Brain death has been discussed extensively for the last 25 years. Most investigators now believe that requiring death of the entire brain as the criterion for brain death in the Uniform Determinati...

Brain Death: Reconciling Definitions, Criteria, and Tests

OBJECTIVE: Cross-cultural ethical conflicts are common. However, little is known about how and to what extent acculturation changes attitudes toward end-of-life care and advance care planning. We compared attitudes toward end-of-life care among Japanese Americans and Japanese in Japan. DESIGN: Self-administered questionnaire in English and Japanese. SETTING AND PARTICIPANTS: Community-based samples of Japanese Americans in Los Angeles and Japanese in Nagoya, Japan: 539 English-speaking Japanese Americans (EJA), 340 Japanese-speaking Japanese Americans (JJA), and 304 Japanese living in Japan (JJ). MEASUREMENTS AND MAIN RESULTS: Few subjects (6% to 11%) had discussed end-of-life issues with physicians, while many (EJA, 40%; JJA, 55%; JJ, 54%) desired to do so. Most preferred group surrogate decision making (EJA, 75%; JJA, 57%; JJ, 69%). After adjustment for demographics and health status, desire for informing the patient of a terminal prognosis using words increased significantly with acculturation (EJA, odds ratio [OR] 8.85; 95% confidence interval, [95% CI] 5.4 to 14.3; JJA, OR 2.8; 95% CI 1.8 to 4.4; JJ, OR 1.0). EJA had more-positive attitudes toward forgoing care, advance care planning, and autonomous decision making. CONCLUSION: Preference for disclosure, willingness to forgo care, and views of advance care planning shift toward western values as Japanese Americans acculturate. However, the desire for group decision making is preserved. Recognition of the variability and acculturation gradient of end-of-life attitudes among Japanese Americans may facilitate decision making and minimize conflicts. Group decision making should be an option for Japanese Americans.

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Acculturation of attitudes toward end-of-life care: a cross-cultural survey of Japanese Americans and Japanese.

Standard bioethics textbooks present the field to students and non-experts as a form of "applied ethics." This ahistoric and rationalistic presentation is similar to that used in philosophy of science textbooks until three decades ago. Thomas Kuhn famously critiqued this self-conception of the philosophy of science, persuading the field that it would become deeper, richer, and more philosophical, if it integrated the history of science, especially the history of scientific change, into its self-conception. This essay urges a similar reconceptualization for bioethics, arguing that the analysis of moral change ought to be integral to bioethics (and to ethics generally). It proceeds by suggesting the sterility of the ahistoric, rationalist applied ethics model of bioethics embraced by standard bioethics textbooks. It also suggests the fecundity of alternative conceptions of the bioethics that focus on the history of successful and failed attempts to negotiate moral change, and the history of multifaceted relations between moral philosophy and practical ethics.

Bioethics and History

Cancer disclosure in Japan: historical comparisons, current practices.

Responsibility and cancer disclosure in Japan.

This paper reports on recent developments in the rise of bioethics in Japan. Much of the recent interest in bioethics in Japan is seen as a response to various civic movements. The women's liberation movement, access to equal opportunity, and the recognition of patients' rights and the importance of informed consent are among some of the movements influencing the development of bioethics in Japan. The author argues that this movement is to be encouraged and fostered by health care professionals, public policy makers, as well as lay persons in Japan.

Bioethics as a prescription for civic action: the Japanese interpretation.

Japan is unusual among industrialized countries in its reluctance to use brain criteria to determine death and harvest transplant organs. This results from public distrust of the medical profession due to an earlier incident, and from concern that technological interventions will threaten religious and cultural traditions surrounding death and dying. Public acceptance is growing, however, as medical professional groups and universities develop brain criteria, and as pressure from patients who could benefit from a transplant, as well as from foreign countries, increases.

Japan's dilemma with the definition of death.

\n This essay is the last of eight in this issue of the Journal of Medicine and Philosophy on the use of anencephalic fetuses and infants as tissue and organ donors. Beginning with a 1981 case in which a kidney from an anencephalic newborn was transplanted into a young girl, Kimura discusses professional and public attitudes in Japan toward anencephalic neonates, brain death criteria, and donation of organs.\n

Anencephalic organ donation: a Japanese case.

Although ethics committees in Japan have been developing in major medical schools and in some hospitals, their members are usually medical professionals from the same institution. The lack of national legislation for setting up ethics committees permits only a voluntary code of standards for doing clinical research work in high tech medical applications. The author argues for the necessity of more open debate on bioethical issues and proposes the participation of the lay public and bioethicists in Ethics Committee in Japan.

Ethics committees for "high tech" innovations in Japan.

To obtain human genetic information with the intention of treating and curing severe genetic disease would be considered to be a positive personal decision of a moral agent in various religious contexts. According to some religious teachings human suffering should not be regarded merely as a negative element of life; however, the scientific achievement of obtaining genetic information should surely increase the possibility of hope for the eventual cure of genetically determined diseases. The elimination of human suffering and tragedy in severe genetically determined illness, on the criterion of the benefit of the patient, is permitted by various contemporary religious teachings, according to an analysis of publications by the World Council of Churches and the Vatican and sources from Jewish, Islamic and Buddhist teachings.

Rihito Kimura

Papers

Bioethics as a prescription for civic action: the Japanese interpretation.

Japan's dilemma with the definition of death.

Anencephalic organ donation: a Japanese case.

Ethics committees for "high tech" innovations in Japan.

Religious Aspects of Human Genetic Information