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.

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.

Psychosocial and Ethical Behaviors and Attitudes of Health Care Professionals in the Clinical Setting of Living Kidney Donors: A Qualitative Study.

BACKGROUND: There are several psychosocial and ethical issues surrounding the decision making of living kidney transplant donors. This study aimed to determine what health care professionals (HPs) consider in their clinical practice and their attitudes toward donors' decision-making processes. METHODS: Face-to-face semistructured interviews were conducted with 15 HPs. A thematic analysis was performed to categorize the thematic elements of the transcripts. All procedures were approved by the relevant review board and conducted in accordance with the Declaration of Helsinki. RESULTS: Six main categories-maintaining family relationships, improving donor understanding, supporting voluntary decision making, setting the environment for the examination, having different attitudes toward the donor's intentions, and resisting confirmation of intent-were identified. The HPs provided diverse considerations to respect the donors' autonomy. CONCLUSION: In clinical practice, there is a lack of practical methods to confirm living donors' levels of understanding and spontaneity, suggesting that these methods need to be established. Factors related to family functioning may reflect the unique culture of Japan, and this may be indicative of the need to consider treatment based on cultural values.

Sacrificing the Fukushima 50 again?

BACKGROUND: In the aftermath of the 2011 Fukushima nuclear plant accident, many workers helped restore the contaminated site, exposing themselves to a highly radioactive environment. They were referred to as the 'Fukushima 50' and applauded as heroes who saved Japan. A cohort study targeting those emergency workers is, currently, underway. We object to the study on ethical grounds. METHODS: Ethical and content analyses. RESULTS: First, the low participation rate raises ethical questions about why potential participants declined. Content analyses of nuclear power plant workers' narratives from a television broadcast extracted eight recurrent themes: disposable, treated like a sacrificial pawn, taboo, fear of contamination, readiness to risk one's life, distrust and dissatisfaction with the nation's response, regret over participating and uncertainty about the future. Second, the unscientific nature of the cohort design undermines the ethical basis for conducting it. Third, public resources were allocated in a way that compromises justice. CONCLUSIONS: We urge re-considering the current Fukushima 50 research study. We also urge applying the public funds now invested in this research project to activities that would directly benefit the Fukushima 50, such as offering free lifetime healthcare and direct financial compensation.

Beliefs held by breast surgeons that impact the treatment decision process for advanced breast cancer patients: a qualitative study.

INTRODUCTION: Although guidelines do not recommend chemotherapy for patients with advanced cancer when death is imminent, many reports suggest the tendency to continue this treatment has been increasing every year. This study aimed to construct a model to clarify the beliefs and communication of doctors who administer chemotherapy to patients with recurrent or metastatic (hereafter, "recurrent/metastatic") breast cancer, and determine how these beliefs are related to the process of treating patients. MATERIALS AND METHODS: Semi-structured interviews were conducted with 21 breast surgeons, and interview contents were analyzed using the grounded theory approach in order to conceptualize the treatment process. RESULTS: The process of chemotherapy for patients with recurrent/metastatic breast cancer differed based on two beliefs held by doctors. One was a "belief that the patient is an entity who cannot accept death," and throughout the treatment process, these doctors consistently avoided sharing bad news that might hurt patients, and always discussed aggressive chemotherapy. They proposed treatments as long as options remained, and when they ultimately judged that the physical condition of patients could not withstand further treatment, treatment was terminated despite the patient hoping for continuation. The other was a "belief that the patient is an entity who can accept death." From early on after recurrence/metastasis, these doctors repeatedly gave patients information including bad news about prognosis, and when they judged that further treatment would hinder a patient's ability to have a good death, they proposed terminating treatment. CONCLUSION: We demonstrated that breast surgeons treating recurrent/metastatic breast cancer patients have two beliefs and constructed a model of the treatment process based on those beliefs. This offered breast surgeons, who make decisions regarding treatment without clearly-defined guidelines, a chance to reflect on their own care style, which we believe will contribute to optimal patient care.