Possibilities and ethical issues of entrusting nursing tasks to robots and artificial intelligence.

In recent years, research in robotics and artificial intelligence (AI) has made rapid progress. It is expected that robots and AI will play a part in the field of nursing and their role might broaden in the future. However, there are areas of nursing practice that cannot or should not be entrusted to robots and AI, because nursing is a highly humane practice, and therefore, there would, perhaps, be some practices that should not be replicated by robots or AI. Therefore, this paper focuses on several ethical concepts (advocacy, accountability, cooperation, and caring) that are considered important in nursing practice, and examines whether it is possible to implement these ethical concepts in robots and AI by analyzing the concepts and the current state of robotics and AI technology. Advocacy: Among the components of advocacy, safeguarding and apprising can be more easily implemented, while elements that require emotional communication with patients, such as valuing and mediating, are difficult to implement. Accountability: Robotic nurses with explainable AI have a certain level of accountability. However, the concept of explanation has problems of infinite regression and attribution of responsibility. Cooperation: If robot nurses are recognized as members of a community, they require the same cooperation as human nurses. Caring: More difficulties are expected in care-receiving than in caregiving. However, the concept of caring itself is ambiguous and should be explored further. Accordingly, our analysis suggests that, although some difficulties can be expected in each of these concepts, it cannot be said that it is impossible to implement them in robots and AI. However, even if it were possible to implement these functions in the future, further study is needed to determine whether such robots or AI should be used for nursing care. In such discussions, it will be necessary to involve not only ethicists and nurses but also an array of society members.

Disclosure of Spousal Death to Patients with Dementia: Attitude and Actual Behavior of Care Managers.

As the number of dementia patients increases, there is a need to protect patients' right to know. However, in reality, there are cases in Japan where spouses' deaths are concealed from patients. We conducted a questionnaire survey of care managers (CMs) to obtain their attitude and actual behavior regarding the disclosure of a spouse's death to patients with dementia. A self-administered, anonymous questionnaire survey was implemented at academic meetings attended by CMs from March to December 2019, inquiring about experiences with spousal deaths of patients with dementia, disclosure rates, behavioral and psychological symptoms of dementia, and depression. Over 80% had experienced the spousal death of a patient with dementia; the percentage of CMs who had implemented the disclosures varied widely. About 18% had experienced worsening behavioral and psychological symptoms of dementia (BPSD), and 26% had worsening depression as a result of the disclosure. About 83% of respondents were positive about disclosure, but about 44% did so less than 50% of the time. This study is the first to reveal the current state of CMs' policies and behaviors regarding the disclosure of spousal death to patients with dementia in Japan. Family members' wishes and the possibility of BPSD put a relatively large number of caregivers in a dilemma regarding disclosure.

COVID-19 Pandemic and Public Health Ethics in Japan.

Public health ethics is a discipline dealing with ethical issues relating to public health. As a branch of medical ethics, it also deals with clinical and research ethics. The core issue of public health ethics is to balance the conflict between individual liberty and the public good. Because of the coronavirus disease 2019 (COVID-19) pandemic, deliberation based on public health ethics is required to reduce social disparities and increase community cohesion. This study presents three public health ethics challenges. The first is to introduce an egalitarian liberal approach to public health concerning social and economic issues experienced by vulnerable populations both domestically and globally. I then propose alternative and compensatory public health policies that serve the principles of justice. Second, public health ethics must ensure procedural justice in all public health policy decisions. For example, when deciding to implement public health policies, including restrictions on individual liberties, the decision making process must be open to the public. Third, citizens and students must be educated on public health ethics. The public must be provided with an open forum to deliberate on ethical issues related to public health as well as the appropriate training to do so.

Factors of influenza vaccine inoculation and non-inoculation behavior of community-dwelling residents in Japan: Suggestions for vaccine policy and public health ethics after COVID-19.

