultants was that they both appeared to adopt an "ethics facilitation" approach. Differences were found in recommendation and assessment between the American and Japanese participants. In selecting a surrogate, the American participants chose to contact the grandson before designating the daughter-in-law as the surrogate decision-maker. Conversely the Japanese experts assumed that the daughter-in-law was the surrogate.ConclusionOur findings suggest that consensus building through an "ethics facilitation" approach may be a commonality to the practice of ethics consultation in the US and Japan, while differences emerged in terms of recommendations, surrogate assessment, and assessing treatments. Further research is needed to appreciate differences not only among different nations including, but not limited to, countries in Europe, Asia and the Americas, but also within each country. (shrink)

Healthcare professionals must make decisions for patients based on ethical considerations. However, they rely on clinical ethics consultations (CEC) to review ethical justifications of their decisions. CEC consultants support the cases reviewed and guide medical care. When both healthcare professionals and CEC consultants face ethical problems in medical care, how is their judgment derived? How do medical judgments differ from the ethical considerations of CECs? This study examines CECs in Japan to identify differences in the ethical judgment of clients and (...) CEC consultants. (shrink)

In the circular sphere around the Pacific Ocean many volcanos have erupted, and, because of tectonic plates, numerous earthquakes have occurred. In Tonga, especially, the resulting devastation has been beyond our wildest imagination. Regarding such natural phenomena, we could not predict anything. Likewise, the Covid-19 pandemic appeared suddenly, and no one can say when its destruction will end. Protective measures against infection have affected the nature of our social interactions: masking has changed our spatial consciousness; observing social distancing has made (...) us less dependent on one another and has influenced us to seek solitude. As a result, inter-subjectivity—the foundation of ethics—has been broken. All of these effects on our interpersonal relationships have instilled in us a new attitude towards nature, because the human being is a part of nature. This new attitude with nature opens up a new paradigm: dialogues with nature and their co-operative activities must be demanded, and we must wait for nature’s movement and ask for its help. It is, in a way, the traditional artistic attitude toward nature. (shrink)

Inspired by earthquakes in the world, I attempt to clarify the relationship between human beings and Nature. Many architects, such as Tange and Isozaki from 1963 until 2005, built modern cities under the idea of urbanism. However, in Eco-ethica, we propose a new concept “urbanica.” It suggests a new relationship—not “city-center and suburbs” but free relations among communities. New relationships must be clarified in ethics. I try to make clear the relationship between inter-subjectivity and inter-objectivity. I analyze this through a (...) Noh play, “Yamanba,” which is a symbol of one natural phenomenon, “wind”: a personified figure of “wind” should link inter-subjectivity and inter-objectivity. Nature itself makes reality, the real world, by the potential movement of wind. (shrink)

The Pragmatics of Multi-Verb Sequences: The Case of the Verb Go This paper is an empirical investigation into the nature of multi-verb sequences in English. Multi-verb sequences such as V-to-VP and V-and-VP present a natural construction type of investigating recurring patterns of event sequences as conceived situations. This paper focuses on the image-schematic properties of both the go-to-VP construction and the go-and-VP construction to which previous accounts have paid little attention, and it demonstrates that the interpretation of the image-schemas has (...) enhanced research. The go-to-VP and the go-and-VP constructions require different image schemas. With respect to the go-to-VP construction, the SOURCE-PATH-GOAL schema plays an important role; sometimes a compound image schema of that type are necessary. Specifically, the image-schematic properties of the first verb go are incorporated into the event structure of the second verb to allow the speaker to construe the event denoted by the second verb in accordance with the image-schematic meaning of the first verb go. Consequently, this paper offers a pragmatic and cognitive account of the two constructions respectively. Some results in a data-driven analysis in this paper also reinforce selected convincing explanations. (shrink)

The method of analytic tableaux is employed in many introductory texts and has also been used quite extensively as a basis for automated theorem proving. In this paper, we discuss the complexity of the system as a method for refuting contradictory sets of clauses, and resolve several open questions. We discuss the three forms of analytic tableaux: clausal tableaux, generalized clausal tableaux, and binary tableaux. We resolve the relative complexity of these three forms of tableaux proofs and also resolve the (...) relative complexity of analytic tableaux versus resolution. We show that there is a quasi-polynomial simulation of tree resolution by analytic tableaux; this simulation is close to optimal, since we give a matching lower bound that is tight to within a polynomial. (shrink)

