Title:
Toward an empowering ethics in healthcare and research

Narifumi Nakaoka
(Clinical Philosophy, Graduate School of Letters , Osaka University )

Abstract:
I want an alternative ethics, based on imagination, power of design, self-control in a broader context.
I will try to offer a platform on which to reconsider ethical problems?why do you think Englishmen are famous for humor, for example?

１ What is ethics?

1.1 Ethics is not law
1.1.1 ‘Ethics’ derives from the Greek word ‘ethos,’ which means character or custom; how things are, not how they should be.
1.1.2 In reference to ethics people tend to mean regulation or compliance. Even law, however, has a creative aspect, as is shown in the new citizen judge system (saiban-in).

1.2 Ethics is not “Don’t bother other people”
Don’t bother other people! ? OK, but the rule can’t be universalized.
1.2.1 Is whistle-blowing, i.e. informing the public that the company he or she is working for is doing something wrong or illegal, unethical?
1.2.2 Is paternalism of a physician ethical?

1.3 Perception is central to Ethics
Practical ethics requires not knowledge but perception or awareness.
Look around yourself, become aware, get trained to think; or use your imagination and attempt thought experiments.

2 Thought experiments in ethical contexts
Some thought experiments can help you extend your ethical imagination, but …
2.1 mathematical or physical types such as non-Euclidean geometry
theoretically productive despite of ? or just because of – counter-intuitiveness
You know also which conditions are altered and which are not.

2.2 historical types such as: “If Cleopatra had had a flat nose, the whole surface of the earth would have been different”
These lack theoretical productivity because we know no legitimate way of detaching the altered condition from unaltered ones (say, the noses of her parents) in configuration with the former.

2.3 The “Suppose the patient before you were a robot” remark
It caused heated discussion between nurses and Clinical Philosophers in 1999.
Is this kind of imagination inhuman or legitimately philosophical?
When do nurses need imagination that distances them from status quo?
Possibly in case they are to have Indonesian or Philippine nurses as their team mates?

3 Do you cross the street on a red light?
It’s my usual question in the information ethics class.
The aim: challenge the students to reflect on for what and how we must obey laws ? without giving away your initiative

3.1 The question or ? more accurately ? the set of questions proceed as follows:
•  Question A): red light, no car at all in sight – will you then cross the road or not?
•  Question B): the same situation as A, but this time you are with a small child (or a child nearby is watching you closely) ? will you then cross the road nor not? Have you perhaps given a different answer?

3.2 Points to be considered here :
Risk assessment both for yourself and for others around you
Meaning of obeying traffic laws
Possible dilemma between obeying social norms and independent thinking and action, the latter being quite important for researchers
reconsideration of your own ethical attitude in relation to other people

4 Healthcare professionals facing commercialism
Should patients be protected from commercialism? ? Example of genetic DTC (Direct-to-consumer) business
Japanese genetic counselors might be liberated from the regulation-oriented idea that most consumers lack genetic literacy, therefore…Impression of overprotection

 5 Ethics within ELSI
‘Ethical’ problems are to be restructured and reconsidered in the perspective of ELSI (Ethical, Legal and Social Issues)
ELSI initially in the field of SciTech communication
The examples of genetic DTC and of ‘ethics’ of nanotechnology
Ethical issues (values + communication) + LS Issues 

6 Moral agents are ‘organismic’
Human capacity and limitation due to being an organism? ethical discussion without this perspective is empty. We need a ‘sustainable’ ethics.

6-1 Example of a medical student during anatomy practice
Cut out an ear from a donor body, put it against the wall saying, “Walls have ears!”
The faculty of medicine expelled him from the university
Now, how far was his behavior “unscrupulous” as the medical professors condemned, given the pressure of anatomy practice for young students ?

6-2 What morality can we expect from human beings as organisms?
Black humor might be tolerated in some contexts (overstress etc.).