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As the number of dementia patients increases, there is a need to protect patients’ right to know. However, in reality, there are cases in Japan where spouses’ deaths are concealed from patients. We conducted a questionnaire survey of care managers (CMs) to obtain their attitude and actual behavior regarding the disclosure of a spouse’s death to patients with dementia. A self-administered, anonymous questionnaire survey was implemented at academic meetings attended by CMs from March to December 2019, inquiring about experiences with spousal deaths of patients with dementia, disclosure rates, behavioral and psychological symptoms of dementia, and depression. Over 80% had experienced the spousal death of a patient with dementia; the percentage of CMs who had implemented the disclosures varied widely. About 18% had experienced worsening behavioral and psychological symptoms of dementia (BPSD), and 26% had worsening depression as a result of the disclosure. About 83% of respondents were positive about disclosure, but about 44% did so less than 50% of the time. This study is the first to reveal the current state of CMs’ policies and behaviors regarding the disclosure of spousal death to patients with dementia in Japan. Family members’ wishes and the possibility of BPSD put a relatively large number of caregivers in a dilemma regarding disclosure.

In recent years, “difficult” patients have gained attention, and behavior contracts have been introduced into clinical practice. This is because some patients behave inappropriately toward healthcare providers, and behavior contracts require patients to refrain from such behavior. However, it has been highlighted that behavior contracts have ethical problems. We present an ethical analysis of behavior contracts from the viewpoint of psychiatric practice and patient psychology. We analyze why patients become “difficult” for medical practitioners and explain why consideration must be given to the psychological aspects of the patient and the burden of mental illness. Behavior contracts are inappropriate because they do not consider individual patients’ psychological or psychiatric conditions and are applied uniformly. Moreover, the behavioral model that behavior contracts assume is not justified by today’s psychiatry. Furthermore, in this article, we show how behavior contracts promote the stigmatization of mental illness. For these reasons, we argue that the use of behavior contracts in clinical practice is not ethically justified. However, we add that physical violence against healthcare providers should not be tolerated under any circumstances.

The number of child abuse cases has been increasing in Japan every year. Medical institutions face issues such as coordinating with welfare offices, child guidance centers, police, and other related agencies concerning child abuse, as well as communicating with parents/guardians who are perpetrators of child abuse. This study examined the awareness and actual behavior of medical institutions regarding the support required while notifying/reporting cases of child abuse. A self-administered and anonymous questionnaire survey was conducted among the staff of the pediatrics departments, emergency departments, and general affairs departments of large hospitals in Japan. Differences in notifying and reporting child abuse cases to the child guidance center and welfare office and the police were assessed. It was found that some cases were not reported to the child guidance center or welfare office despite being considered “abuse.” Furthermore, a difference of opinion was observed among staff members, especially in judging “whether abuse is suspected or not.”

Background: Medical institutions are required to report suspected cases of child abuse to administrative agencies, such as child guidance centers in Japan. It is left to the discretion of the medical institutions whether to notify the family of the child or the center. However, it is unclear what kinds of measures are being taken to ensure a robust policy of notification versus non-notification and how notifying the family will affect the child. Methods: An unregistered questionnaire survey on reporting suspected child abuse cases to child consultation centers and notifying families was conducted by mail across 518 pediatric specialist training facility hospitals designated by the Japanese Pediatric Society. Results: Responses were received from 323 facilities (62.4% response rate), of which 5 facilities were excluded because of incomplete responses. Therefore, in all, 318 facilities were included in the analysis. The results showed that 59.8% of the facilities had a policy of notifying the family, 33.7% said the decision varies from case to case, and 6.6% did not have a policy of notifying the family. The facilities that had a policy of either notifying or not notifying the family were less likely to experience problems than those with a policy of deciding on a case-by-case basis. The proportion of cases in which some problems occurred was higher in the cases where families were notified than in the cases where they were not, with 51.4% of the children experiencing worsening of relationships with family members. In the cases where the families were not notified, the children were twice as likely to experience further abuse than in cases where the families were notified. Conclusion: Problems arise in the case of both notification and non-notification. It is necessary to examine background factors and specific methods of notification in the cases where problems arise.

