Criticism of "brain death" policy in Japan

The 1997 Japanese organ transplantation law is the fruit of a long debate on "brain death" and organ transplantation, which involved the general public and experts in the relevant fields. The aim of this paper is to trace the history of the implementation of the law and to critique the law in terms of its consistency and fairness. The paper argues that the legislation adopts a double standard regarding the role of the family. On the one hand, the legislation over-emphasizes the family's authority by granting the family a veto on the matter of organ transplantation, while, on the other hand, not allowing the family to make surrogate decisions. In addition, the role of law in cases involving minor or incompetent patients is shown to be similarly misguided. The paper argues that accepting a decisive role for the family in current law is compatible with Japanese culture.     

Commentary on "Quantifying the value of human life

...In his article, "Quantifying the value of human life for cost accounting of safeguards," L. Eugene Arnold proposes a cost-benefit analysis to address three allocation issues concerning the very expensive program of blood monitoring proposed by Sandoz at the time it placed Clozaril...on the American market....It is important to realize that the use of seemingly value-free procedures to arrive at answers to ethically complex questions does not eliminate the values that underlie the choice of variables to be analyzed. The analyses employed by the author to three ethical questions illustrate this point very well....     

Thinking too much: How young people experience rumination in the context of loneliness

The recent rise in the prevalence of loneliness, particularly among young adults, coupled with its deleterious effects on wellbeing, makes understanding the issue of pressing concern. As most research on loneliness has focused on older adults, this study explored how 48 young adults aged 18–24 subjectively experienced loneliness through free association-based interviews. Participants were sampled from the four most deprived boroughs in London, as area deprivation has been associated with a higher prevalence of loneliness. This facilitates understanding of contributors and consequences of loneliness within this demographic group. In particular, the focus is on rumination arising from loneliness; while the link between the two is well-established quantitively, research into rumination and the context of ruminative thoughts in the context of loneliness remains sparse. Thus, this study aimed to understand the subjective experience of rumination in young adults whilst they experienced loneliness. Thematic analysis of interviews using ATLAS.ti 9 revealed five themes capturing these experiences: ‘temporal experience of rumination’, ‘ruminating life and death’, ‘rumination related to others’, ‘outcomes of rumination’ and ‘coping with loneliness-related rumination’. Based upon knowledge of the nature and content of rumination, further research could devise models of rumination and interventions targeted at rumination such as mindfulness meditation, journaling and engaging in prosocial behaviour, to mitigate the adverse effects loneliness can have on wellbeing.     

Commentary on "Sedation before ventilator withdrawal

In any important article in the field of clinical ethics, the focus should not be on the specific case example, but rather on the issues it presents for thought and discussion. Barbara Springer Edwards and Winston M. Ueno achieve this end admirably. They present a terminally ill patient who requested termination of ventilator support, despite the overwhelming odds that he would die as a result. The authors ask whether or not the physician acted appropriately in accommodating the patient's wish and in sedating him to decrease suffering in his last moments. They present compelling arguments that sedation was warranted in this case. They also note correctly that competent patients have the right to refuse treatment. However, in addition to the question of sedation, this case raises other important issues, specifically those related to pain management and depression in the terminally ill....     

Commentary on "Being on time for appointments

In "Being on time for appointments," Sharon Schwarze addresses an important issue -- the tendency for doctors to keep patients waiting for their appointments. Let me state categorically that I agree that this is a deplorable situation that warrants discussion and warrants a serious attempt to correct the practice. I do believe, however, that this is an issue more appropriately considered under the rubric of etiquette rather than ethics, though clearly it is subsumed in the category of respect for persons....