Although euthanasia has been a pressing ethical and public issue, empirical data are lacking in Japan. We aimed to explore Japanese nurses’ attitudes to patients’ requests for euthanasia and to estimate the proportion of nurses who have taken active steps to hasten death. A postal survey was conducted between October and December 1999 among all nurse members of the Japanese Association of Palliative Medicine, using a self-administered questionnaire based on the one used in a previous survey with Australian nurses in (...) 1991. The response rate was 68%. A total of 53% of the respondents had been asked by patients to hasten their death, but none had taken active steps to bring about death. Only 23% regarded voluntary active euthanasia as something ethically right and 14% would practice it if it were legal. A comparison with empirical data from the previous Australian study suggests a significantly more conservative attitude among Japanese nurses. (shrink)

ABSTRACT Objectives: the purpose of this study is to explore laypersons’ attitudes towards and experiences of medical research, and to compare them with those of physicians in Japan. Designs and Participants: fourteen Japanese adults from the general public and seven physicians participated in one of three focus interviews. Setting: Osaka, Japan. Results: trust and distrust in the physician by whom the participants were invited to participate in research played a considerable role in their decisions about participation. That the participants felt (...) an obligation to participate was also expressed. The lay participants perceived medical research as something entirely outside of their world. A greater willingness to volunteer for research was expressed if there were direct benefits to themselves or their families. Research methods such as use of placebos, double blinds, and randomisations seemed to cause negative attitudes to medical research. All physicians were convinced of the need for medical research, including double‐blinded randomised control trials, and its significant role in medical progress. Most physicians thought that the greater awareness of the need for medical research in the community and a better understanding of the psychology of potential research participants were necessary and urgent. Conclusions: there is a good possibility that the lay public and medical professionals have sharply different beliefs about and attitudes towards every aspect of medical research. Building up a better and equal patient‐doctor relationship based on trust is a key issue in medical research, and it is mandatory to fill the gap in perception regarding medical research between them through fully informed debates. (shrink)

Background: Patients in different countries have different attitudes toward self‐determination and medical information. Little is known how much respect Japanese patients feel should be given for their wishes about medical care and for medical information, and what choices they would make in the face of disagreement. Methods: Ambulatory patients in six clinics of internal medicine at a university hospital were surveyed using a self‐administered questionnaire. Results: A total of 307 patients participated in our survey. Of the respondents, 47% would accept (...) recommendations made by physicians, even if such recommendations were against their wishes; 25% would try to persuade their physician to change their recommendations; and 14% would leave their physician to find a new one. Seventy‐six percent of the respondents thought that physicians should routinely ask patients if they would want to know about a diagnosis of cancer, while 5% disagreed; 59% responded that physicians should inform them of the actual diagnosis, even against the request of their family not to do so, while 24% would want their physician to abide by their family's request and 14% could not decide. One‐third of the respondents who initially said they would want to know the truth would yield to the desires of the family in a case of disagreement. Interpretations: In the face of disagreement regarding medical care and disclosure, Japanese patients tend to respond in a diverse and unpredictable manner. Medical professionals should thus be prudent and ask their patients explicitly what they want regarding medical care and information. (shrink)

What should Japanese doctors do when asked by a patient for active voluntary euthanasia, when the family wants aggressive treatment to continue? In this paper, we present the results of a questionnaire survey of 366 Japanese doctors, who were asked how they would act in a hypothetical situation of this kind, and how they would justify their decision, 23% of respondents said they would act on the patient’s wishes, and provided reasons for their view; 54% said they would not practice (...) VE, either because they were opposed to VE as such, or because they believed that the wishes of the patient’s family should be respected.Analysis of these responses yielded the following results: Doctors willing to respect the patient’s wishes defended their decision by highlighting the significance of patient autonomy and the patient’s exclusive ownership of his or her life; doctors unwilling to act on the patient’s wishes fell into two broad categories — those who based their reasoning on the family’s objections, and those who provided other reasons for refusing VE. Respondents who said they would not comply with the patient’s wishes because of family objections provided the following kinds of rationale: doctors have serious responsibilities not only to the patient, but also to the patient’s family; the importance of the family-doctor relationship; fear of lawsuits for murder and related criminal offences; the need for agreement among all those affected by the decision, and the belief that the patient’s life is not his or her own, but the family’s. Respondents who gave non-family centred reasons for not complying with the patient’s wishes pointed to values such as the sanctity of life, or the importance of a natural deathIn the remainder of this paper, we discuss the implications of a family-centred approach to VE. (shrink)