Ethical debates about the life-prolonging treatment of extremely premature infants and infants with congenital abnormalities with poor prognoses have long been held. We will examine approaches in Norway and Japan as examples because Norway is a well-known welfare state. By comparing the traditional Norwegian approach, the newly proposed approach of postponed withholding (PPWH) and the Japanese approach, we will revisit shared decision making in neonatology in general, where patients (i.e., newborns) inevitably have no decision-making capacity. We argue that in shared decision making, the process is critical, and that it is important to clarify who will be the final decision-maker and whose benefits are most important. In addition, we argue that the issue of cost cannot be avoided in this current time of economic disparities in global health. Shared decision making should not be a mere formality. These are significant examples of new ethical debates to be discussed in the modern era in the neonatology field.

The World Economic Forum’s Gender Gap Index shows the serious nature of Japan’s gender gap. The gender gap with respect to political and economic participation is obvious. The percentage of women in the Diet (the national parliament) is significantly low, and few women hold management positions. Although not shown in the Gender Gap Index, there are hidden gender inequalities in education and health care in Japan. These gender inequalities are largely due to the remnants of Japan’s traditional family culture and customs. In order to empower Japanese women from the confines of the family and community, drastic measures guided by the principles of gender equality, diversity, and inclusion are needed. A quota system is one of the most important strategies to achieve this, and the time has come for Japan to seriously discuss the introduction of a quota system in politics, corporate culture, and university entrance examinations.

The Roe v. Wade case, which legally supported abortion in the U.S., was overturned in 2022, and the international conversation about reproductive justice gained momentum as a result. Reproductive justice is a concept that advocates reproductive freedom (the freedom to have/not have children and the freedom to raise children in a healthy environment) for all couples and individuals. This paper introduces the family care relationship in reproductive justice and presents a concept of reproductive justice. By incorporating family care relationships in the concept of reproduction, the complexity and uniqueness of the reproductive choice process are preserved. Family care relationships are well suited for focusing on family-centered societies and the processes leading to abortion care, and autonomous decision-making in reproductive choice can be strengthened. It is important to explore appropriate support methods from the dynamism of the caring network, advocate for positive freedom, and settle the decision-making power in a moderated position, even with some abandonment of individualism.

During the COVID-19 pandemic, the socially vulnerable were placed in an even more difficult position. High school and college liberal arts education on social justice is needed to address the possible emerging and re-emerging infectious disease pandemics. A desirable educational curriculum to actualize this should include (1) Basic Theory of Ethics and Social Justice—justice and goodness, justice in Ancient Greece, deontology, utilitarianism, and the principle of inequality—, (2) Social Justice Theories—liberal egalitarianism, communitarianism, and social structural approach, (3) Psychology and Behavioral Economics—social intuitionist model, implicit association test, and nudge—, and (4) Advocacy—racism and xenophobia, elderly, disabilities, women, gender and justice—. The curriculum on social justice aims to help students understand the value of social justice, recognize inequality and disparity in society, and acquire the ability to address the widening social gap and inequality. The concept of justice is internationally diverse. Thus, extracting “social justice” in the context of each country’s culture and adding it to the social justice education curriculum is important.

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.

End-of-life decision making is a troublesome ethical dilemma. These decisions should be made in trustful patient–doctor relationships. We aimed to propose a balanced approach when discussing this complex issue. We categorized the research into four approaches and suggest that a multidisciplinary approach may be appropriate. We also analyzed the pitfalls of the multidisciplinary approach. Our conclusion is two-fold. First, discussions in this field should be based on real-world practice. If this is not the case, the proposal may be armchair theory, which is not effective in a clinical setting. Second, interdisciplinary researchers should not stick to their position too firmly and should listen to others. Otherwise, proposals made will be paternalistic or philosophically biased. Therefore, when philosophical collaboration is applied to the topic of clinical bioethics, it is necessary to thoroughly examine different positions and carry out careful discussions with consideration for medical care settings. Researchers must also understand what is needed for a trustful patient–doctor relationship. By making such efforts, clinical bioethics will contribute to the wellbeing of patients.

(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.

