The famous Japanese novelist offers his personal interpretation of a classic work on samurai ethics, everyday life, and spiritual salvation.

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)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 20 (2000) 59-69 [Access article in PDF] Buddhist Views on Ritual Pactice Protestant Character of Modern Buddhist Movements Yukio MatsudoUniversity of HeidelbergWhat is the relationship between ritual and ethical activities in Nichiren Buddhism, as practiced in the Soka Gakkai (SG)? SG is a lay Buddhist organization which is, as such, involved extensively in secular affairs, specifically in the field of educational, cultural, social, and peace-promoting programs. (...) The question is, therefore, not at all whether there is a connection of religious practice and ethical activities. Rather it begs an explanation regarding its ideological background. In this respect a further reflection on a metareflection level would be useful to clarify the "modern" character of SG, which may be discussed in relation to Christian Protestantism since it has been regarded as a spiritual background for the formation of modern ethos such as individualism, egalitarianism, and social engagement. Thus, I will depict the fundamental feature of Nichiren Buddhism as "reformative Buddhism," which makes the practice of Buddhism congruent with "modern" understanding of religious roles in daily life as well as social engagement. On the other hand, I will also discuss some problems being inherent to the Western acculturation of the reformed and "engaged Buddhism." 1 The Ethical Activities of the SG in the World Ethical and Social Aspects of the Movement It is generally well known that the lay Buddhist organization, SG, as a whole has initiated wide and multifaceted activities even in an international level in order to transform its religious ideals into social reality, specifically in the field of educational, cultural, social, and peace-promoting programs. For this purpose it established educational institutes ranging from kindergartens to universities as well as research [End Page 59] institutes such as the Institute of Oriental Philosophy (founded 1961), the Boston Research Center for the 21st Century (founded 1993), the Toda Institute for Global Peace and Policy Research (founded 1996), and other centers for ecological researches. For promoting mutual respect and understanding through cultural expressions and exchanges several institutes have been established, like the Min-On Concert Association (founded 1963), the Tokyo Fuji Art Museum (founded 1991), and La Maison Littéraire de Victor Hugo in Bièvre, France (founded 1992). On a global level, its political involvement is, for a large part, situated as a NGO in the frame of the UNO and the UNESCO. With the help of the UNO, SG has organized all over the world expositions translating its concerns for peace, e.g., "Nuclear War: Threat to our World" and "War and Peace." With the Simon Wiesenthal Center it organized an exhibition "The Courage to Remember: Anne Frank and the Holocaust Exhibition." The issue of human rights is another of its major concerns. Commemorating the forty-fifth anniversary of the United Nations' adoption of the Universal Declaration of Human Rights, SG held an exhibition entitled "Toward the Century of Humanity: An Overview of Human Rights in Today's World" at the UN office in Geneva. Also, money received from fund-raising activities has been donated to the Office of the United Nations High Commissioner for Refugees and related agencies to provide medical supplies and food, and to support educational programs in the areas concerned. To expose the horrors of war, SG has also published life histories written by members about their sufferings in war: "Women against War," "Cries for Peace," and "Peace is our Duty." Segmental Differentiation of Organizational Structure To meet the requirements of functional differentiation of today's modern societal life SG is organized in a segmental and hierarchical structure. The basic structure is the regional units, organized in a hierarchical model, and all members are integrated "in each group" in their residence area. At the same time each member belongs to a specific "division" which is organized according to gender, age, and occupation. There are the four divisions of men, women, young men, and young women. Additionally there are divisions for school boys and girls, university students, as well as divisions according to occupation such as artists, lawyers, medical doctors, academics, and so on. These divisional differentiations reflect the need... (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)

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)

The aim of the present paper is to evaluate the role of a patient’s religious and non-religious beliefs in making decisions about medical care. Faith exerts a profound influence on our spiritual lives and on our daily actions, including ethical decisions. Religion determines the believer’s fundamental worldview, view of humanity, perspective on life and death, and values. In this paper, we investigated the treatment of medical decisions based on religious or non-religious beliefs. To understand this issue, it is necessary to (...) assess the uniqueness and validity of religious beliefs, as well as the rationality of beliefs. We concluded that decisions based on religious and non-religious beliefs shouldbe treated in the same way and that the distinguishing features of valid beliefs are deeply held and do not cause harm to others. In addition, we stated that the root beliefs we hold, whether religious or secular, cannot necessarily be explained logically, and that patient decisions should be judged by the logical consistency of their reasoning with their beliefs as starting points. (shrink)