The aim of this study is to provide basic information that contributes to vaccine inoculation policy after COVID-19. We used the secondary data of the influenza vaccine inoculation behavior survey for community-dwelling adults conducted in 2011, before the COVID-19 pandemic, but after the 2009 novel influenza A (H1N1) pdm 09 pandemic. All factors such as socio-demographic characteristics, health-related behaviors, family environment, physical and social environment, and area of residence were adjusted, and factors related to vaccine inoculation behavior were analyzed. Those living with pregnant women had a significantly higher odds ratio of inoculation; this was self-evident in that those people considered infection to their family. Regarding the social environment, those aged 20-64 years with a significantly higher adjusted odds ratio of inoculation were those with "at least five people with which they interacted in the neighborhood". This result can be interpreted in two ways relating to altruism in Japan. Finally, we indicated the importance of learning from the past, including the case of 2009.

What is the contemporary role of second-generation philosophical bioethicists?

Bioethics originated in the 1970s and has now been around for half a century. During that half-century, brilliant achievements have been made, especially in the West. Basic bioethics theories have been developed that have proved useful in solving many bioethical issues including policies. Moreover, ethics committees and clinical ethics consultations have been implemented in the medical field. However, there seems to be a pessimistic discourse in bioethics in developed countries. For example, mid-career researchers from the world's leading bioethics centres in the UK and North America, Blumenthal-Barby et al, expressed concern and frustration about the current situation of philosophy in bioethics in their 2021 paper "The Place of Philosophy in Bioethics Today" [1]. The authors pessimistically say that.

The consciousness of virtue: uncovering the gaps between educational specialists and the general public in their understanding of virtue in Japan.

Virtue is a normative concept that constitutes social and moral codes. The notion of virtue can be identified in both the West and the East. Since this concept was revived in academia in the 20th century after a long sinking into oblivion, contemporary professional researchers, but not the general public, may be familiar with this notion. We conducted a survey on the attitudes of educational specialists and the general public regarding the notion of virtue in Japan. Our study found that, in contrast to educational specialists, the general public were not so familiar with the notion; both had a positive image of virtue and a poor understanding of the Confucian notions of virtue; both retain Buddhist values under the term of virtue, but educational specialists tended to associate ancient Greek and Western elements with the notion of virtue. Educational specialists emphasized active, intellectual virtues, such as practical wisdom, whereas the general public emphasized passive, emotional virtues, such as gratitude. Our study showed that, the notion of virtue was understood in different ways between educational specialists and the general public in Japan. This finding has several social implications, such as academic integrity and educational policy.

Ethics of Treatment Decisions for Extremely Premature Newborns with Poor Prognoses: Comparison of Shared Decision Making in Norway and Japan.

Ethical debates about the life-prolonging treatment of extremely premature infants and infants with congenital abnormalities with poor prognoses have long been held. We will examine approaches in Norway and Japan as examples because Norway is a well-known welfare state. By comparing the traditional Norwegian approach, the newly proposed approach of postponed withholding (PPWH) and the Japanese approach, we will revisit shared decision making in neonatology in general, where patients (i.e., newborns) inevitably have no decision-making capacity. We argue that in shared decision making, the process is critical, and that it is important to clarify who will be the final decision-maker and whose benefits are most important. In addition, we argue that the issue of cost cannot be avoided in this current time of economic disparities in global health. Shared decision making should not be a mere formality. These are significant examples of new ethical debates to be discussed in the modern era in the neonatology field.

Facts and Recommendations regarding When Medical Institutions Report Potential Abuse to Child Guidance Centers: A Cross-Sectional Study.

BACKGROUND: Medical institutions are required to report suspected cases of child abuse to administrative agencies, such as child guidance centers in Japan. It is left to the discretion of the medical institutions whether to notify the family of the child or the center. However, it is unclear what kinds of measures are being taken to ensure a robust policy of notification versus non-notification and how notifying the family will affect the child. METHODS: An unregistered questionnaire survey on reporting suspected child abuse cases to child consultation centers and notifying families was conducted by mail across 518 pediatric specialist training facility hospitals designated by the Japanese Pediatric Society. RESULTS: Responses were received from 323 facilities (62.4% response rate), of which 5 facilities were excluded because of incomplete responses. Therefore, in all, 318 facilities were included in the analysis. The results showed that 59.8% of the facilities had a policy of notifying the family, 33.7% said the decision varies from case to case, and 6.6% did not have a policy of notifying the family. The facilities that had a policy of either notifying or not notifying the family were less likely to experience problems than those with a policy of deciding on a case-by-case basis. The proportion of cases in which some problems occurred was higher in the cases where families were notified than in the cases where they were not, with 51.4% of the children experiencing worsening of relationships with family members. In the cases where the families were not notified, the children were twice as likely to experience further abuse than in cases where the families were notified. CONCLUSION: Problems arise in the case of both notification and non-notification. It is necessary to examine background factors and specific methods of notification in the cases where problems arise.