Decisions regarding invasive ventilation with tracheostomy (TIV) in patients with amyotrophic lateral sclerosis (ALS) involve serious ethical issues. Cultural differences in the attitudes of patients, caregivers, and physicians toward TIV initiation and withdrawal decisions have been analyzed based on a narrative review approach, comparing the situation between Japan and the U.S. Three main issues were identified regarding the implementation of TIV. The first is the lack of Advance Care Planning. Second, some patients may choose TIV based on the wishes of their physicians or caregivers, even if the patients themselves do not want TIV in the Japanese context. Third is the influence of patient associations, which advocate for the protection of patients’ rights. Next, this study identifies the following issues related to TIV discontinuation. The main concern here is cultural differences in legislation and ethical intuitions regarding the discontinuation of TIV. The treatment guidelines for patients with ALS advise physicians to reassure patients that TIV can be withdrawn at any point. However, TIV withdrawal is not explicitly discussed in Japan. Moreover, Japanese ALS treatment guidelines state that ventilation withdrawal is currently impossible, due to a lack of legal support. Most Japanese physicians have told patients that they are not allowed to stop ventilation via such a request. Unlike in the U.S., withholding and withdrawing ventilators are not ethically equivalent in Japan. In conclusion, the decision-making process regarding TIV is difficult, not only for the patients and caregivers, but also for physicians. Even if patients are legally entitled to refuse unwanted treatment, there have been cases in which Japanese physicians have felt an ethical dilemma in stopping TIV for patients with ALS. However, few studies have investigated in detail why physicians oppose the patient’s right to discontinue TIV in Japan.

Abstract Background With a recent increase in the prevalence of autism spectrum disorder (ASD), an important issue has emerged in clinical practice regarding when and how patients themselves should be given explanations following a diagnosis of ASD. The clinical guidelines of the UK National Institute for Health and Care Excellence state that children diagnosed with ASD should receive an explanation about what ASD is and how it affects their development and functioning—“if appropriate”. However, the guidelines do not provide any specifics regarding what constitutes “appropriate” situations Methods We conducted an anonymous self-administered postal questionnaire survey targeting all members of the Japanese Society for Child and Adolescent Psychiatry (n=1,995). The analysis included only physicians who had newly diagnosed pediatric patients with ASD in the past year. We imposed a limit of one year because diagnoses further back than that are difficult to recall; in other words, this would enhance the recall bias Results The recovery rate was 30.8%, and the rate of diagnosis disclosure to patients themselves without intellectual disability was 15.3%. We asked 361 physicians who responded that “deciding on a case-by-case basis” was the ideal way to disclose an ASD diagnosis about 20 items prioritized by physicians at the time of diagnosis disclosure and extracted three factors through exploratory factor analysis. Multiple logistic regression analysis was performed with physician attributes, awareness of ASD as a disorder or personality, and the three extracted factors as explanatory variables; diagnosis disclosure was the dependent variable. The patient age group and only one of the three factors (i.e., “factor related to readiness to accept diagnosis”) showed a significant association with disclosure of the diagnosis to the individual. Items included in the “factor related to readiness to accept diagnosis” were as follows: the degree of parental understanding, relationship of the patient with their parents/physician, agreement in opinion between parents, parental consent, “sufficient” patient understanding, symptom stabilization, and a guarantee of sufficient time required to explain the diagnosis to the patient Conclusion In clinical settings, disclosing an ASD diagnosis with the consideration of patient/parent readiness toward accepting the diagnosis could help to guide physicians in determining an ideal timing for disclosure. Future studies are needed to establish detailed and concrete guidelines regarding disclosure of an ASD diagnosis to patients.

Manuscript writing support services using AI technology have become increasingly available in recent years. In keeping with this trend, we need to sort out issues related to authorship in academic writing. Authorship is attached to the contribution of researchers who report innovative research, the originality of which forms the core of their identity. The most important originality is demonstrated in the discussion of study findings. In the discussion section of this paper, we argue that if a researcher uses AI-based manuscript writing support to draft the discussion section, this does not necessarily diminish the researcher’s originality. Rather, AI support may allow the researcher to perform creative work in a more refined fashion. Presumably, selecting which AI support to use or evaluating and properly adjusting AI would still remain an important aspect of research for researchers. It is thus reasonable to view a researcher as a cooperative existence realized through a network of cooperative work that includes the use of AI. Discussions on this topic will be scientifically and socially important as AI technology advances in the future.