Pyridoxal 5′‐phosphate, the vitamin B6 derivative, acts as the coenzyme of many enzymes involved in amino acid metabolism. Exceptionally, this compound was found covalently bound to glycogen phosphorylase, the key enzyme in the regulation of glycogen metabolism. Although it is essential for the function of phosphorylase, its direct role has remained an enigma. We have recently found that the glucose moiety of pyridoxal (5′)diphospho (1)‐α‐D‐glucose, a conjugate of pyridoxal 5′‐phosphate and glucose 1‐phosphate through a pyrophosphate linkage, is transferred to the (...) nonreducing end of glycogen, forming a new α‐1,4‐glucosidic linkage. This finding emphasizes the importance of the direct phosphate‐phosphate interaction between the coenzyme and the substrate in the phosphorylase catalytic reaction. We have proposed a catalytic mechanism for phosphorylase in which the phosphate group of pyridoxal 5′‐phosphate acts as an electrophile to the phosphate group of glucose 1‐phosphate. This appears to represent the first instance of the direct involvement of a phosphate group in catalysis by enzymes. (shrink)

In a study concerning visual body part recognition, a “self-advantage” effect, whereby self-related body stimuli are processed faster and more accurately than other-related body stimuli, was revealed, and the emergence of this effect is assumed to be tightly linked to implicit motor simulation, which is activated when performing a hand laterality judgment task in which hand ownership is not explicitly required. Here, we ran two visual hand recognition tasks, namely, a hand laterality judgment task and a self-other discrimination task, to (...) investigate whether the self-advantage emerged even if implicit motor imagery was assumed to be working less efficiently and how individual traits [such as autistic traits and the extent of positive self-body image, as assessed via the Autism Spectrum Quotient and the Body Appreciation Scale-2, respectively] modulate performance in these hand recognition tasks. Participants were presented with hand images in two orientations [i.e., upright and upside-down ] and asked to judge whether it was a left or right hand. They were also asked to determine whether it was their own, or another person’s hand. Data collected from men and women were analyzed separately. The self-advantage effect in the hand laterality judgment task was not revealed, suggesting that only two orientation conditions are not enough to trigger this motor simulation. Furthermore, the men’s group showed a significant positive correlation between AQ scores and reaction times in the laterality judgment task, while the women’s group showed a significant negative correlation between AQ scores and differences in RTs and a significant positive correlation between BAS-2 scores and dprime in the self-other discrimination task. These results suggest that men and women differentially adopt specific strategies and/or execution processes for implicit and explicit hand recognition tasks. (shrink)

Little is known about health of the growing subpopulation of the working poor in Japan. We aimed to evaluate health status and healthcare utilization in relation to income among Japanese working adults. We conducted a one-month prospective cohort study using a health diary in working adults from a nationally representative random sample in Japan. Based on the government criterion, the working poor group was defined as earning an equivalent annual income of less than 1.48 million Japanese-yen. For health status, we (...) measured symptomatic episodes and health-related quality of life (HRQOL). For healthcare utilization, we measured frequencies of visits to a physician or pharmacy, and use of complementary and alternative medicine (CAM). We constructed multiple linear regression models for these measures adjusted for age, gender, and co-morbidity, using annual equivalent income as a 4-level categorical variable. (shrink)