Each country may face some distinctive ethical problems. Little is known about what kind of ethical problems exist and how often physicians are faced with them in clinical settings in Japan. The authors conducted both retrospective and prospective studies to identify ethical dilemmas at a general medical ward of a university hospital in Japan. In the first phase of the study, retrospective chart reviews were conducted for 61 patients who had been admitted to our general medical ward. It revealed that (...) ethical dilemmas were recorded in 17 cases. In the subsequent period, as the second phase of the study, 6-month prospective case findings were conducted, showing that 22 of 47 patients had ethical dilemmas that attending physicians were concerned about. Ethical dilemmas frequently identified included refusal of or unnecessary requests for diagnostic procedures or treatment by patients, issues concerning truth-telling to patients with a serious illness, and disagreement regarding plans for patient care between patients' family and physicians in charge. The prospective case findings identified a significantly higher frequency of ethical dilemmas than did retrospective chart reviews . Demographics were not significantly different for the two patient groups. The data suggests that ethical dilemmas are not uncommon in general medical wards in Japan. The patients' family played a significant role in clinical decision making, leading on some occasions to complicated ethical dilemmas. (shrink)

When I am asked “What are you doing?”, I answer e.g. “I am making coffee”. Anscombe called the knowledge that this kind of answer involves “practical knowledge”. Practical knowledge is knowledge not involving observation and inference. In this presentation I would like to apply this concept to the collectiveaction of many persons. Given that we are playing soccer if someone comes here and asks “What are you doing now?”, we can answer immediately “We are playing soccer”. I would like to (...) claim that the above answer “We are playing soccer” is ‘our’ knowledge of ‘our’ intentional action and the subject of this intention is ‘we’ and there is a collective intention and the subject of knowledge of this intentional action is also ‘we’ and this is collective knowledge, i.e. common knowledge. We anticipate the following objection against this claim: Who utters “We are playing soccer” is an individual and who answers is not “we” but an individual person and she is describing “our” action. I reply to this objection. Furthermore I consider the background knowledge of ‘our’ practical knowledge and try to extend the concept of ‘practical knowledge’. (shrink)

When participants observed a rubber hand being touched, their sense of touch was activated . While this illusion might be caused by multi-modal integration, it may also be related to empathic function, which enables us to simulate the observed information. We examined individual differences in the RHI, including empathic and schizotypal personality traits, as previous research had suggested that schizophrenic patients would be more subject to the RHI. The results indicated that people who experience a stronger RHI might have stronger (...) empathic and schizotypal personalites simultaneously. We discussed these relationships in terms of self-other representations. (shrink)

Background: The introduction of healthcare AI to society as well as the clinical setting will improve individual health statuses and increase the possible medical choices. AI can be, however, regarded as a double-edged sword that might cause medically and socially undesirable situations. In this paper, we attempt to predict several negative situations that may be faced by healthcare professionals, patients and citizens in the healthcare setting, and our society as a whole. Discussion: We would argue that physicians abuse healthcare AI (...) through their excessive and dependent use of it, and they will focus only on the AI services in their office and patient medical data and information, and forget to observe the patient in their clinical encounters. In the era of AI introduction, data from the wearable terminal or AI advice will become the primary target of the physician’s interest, and could be regarded as a patient surrogate. Paternalism would be paradoxically resurrected by the introduction of state-of-the-art AI. A physician’s conflict of interest related to AI as a commercial product could strongly influence his or her actions in clinical settings. We also worry that the general public will become uneasy and hypersensitive slaves to information, compulsively and uninterruptedly requesting healthcare information concerning their own health and advice from AI. An AI system capable of expressing proper and timely empathy to suffering patients could deprive healthcare professionals of their roles in terms of hospitality and emotional exchange. Finally, entire societies would soon share and consolidate healthcare sensitive information from all in the general public as part of a totalitarian healthcontrolled society where individual privacy and personal secrets could be neglected. The advent of the healthcontrolled society could lead to the metamorphosis of the concept of privacy itself into something completely different. Conclusion: Although AI which surpasses human healthcare professionals may never appear, hoping for the best and preparing for the worst is the best approach to take. To this end, we present some potential countermeasures including conducting clinical research and social investigations concerning problems surrounding the introduction of AI and developing guidelines for its appropriate use. (shrink)