In a 2021 survey, we found that “limit or suppression experiences” were related to a willingness to use enhancement technologies. However, the concept of “limit or suppression experiences” is vague and difficult to interpret in relation to neuroethics/enhancement. Thus, we aimed to better understand “limit or suppression experiences” and establish a robust philosophical concept of the topic. To do so, we exploratively investigated the concept to determine individual experiences with the presence or absence of sensing limits, investigate different ways in which limits can be sensed (factors of the sense of limits: “FSLs”), and identify factors that correlate with the strength of FSLs. Data from an Internet survey investigating respondents’ experiences with limits (1258 respondents) were analyzed using exploratory factor analysis and a linear regression model. Five variables were extracted as the FSLs. The highest regression coefficients were found between physical FSL and sports activities and between cognitive FSL and academics. The lowest regression coefficients were found between relational FSL and academics, sports activities, and arts and cultural activities. The results facilitate a detailed discussion of the motivations of enhancement users, and the extraction of the suppression experience opens new enhancement directions. Further normative and empirical studies are required.

The aim of this study is to provide basic information that contributes to vaccine inoculation policy after COVID-19. We used the secondary data of the influenza vaccine inoculation behavior survey for community-dwelling adults conducted in 2011, before the COVID-19 pandemic, but after the 2009 novel influenza A (H1N1) pdm 09 pandemic. All factors such as socio-demographic characteristics, health-related behaviors, family environment, physical and social environment, and area of residence were adjusted, and factors related to vaccine inoculation behavior were analyzed. Those living with pregnant women had a significantly higher odds ratio of inoculation; this was self-evident in that those people considered infection to their family. Regarding the social environment, those aged 20–64 years with a significantly higher adjusted odds ratio of inoculation were those with “at least five people with which they interacted in the neighborhood”. This result can be interpreted in two ways relating to altruism in Japan. Finally, we indicated the importance of learning from the past, including the case of 2009.

Abstract Background Solitary death (kodokushi) has recently become recognized as a social issue in Japan. The social isolation of older people leads to death without dignity. With the outbreak of COVID-19, efforts to eliminate solitary death need to be adjusted in line with changes in lifestyle and accompanying changes in social structure. Health monitoring services that utilize wearable devices may contribute to this end. Our goals are to outline how wearable devices might be used to (1) detect emergency situations involving solitary older people and swiftly connect them with medical treatment, to (2) reduce the frequency of deaths that remain undiscovered and (3) to reduce social isolation by promoting social interaction. Methods Theoretical and philosophical approaches were adopted to examine ethical issues surrounding the application of wearable devices and cloud-based information processing systems to prevent solitary death in the world with/after COVID-19. Main body (1) Technology cannot replace social connections; without social support necessary to foster understanding of the benefits of health management through wearable devices among older adults, such devices may remain unused, or not used properly. (2) Maturity of the technology; systems face the difficult task of detecting and responding to a wide range of health conditions and life-threatening events in time to avert avoidable morbidity and mortality. (3) Autonomy and personhood; promoting the voluntary use of wearable devices that are a part of larger efforts to connect isolated individuals to a community or social services might be effective. Legal force should be avoided if possible. There is some concern that landlords may require an older person to sign a contract agreeing to wear a device. The autonomy of solitary older people should be respected. (4) Governance: policies must be developed to limit access to data from wearables and the purposes for which data can be used. Conclusion If thoughtfully deployed under proper policy constraints, wearable devices offer a way to connect solitary older people to health services and could reduce cases of solitary death while respecting the personhood of the user.