The mechanism of chromosome condensation is one of the classic mysteries of mitosis. A number of years ago, it was suggested that nonhistone proteins of the chromosome scaffold fraction might help chromosomes to condense, possibly by constructing a framework for the condensed structure. Recent results have shown that topoisomerase II and the SMC proteins, two abundant members of the scaffold fraction, are required for chromosome condensation and segregation during mitosis. Topoisomerase II is a well‐characterized enzyme. In contrast, nothing is yet (...) known about the function of the SMC proteins. We summarize evidence suggesting that these proteins may be enzymes whose activity is somehow involved in the establishment and maintenance of mitotic chromosome morphology. (shrink)

Resolution and cut-free LK are the most popular propositional systems used for logical automated reasoning. The question whether or not resolution and cut-free LK have the same efficiency on the system of CNF formulas has been asked and studied since 1960 425–467). It was shown in Cook and Reckhow, J. Symbolic Logic 44 36–50 that tree resolution has super-polynomial speed-up over cut-free LK. Naturally, the current issue is whether or not resolution and cut-free LK expressed as directed acyclic graphs have (...) the same efficiency. In this paper, we introduce a new algorithm to eliminate atomic cuts and show that cut-free LK polynomially simulates resolution when the input formula is expressed as a k-CNF formula. As a corollary, we show that regular resolution does not polynomially simulate cut-free LK . We also show that cut-free LK polynomially simulates regular resolution. (shrink)

Women make up about ten per cent of the scientists and engineers in Japan. The aim of this essay is to make clear why, even in the year 2001, there are so few women in these disciplines. I will suggest that the socio-economic structure and gender ideology of Japan since the Second World War is responsible for this shortage which is often erroneously attributed to the cultural traditions of feudal Japan.

Avec et après la pandémie, notre conscience de l’espace et du temps a subi un changement radical : les individus ont expérimenté l’oisiveté forcée, les gestes barrières et la distanciation physique qui redouble l’éloignement induit par les nouvelles technologies ayant substitué la communication à l’échange. Or, les progrès techniques n’ont de progrès que le nom et ne cherchent que l’efficacité assurée par la vitesse qui fait violence aux cycles de la nature. Pourtant, seule cette dernière est capable de nous réconcilier (...) avec nous-mêmes en nous extrayant de la domination de la machine et en nous enseignant la patience de laquelle peut surgir la beauté : beauté du geste artistique qui défie le temps, accès à la transcendance à travers la contemplation du vivant. C’est dans ce rapport d’interdépendance avec la nature que nous pouvons échapper à la déshumanisation de la société moderne et renouer avec la beauté du monde. (shrink)

Objective:This study aimed to investigate the effect of robot-assisted gait training therapy combined with non-invasive brain stimulation on lower limb function in patients with stroke and spinal cord injury.Data sourcesPubMed, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Web of Science were searched.Study selectionRandomized controlled trials published as of 3 March 2021. RCTs evaluating RAGT combined with NIBS, such as transcranial direct current stimulation and repetitive transcranial magnetic stimulation, for lower limb function and activities in patients with stroke and (...) SCI were included.Data extractionTwo reviewers independently screened the records, extracted the data, and assessed the risk of bias.Data synthesisA meta-analysis of five studies and risk of bias were conducted. Pooled estimates demonstrated that RAGT combined with NIBS significantly improved lower limb function [standardized mean difference = 0.52; 95% confidence interval = 0.06–0.99] but not lower limb activities. Subgroup analyses also failed to find a greater improvement in lower limb function of RAGT with tDCS compared to sham stimulation. No significant differences between participant characteristics or types of NIBS were observed.ConclusionThis meta-analysis demonstrated that RAGT therapy in combination with NIBS was effective in patients with stroke and SCI. However, a greater improvement in lower limb function and activities were not observed using RAGT with tDCS compared to sham stimulation. (shrink)

Hospital ethics committees (HECs) are expected to play extremely broad and pivotal roles such as case consultation, education of staffs on healthcare ethics, and institutional policy formation. Despite the growing importance of HECs, there are no standards for setup and operation of HECs, and composition and activities of HECs at each institution are rarely disclosed in Japan. In addition, there is also a lack of information sharing and collaboration among HECs. Therefore, the authors established the Consortium of Hospital Ethics Committees (...) (CHEC) in October 2020, which has been regularly hosting a couple of core activities. One is the Healthcare Ethics Forum, held monthly online for CHEC members to freely discuss HECs and healthcare ethics consultation. The other is the Collaboration Conference of Hospital Ethics Committees, intended to provide a place for HEC members and administrative officers from across Japan to exchange information of their HECs, learn from each other, and cooperate to operate HECs appropriately. In this paper, the authors introduced CHEC as well as reported the results of a questionnaire survey conducted at the first conference among participating facilities, suggesting the diverse structures and activities of HECs in Japan. (shrink)