Grodzinsky's general approach to the neuroscience of language is interesting, but the evidence currently available has problems with pragmatic infelicity in experiments involving Japanese scrambling and the interpretation of experimental results on Japanese indirect passives. I will suggest a more direct way of testing the Trace-Deletion Hypothesis (TDH).

In Japan, where a prominent gap exists in what is considered a patient’s best interest between the medical and patient sides, appropriate decision-making can be difficult to achieve. In Japanese clinical settings, decision-making is considered an act of choice-making from multiple potential options. With many ethical dilemmas still remaining, establishing an appropriate decision-making process is an urgent task in modern Japanese healthcare. This paper examines ethical issues related to shared decision-making (SDM) in clinical settings in modern Japan from the psychocultural-social (...) perspective and discusses the ideal decision-making process in present Japan. Specifically, we discuss how five psychocultural-social tendencies – “surmise (Sontaku),” “self-restraint (Jishuku),” “air (atmosphere or mood, Kuuki),” “peer pressure (or tuning pressure, Docho-Atsuryoku),” and “community (Seken)”—which have often been referred to as characteristics of present-day Japanese people, may affect the ideal practice of SDM in Japanese clinical settings. We conclude that health care professionals must be aware of the possible adverse effects of the above Japanese psychocultural-social tendencies on the implementation of SDM and attempt to promote autonomous decision-making, thereby allowing patients to make treatment choices that sufficiently reflect their individual and personal views of life, experiences, goals, preferences, and values. (shrink)

Floridi’s infosphere consisting of informational reality is estimated and delineated by introducing the new notion of Typ-Ken, an undifferentiated amalgam of type and token that can be expressed as either type or token dependent on contingent ontological commitment. First, we elaborate Floridi’s system, level of abstraction (LoA), model, and structure scheme, which is proposed to reconcile ontic with epistemic structural reality, and obtain the duality of type and token inherited in the relationship between LoA and model. While we focus on (...) the ontological commitment that can negotiate and emphasize the discrepancy between type and token, we show that most research focusing on different hierarchical layers (type and token) has converged onto the flattened perspective of type and token to clarify the role of ontological commitment. We propose the idea of Typ-Ken to avoid this flattening. In addition, we elaborate Taddeo and Floridi’s criticism of approaches to the symbol grounding problem and show that their criticism based on the zero semantical commitment condition is specific to the agents affected by the flattening. We then take bird flocks as a metaphor for the living infosphere as if it had one mind. The knowledge recently yielded by image analysis indicates that it is difficult for previous flock models based on agents equipped with the flattening of local (token) and global (type) to show the special feature of a flock of the scale-free proportion (SFP). We show here that agents based on the Typ-Ken can reveal the SFP, which is the essential characteristic of the living infosphere. In other words, Typ-Ken is an expression for informational reality (LoA and model with ontological commitment) that can reveal seamless local and global interactions in the functioning of a flock or infosphere. (shrink)

This paper deals with the debates over _kālamṛtyu_ (“timely death” or human death at the end of the life span) and _akālamṛtyu_ (“untimely death” or premature death that occurs when the life span still remains). In cultural areas like ancient India, where the _karman_ doctrine or the law of _karman_ is firmly rooted, such “timely death” and “untimely death” have seemed to be the catalysts for the philosophical and ethical debates. Assuming that a person’s life itself would be affected by (...) the person’s past _karman_s, each life span and death of individual persons would have been predetermined by their past _karman_s, and consequently, any efforts for preserving or prolonging life span in this world would have no meaning. If it were so, in the first place, does the _karman_ doctrine leave room for “untimely death”? This paper discusses how Buddhist literature, especially the _Questions of King Milinda_ (_Milindapañha_), and the Āyurvedic literature approach the above issues. (shrink)