Over-the-Counter Drug Misuse and Dependence: Public Health Ethics' Foray into Fight against the Codeine Crisis.

Over-the-counter (OTC) drugs, such as codeine, are available as an OTC drug at common drugstores and major e-commerce platforms, despite their known propensity for causing psychological dependence and harm from overuse. Misuse of and dependence on over-the-counter drugs are serious public health issues. Possible measures include stricter regulation and control, as well as regulation of access to information and awareness activities, but their effectiveness is limited. Up-scheduling, in which OTC drugs are placed under prescription or full regulation, is expected to have a definite effect. However, up-scheduling poses public health ethical challenges. Up-scheduling restricts the freedom of consumers to purchase OTC drugs, and the economic right of manufacturers and sellers. Up-scheduling may also interfere with people's right to seek self-care through the proper use of OTC drugs. Limited up-scheduling with respect to age may be an effective way to implement up-scheduling while avoiding ethical issues. However, from a public health perspective, it is necessary to improve the information infrastructure so that prescription drug information can be shared electronically, and to strengthen measures to prevent mental health problems among young people that lead to OTC drug misuse, even after up-scheduling.

The Ethical Acceptability of a Recipient's Choice of Donor in Directed and Nondirected Transplantation: Japanese Perspective.

In organ transplantation, there is a lack of ethical discussion about the recipient's right not to receive a transplant. Using the current situation of living organ transplantation and deceased organ transplantation in Japan as an example, we prospectively discussed to what extent the recipient's right not to receive a transplant is ethically acceptable. In directed transplantation from a living donor, a recipient may refuse organ donation from a particular donor. It is preferable that a recipient's request for organ donation from a donor occurs as part of a transparent process. In nondirected transplantation from a deceased donor, refusal of transplantation from a particular type of donor appears potentially justifiable. There are both moral and pragmatic considerations. Certain refusals based solely on belief are morally unacceptable, and refusal to transplant a recipient based on the donor's age jeopardizes the entire transplant system. When religious beliefs affect mental and physical health, individualized measures are required for transplant rejection. We also deductively developed a prospective argument based on the current status of donor-recipient communication in living organ transplantation in Japan and the 2010 amendment of the law allowing relatives to be given priority in organ transplantation from deceased donors.

The creation of the Belmont Report and its effect on ethical principles: a historical study.

The Belmont Report continues to be held in high regard, and most bioethical analyses conducted in recent years have presumed that it affects United States federal regulations. However, the assessments of the report's creators are sharply divided. Understanding the historic reputation of this monumental report is thus crucial. We first recount the historical context surrounding the creation of this report. Subsequently, we review the process involved in developing ethical guidelines and describe the report's features. Additionally, we analyze the effect of unfolding events on the subsequent creation of federal regulations, especially on gene therapy clinical trials. Moreover, throughout this paper we evaluate the ethical principles outlined in this report and describe how they overlap with the issue of protecting socially vulnerable groups. Based on the analysis, we conclude that the features of the Belmont Report cannot be considered as having affected the basic sections of the federal regulations for ethical reviews that were made uniform in 1981. Nevertheless, regarding the regulations on gene therapy clinical trials-which were at first expected to be applicable to research involving children-in addition to implementing policies regarding the public review of protocols that passed ethical review, this report's principles are clearly reflected in the key notes that should have been referred to when the report was created.

Autonomy in Japan: What does it Look Like?

