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2005.05.25 ワシントン大学医学部医学史・倫理学科での講演[仏教徒の観点からヘルス・ケアの決定」 
Decision Making in Healthcare from a Buddhist Viewpoint, 11:30-12:30 Conference Rooms A & B,
Department of Medical History and Ethics, Medical School, University of Washington, Seattle, U.S.A.  

2005/5/25 仏教徒の観点からヘルス・ケアの決定(52分) mp3/24.2MB
 四十年前、日本のガン治療の現場では、次のような「実例」と称するエピソードが真剣に語られました。一つは、ある高僧がガンに罹った。自分は、何を宣告されても驚きはしない。病名を教えろと弟子に命じます。悟りを開いた偉い師匠でございますから、「それでは」と、ガンを告知したところが、動揺して食事も喉を通らず、死期を早めたというものです。二つは、ある高名なガン専門の教授がガンに罹ります。おおよそ自覚症状からガンと自己診断をしているが、本当のことを告げて欲しいと弟子の専門医に頼みます。教授がそう仰るのであればと、病名を告げます。ところが教授は、動けるうちにと、全財産を使い果たして家族が困った、と言うエピソードであります。ともにガンの告知は、絶対にしてはならないと言うものです。(52分 日本語)

In mid-6th century, Buddhism came to Japan through China.  Along with the teachings of Chinese medicine, came Buddhist beliefs.  So, it can be said that Japanese view of life and death originated from India.  It is a belief that when one dies, the body returns to earth and the spirit rests in peace with Buddha. However, in early 19th century… about 180 years ago, Japan incorporated medicine from Holland.  And a little later, about 130 years ago, Japan sent many students to Germany to study medicine.  As a result, western medicine became the primary part of Japanese medicine, and the Chinese medicine, which focused on nutrition and wellness, became a minor supporting existence to western medicine.

Before the times of modernization, there were countless infant deaths in Japan.  Even in the Imperial families and families of shoguns, where medicine was easily accessible, they used Chinese medicine; therefore, infant deaths used to be unavoidable.  However, with the adoption of western medicine, the average life span increased tremendously.  The effectiveness of western medicine, especially that of public hygiene, was also seen in the increased average life span in both Taiwan and Korea, which were under Japanese governance during that time.

However, very recently in Japan, there is a trend to reconsider Chinese medicine, because western medicine is based on the idea of subtraction.  “You can recover your health by finding what is bad and removing it.”  This is the idea of western medicine.  However, people started to realize that this idea my not be complete enough.  This is where Japanese medicine is, at this point in time; to try to cure illnesses by strengthening the body’s weak parts.  In other words, people’s thoughts of medicine are transferring from western ideas of subtraction to Chinese ideas of addition.

Until recently, Japanese medicine has advanced and developed by focusing solely on medical treatment, with the strong belief that that is the best for the patients.  However, it has come to our attention that a focus only on treatment may not be the best for patients.  For instance, a recent survey was conducted about the newest medical therapy, especially regarding organ transplantation from brain dead donors, and it showed that the opinions of the Japanese people regarding these topics were strongly rooted in the views of life and death.  As a result, it is being debated that the culture and awareness of patients must be considered, in conjunction with western medicine, during medical decision making.

First such movement was regarding the notice to patients about cancer.  To give you an idea of what the awareness was like 40 years ago in Japan, let me tell you these two episodes that doctors often told to families of cancer patients as actual cases. 

In one case, a high priest became ill with cancer.  As a high priest, he orders his disciples, “Tell me what disease I have.  I will not lose my composure.”  His disciples knew that the high priest was benevolent and full of wisdom, so they told him that he has cancer.  However, the priest was so shocked and distraught that he was not able to eat, resulting in his quick death. 

In the second case, a very well known professor who specializes in cancer became ill with the same disease.  He tells his students, “I specialize in cancer, and I can almost self-diagnose that I have cancer, but I am not 100% sure.  Will you tell me what I have?”  So, his students told him that he has cancer.  After hearing his diagnosis, the professor goes out and spends all of the money he can, while he is still able to move around, and the story ends with his family suffering the debt.  In both cases, the lesson is to never tell the patient that he or she has cancer. (52 minutes in Japanese)

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Decision Making in Healthcare from a Buddhist Viewpoint
Department of Medical History and Ethics, Medical School, University of Washington, Seattle, U.S.A.

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