In the case of Japan, we accepted the Chinese philosophy of morality when we received the Chinese character Yi: it means responsibility to Heaven (vertical) and, at the same time, responsibility to community (horizontal). An act having this structure might be our responsibility as human beings: yi means “justice”, keeping balance between Heaven and Earth. The Japanese people had such a balance until the Edo era. In 1868, when the Meiji Restoration occurred, the Japanese government tried to accept Western ideas. (...) Cyoumin Nakae introduced the Western philosophy of law and the constitutional system. He translated Rousseau’s The Social Contract into Japanese and gave a series of lectures on the social contract. The fundament of his thought is concentrated in the “rights of Liberty”. He emphasized transcendental liberty beyond personal, phenomenal liberty and found the same structure in Mencius. His idea of ft suggests the way of justice. Unfortunately, this idea was crushed with the death of his talented disciple in prison. After the book of Bushido, ft was only translated as “duty” for the community (horizontal), and we lost the vertical perspective: transcendental liberty. (shrink)

In the past few years, a second phase of biomedical ethics in Japan has begun to surface with a succession of governmental guidelines and laws regulating biomedical technology. Although this rush of guidelines exemplifies a heightened awareness concerning ethical standards for healthcare research, it also invites several practical, political, and procedural problems.

The main theme of volume 6 of Eco-ethica is "Ethics and Justice" which focuses on the idea of "justice" in a metaphysical, social, and personal sense. Justice is considered as a balance between opposite ambitions in interdependent persons, and as equity in legislation, but not as blind justice. Today it is valuable not only on the national, but also on the cosmopolitan level. Before it became personal justice, the idea of justice was considered metaphysical and social, both in European and (...) Chinese culture. However, in modern times, it is often reduced to a moral duty without meta-ethical responsibility. The last section considers the importance of the philosophy of Paul Ricoeur (1913-2005) for clarifying the idea of justice. (Series: Eco-Ethica, Vol. 6) [Subject: Philosophy, Ethics]. (shrink)

Detection of genuine altruists could be a solution to the problem of subtle cheating. Brown et al. (Evol Psychol 1:42–69, 2003) found that humans could detect altruists using nonverbal cues. However, their experiments can be improved upon in several ways, and further investigation is needed to determine whether altruist-detection abilities are human universals. In our experiment, we used video clips of natural conversations as the stimulus. We asked a sample of Japanese undergraduates to rate their own level of altruism and (...) then to estimate the videotaped targets’ altruism using the same scale. The perceivers were able to estimate the targets’ altruism levels accurately. Perceivers’ altruism score did not affect their ability to discriminate between altruists and non-altruists. Perceivers’ impressions of the altruist and non-altruist targets were also found to be different. Coding of nonverbal behavior of the targets revealed that altruists exhibited more “felt smiles” than non-altruists, which also supports the results of the previous study. (shrink)

「カワイイ」価値をめぐる冒険の旅へ。「カワイイ」に代表されるポピュラーな感性的価値に、一流の研究者たちが学問領域の枠を超えて真摯に向き合う。社会のダイナミズムとメカニズムの実態に迫る、シリーズ第二弾。 .

This study aimed to identify the ethical issues faced by home care physicians and nurses, and the support they require. It was conducted in collaboration with the Japanese Association for Home Care Medicine from November to December 2020. An e-mail was sent to 2785 physicians and 582 nurses who are members of the society, requesting their participation in a web-based survey targeting physicians and nurses with practical experience in home care; 152 physicians and 53 nurses responded. Home care physicians and (...) nurses face ethical issues, some of which are that “the patient’s wishes cannot be reliably understood owing to their impaired decision-making capacity” and “there is disagreement between the patient and their family members over the necessary healthcare.” The respondents sought “experience with, and insight into, healthcare ethics” and “home care” from people with whom they would consult on ethical issues, but at the time of the actual consultation, those individuals were the main healthcare professionals involved with the patient. In addition, the respondents desired to have “multidisciplinary discussions in the community,” “participation of healthcare ethics experts at meetings,” and “meetings held by healthcare ethics experts” to discuss specific cases. Given these results and the history of healthcare ethics education in Japan—which has been implemented mostly for healthcare providers—we conclude that it is important for academic societies that offer healthcare ethics education to healthcare providers and regional core hospitals with ethics support resources to collaborate to provide ethics consultation services in the community. (shrink)