This paper analysed the nature of autonomy, in particular respect for autonomy in medical ethics/bioethics in Japan. We have undertaken a literature survey in Japanese and English and begin with the historical background and explanation of the Japanese word Jiritsu (autonomy). We go on to identify patterns of meaning that researchers use in medical ethics / bioethics discussions in Japan, namely, Beauchamp and Childress's individual autonomy, relational autonomy, and O'Neill's principled autonomy as the three major ways that autonomy is understood. We examine papers discussing these interpretations. We propose using the term 'a form of autonomy' first used by Edmund Pellegrino in 1992 and examine the nature of 'a form of autonomy.' We finally conclude that the crux of what Pellegrino calls 'something close to autonomy,' or 'a form of autonomy' might best be understood as the minimization of physician paternalism and the maximization of respect for patient preference. Simultaneously, we introduce a family-facilitated approach to informed consent and respond to criticism by Laura Sullivan. Finally, we discuss cross-cultural approaches and global bioethics. Furthermore, we use the term 'Bioethics across the Globe' instead of 'Global Bioethics', calling for international scholars to write works to provide an in-depth understanding of each country. We conclude that deep understanding of others is pivotal for dialogue to be of value. We hope this article will deepen the reader's understanding of Japan and will contribute to the progress of bioethics worldwide.

Wearable Technology for Monitoring Respiratory Rate and SpO2 of COVID-19 Patients: A Systematic Review.

With the significant numbers of sudden home deaths reported worldwide due to coronavirus disease 2019 (COVID-19), wearable technology has emerged as a method for surveilling this infection. This review explored the indicators of COVID-19 surveillance, such as vitals, respiratory condition, temperature, oxygen saturation (SpO2), and activity levels using wearable devices. Studies published between 31 December 2019, and 8 July 2022, were obtained from PubMed, and grey literature, reference lists, and key journals were also searched. All types of articles with the keywords "COVID-19", "Diagnosis", and "Wearable Devices" were screened. Four reviewers independently screened the articles against the eligibility criteria and extracted the data using a data charting form. A total of 56 articles were on monitoring, of which 28 included SpO2 as a parameter. Although wearable devices are effective in the continuous monitoring of COVID-19 patients, further research on actual patients is necessary to determine the efficiency and effectiveness of wearable technology before policymakers can mandate its use.

What Does It Mean to Truly Empathize with a Patient? An Analysis of Japanese Cases Employing the Narrative Approach Perspective.

What does it mean to truly empathize with a patient? The authors (a psychiatrist and a philosopher) explore this topic from the unique perspectives gained from decades of experience. We discuss how some approaches that may be criticized are necessary if we are to empathize with a patient. We also touch on the current situation surrounding personnel involved in the restoration of the Fukushima Daiichi Nuclear Power Plant (the so-called Fukushima 50) after the nuclear meltdown caused by the Great East Japan Earthquake in 2011. We conclude with what we have learned to truly emphasize with patients from these cases: (1) small deviations seem to be useful sometimes; (2) healthcare professionals do not have to be too hard on themselves to empathize with patients, and a natural, narrative approach-based attitude is sometimes more than enough; and (3) physical stance, in addition to psychological stance, might also be a factor. Moreover, we look at the idea of the "village society" and argue that it is necessary for medical professionals to be fully aware of the negative connotations of village societies.

Decision-Making Capacity to Refuse Treatment at the End of Life: The Need for Recognizing Real-World Practices.

End-of-life decision making is a troublesome ethical dilemma. These decisions should be made in trustful patient-doctor relationships. We aimed to propose a balanced approach when discussing this complex issue. We categorized the research into four approaches and suggest that a multidisciplinary approach may be appropriate. We also analyzed the pitfalls of the multidisciplinary approach. Our conclusion is two-fold. First, discussions in this field should be based on real-world practice. If this is not the case, the proposal may be armchair theory, which is not effective in a clinical setting. Second, interdisciplinary researchers should not stick to their position too firmly and should listen to others. Otherwise, proposals made will be paternalistic or philosophically biased. Therefore, when philosophical collaboration is applied to the topic of clinical bioethics, it is necessary to thoroughly examine different positions and carry out careful discussions with consideration for medical care settings. Researchers must also understand what is needed for a trustful patient-doctor relationship. By making such efforts, clinical bioethics will contribute to the wellbeing of patients.

