Published papers

Aim: This study aimed to clarify physicians’ awareness of and attitudes toward family presence during resuscitation (FPDR) and related factors. Subject and methods: A web-based questionnaire survey was conducted of 7859 physicians who were members of the Japanese Society of Intensive Care Medicine (survey period: October 12, 2022, to December 31, 2022). Focusing on cardiopulmonary arrest, the survey questioned their awareness and attitudes, with a comparison of exogenous and non-exogenous patients. Results: The proportion of respondents who have family present during resuscitation was 100 (25.0%) for exogenous and 105 (29.2%) for non-exogenous. The proportion who believed that the family’s acceptance of death is greater with FPDR was 255 (61.7%) for exogenous and 245 (65.7%) for non-exogenous. The proportion who believed that the family’s acceptance of death is greater with FPDR included a significantly higher number of respondents who had family present than in the proportion who believed that FPDR has no effect. The proportion who believed that the family is emotionally traumatized by FPDR was 251 (60.8%) for exogenous and 217 (58.2%) for non-exogenous. The proportion who believed that families are emotionally traumatized by FPDR included a significantly higher number of respondents who do not have family present than the proportion who believed that FPDR has no effect. Conclusion: Various international resuscitation guidelines have recommended FPDR from an early stage to alleviate grief and prevent mental disorders. However, these guidelines are not always followed in Japan.

Radiologic errors arise from the interaction of human fallibility and systemic weakness. Using a fatigue-related missed renal mass, this paper proposes a model that joins two complementary duties: ethical transparency through disclosure and apology, and system redesign grounded in Just Culture and human factors engineering. Together, these principles create a sustainable path toward safety. We outline common malpractice sources, offer practical guidance for disclosure and apology, and emphasize institutional strategies that transform individual error into system learning and patient-centered improvement.

This study examined a discrepancy that exists between the duration of resuscitative efforts that physicians perceive as appropriate and the duration that laypersons desire. We conducted an online nationwide cross-sectional survey with 323 physicians and 2,667 laypersons. Physicians were significantly more likely than laypersons to consider a duration of ≥ 30 min as appropriate for resuscitation, especially in younger patients (age 0–6:85% vs. 27%; age 7–17:84% vs. 29%; both p < 0.001). Although these responses arise from fundamentally different psychological frames, identifying this discrepancy may provide a conceptual foundation for discussing more appropriate termination-of-resuscitation approaches in real-world clinical settings.

Background: The Act Regarding the Promotion of the Appropriate Supply of Hematopoietic Stem Cells for Transplant regulates only how public banks store and provide umbilical cord blood (UCB) for research or transplantation. Japan had no laws to regulate how the private banks manage the procedures, harvesting, preparation, and storage of such blood. As a result, the status of UCB distribution remains unknown. We conducted a survey to investigate the current status of UCB storage and provision to private biobanks by Japanese institutions that handle childbirth. Methods: Questionnaire forms were mailed to 3,277 facilities handling childbirth that were registered in the Japan Council for Quality Health Care website. Results: Of the 1,192 institutions handling childbirth that participated in the survey (response rate: 36.7%), 34.4% responded that they currently provide UCB to private biobanks, while 16.1% of facilities did so in the past. Moreover, some institutions currently provide or formerly provided UCB to medical treatment facilities (2.6%), research institutions (5.9%), companies (2.2%), or overseas treatment facilities, research institutions, or companies (0.3%). A certain number of institutions handling childbirth did not even provide explanations or obtain consent when the UCB was harvested from private bank users. Conclusions: This is the first study to determine the status of UCB provision to private banks by Japanese institutions handling childbirth. Future studies will need to examine in detail how institutions handling childbirth provide explanations to private bank users and UCB providers as well as how these institutions obtain consent.

Retrospective observational studies using medical records require researchers to guarantee the right to opt out of the study. However, is it also necessary to confirm whether the medical professionals who created those medical records permit their use as well? In this article, we consider possible options based on a fictitious scenario. Based on our deliberations, we recommend that the information be disclosed on the hospital’s homepage or in leaflets (principal investigator: hospital director), and, similar to patients, attending physicians should be given the opportunity to opt out. We also recommend that an application be submitted to the hospital’s research ethics committee. In this paper, we address the public interest aspect of the use of patient information as a primary item for ethical scrutiny. In addition to research ethics, this particular point underscores the importance of public health ethics, particularly as they pertain to the conflict between individual freedom and public interest.

(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.

Background: This paper examines the ethical aspects of organ transplant surgery in which a donor heart is transplanted from a first recipient, following determination of death by neurologic criteria, to a second recipient. Retransplantation in this sense differs from that in which one recipient undergoes repeat heart transplantation of a newly donated organ, and is thus referred to here as "reuse cardiac organ transplantation." Methods: Medical, legal, and ethical analysis, with a main focus on ethical analysis. Results: From the medical perspective, it is critical to ensure the quality and safety of reused organs, but we lack sufficient empirical data pertaining to medical risk. From the legal perspective, a comparative examination of laws in the United States and Japan affirms no illegality, but legal scholars disagree on the appropriate analysis of the issues, including whether or not property rights apply to transplanted organs. Ethical arguments supporting the reuse of organs include the analogous nature of donation to gifts, the value of donations as inheritance property, and the public property theory as it pertains to organs. Meanwhile, ethical arguments such as those that address organ recycling and identity issues challenge organ reuse. Conclusion: We conclude that organ reuse is not only ethically permissible, but even ethically desirable. Furthermore, we suggest changes to be implemented in the informed consent process prior to organ transplantation. The organ transplant community worldwide should engage in wider and deeper discussions, in hopes that such efforts will lead to the timely preparation of guidelines to implement reuse cardiac organ transplantation as well as reuse transplantation of other organs such as kidney and liver.