Is It Worth Knowing That You Might Die Tomorrow? Revisiting the Ethics of Prognosis Disclosure.

Ethical discourse on prognosis disclosure is not yet well established. The core of the problem continues to be the dilemma between the right of self-determination and non-maleficence of patients. The prognosis disclosure policy based on Kantian autonomy provides a good solution for the problem. The policy includes demand for strict truth telling and its compatibility with patients' best interest. However, there remains a discrepancy between theory and practice, especially when prognosis is disclosed just prior to their death. Kantian theory of prognosis is supplemented by a moralistic perspective. The moralistic perspective places high importance on temporality and relationships with others, which all human beings inherently possess. From the moralistic viewpoint, decisions about prognosis disclosure at the final stages of life must be individualized in order to be authentically autonomous. The decision to disclose a prognosis or not can only be determined by the relationships fostered over time with patients.

Narratives on the Current Medical Situation in Japan According to Highly Specialized Foreign Professionals.

In order to understand the difficulties faced by highly skilled foreign professionals when dealing with the Japanese healthcare system and to identify the support they require therein, university health center staff members of the Okinawa Institute of Science and Technology Graduate University conducted semi-structured interviews with faculty, staff, and students from the Institute. Data from the interviews were analyzed by subject matter analysis using a narrative-oriented approach. In total, 13 participants were interviewed, and five themes and 15 subthemes were generated from the 40 codes extracted. Although participants considered themselves to be accepting of other cultures and made little mention of the need for cultural and religious considerations that previous studies have identified as important, they reported that their experiences receiving healthcare in Japan were fraught with many difficulties. They felt that the capacity to communicate in Japanese was a prerequisite for receiving appropriate healthcare and that hospitals should assume the responsibility of providing language support. While they reported satisfaction with the easy and inexpensive access to advanced medical equipment and specialists in Japan, they also noted challenges in selecting medical institutions and departments, the flow and procedures in the hospital, and building open and direct relationships with doctors. In addition, based on the present study, people with chronic illnesses felt isolated from the community, worried about a lack of privacy, and wanted a primary care physician they could trust. In order to provide appropriate healthcare to foreigners, we require an accurate understanding of their needs, how to address these comprehensively and in a multifaceted manner, and how the communication responsibilities should be shared among the involved parties (i.e., foreign care recipients and Japanese medical professionals).

An Exploratory Study on Information Manipulation by Doctors: Awareness, Actual State, and Ethical Tolerance.

(1) Background: To what extent is information manipulation by doctors acceptable? To answer this question, we conducted an exploratory study aimed at obtaining basic data on descriptive ethics for considering this issue. (2) Methods: A self-administered questionnaire survey was conducted on a large sample (n = 3305) of doctors. The participants were queried on (1) whether they consider that information manipulation is necessary (awareness), (2) whether they have actually manipulated information (actual state), and (3) their ethical tolerance. (3) Result: The response rate was 28.7%. Sixty percent of the doctors responded that information manipulation to avoid harm to patients is necessary (awareness), that they have actually manipulated information (actual state), and that information manipulation is ethically acceptable. (4) Conclusion: While the present survey was conducted among doctors in Japan, previous studies have reported similar findings in the United States and Europe. Based on our analysis, we hypothesize that a relationship of trust between patients and medical personnel is crucial and that information manipulation is not needed when such a relationship has been established.

An American's Experience with End-of-Life Care in Japan: Comparing Brain Death, Limiting and Withdrawing Life-Prolonging Interventions, and Healthcare Ethics Consultation Practices in Japan and the United States.

American and Japanese laws, customs, and practices in end-of-life decision-making differ significantly. We present a case with which one of the authors was involved to illustrate some of the key legal and cultural differences in the declaration of brain death, limiting and withdrawing life-prolonging interventions, and healthcare ethics consultation practices. The analysis presented facilitates understanding of similarities and differences between Japanese and American healthcare ethics specifically in regards to end-of-life care. Further, the analysis provides insights that can aid in developing policies and practices in regions where multiple cultures coexist.