Abstract Background The present study aimed to characterize factors associated with patients issued DNR orders during hospitalization who are discharged alive without any instruction orders by physicians regarding end-of-life treatment, with a focus on the timing of DNR order issuance. Methods In total, 2997 DNR cases from all 61,037 patients aged ≥20 years admitted to a representative general hospital in Tokyo were extracted and divided into two groups by patient hospital release status (discharged alive/deceased). Study items included age, sex, disease type (non-cancer/cancer), hospital department (internal medicine/others), timing of DNR order issuance, implementation (or not) of life-sustaining treatment (LST) or the presence of any restrictions on LST and hospital length of stay. We conducted multiple logistic regression analysis, setting hospital release status as the dependent variable and each above study item as explanatory variables. Results DNR orders were issued at a rate of 4.9%. The analysis revealed that patients with a DNR who were ultimately discharged alive were statistically more likely to be those for whom DNR orders are issued early after admission (adjusted odds ratio: AOR, 13.7), non-cancer patients (AOR, 3.4), internal medicine department patients (AOR, 1.63), females (AOR, 1.34), and elderly (aged ≥85 years; AOR, 1.02); these patients were also less likely to be receiving LST (AOR, 0.36). Conclusions By focusing on those with DNR orders who were ultimately discharged alive, we discovered that these patients were likely to have DNR orders issued early after admission, and that they were more likely to be elderly, female, non-cancer patients, or those in internal medicine departments. Further examination of these data may help to elucidate why these particular DNR-related characteristics (including socio-economic and cultural factors) are evident in patients who end up being discharged alive.

A follow-up study was conducted 25 years after the 1997 British Medical Journal report. Articles with at least one Japanese author were defined as ‘Article by Japanese’ and those with no Japanese authors were defined as ‘Article by Non-Japanese’. The number of authors per article for the years 2000, 2010, and 2020 in Circulation, Circulation Research, and the Japanese Circulation Journal was studied. Results are: (1) In all journals and all years covered, ‘Article by Japanese’ had more authors per article than ‘Article by Non-Japanese’. Twenty-five years later, the results were similar. (2) Comparison by year revealed that all journals showed increases with time in the number of authors per article. We have discussed the problem of the Science Council of Japan’s statement, influence on practising physicians and sample providers, and influence on international collaborations. This 25-year follow-up study highlights once again the need for global discussions on the qualifications for authorship in research studies.

With the significant numbers of sudden home deaths reported worldwide due to coronavirus disease 2019 (COVID-19), wearable technology has emerged as a method for surveilling this infection. This review explored the indicators of COVID-19 surveillance, such as vitals, respiratory condition, temperature, oxygen saturation (SpO2), and activity levels using wearable devices. Studies published between 31 December 2019, and 8 July 2022, were obtained from PubMed, and grey literature, reference lists, and key journals were also searched. All types of articles with the keywords “COVID-19”, “Diagnosis”, and “Wearable Devices” were screened. Four reviewers independently screened the articles against the eligibility criteria and extracted the data using a data charting form. A total of 56 articles were on monitoring, of which 28 included SpO2 as a parameter. Although wearable devices are effective in the continuous monitoring of COVID-19 patients, further research on actual patients is necessary to determine the efficiency and effectiveness of wearable technology before policymakers can mandate its use.

What does it mean to truly empathize with a patient? The authors (a psychiatrist and a philosopher) explore this topic from the unique perspectives gained from decades of experience. We discuss how some approaches that may be criticized are necessary if we are to empathize with a patient. We also touch on the current situation surrounding personnel involved in the restoration of the Fukushima Daiichi Nuclear Power Plant (the so-called Fukushima 50) after the nuclear meltdown caused by the Great East Japan Earthquake in 2011. We conclude with what we have learned to truly emphasize with patients from these cases: (1) small deviations seem to be useful sometimes; (2) healthcare professionals do not have to be too hard on themselves to empathize with patients, and a natural, narrative approach-based attitude is sometimes more than enough; and (3) physical stance, in addition to psychological stance, might also be a factor. Moreover, we look at the idea of the “village society” and argue that it is necessary for medical professionals to be fully aware of the negative connotations of village societies.

In order to understand the difficulties faced by highly skilled foreign professionals when dealing with the Japanese healthcare system and to identify the support they require therein, university health center staff members of the Okinawa Institute of Science and Technology Graduate University conducted semi-structured interviews with faculty, staff, and students from the Institute. Data from the interviews were analyzed by subject matter analysis using a narrative-oriented approach. In total, 13 participants were interviewed, and five themes and 15 subthemes were generated from the 40 codes extracted. Although participants considered themselves to be accepting of other cultures and made little mention of the need for cultural and religious considerations that previous studies have identified as important, they reported that their experiences receiving healthcare in Japan were fraught with many difficulties. They felt that the capacity to communicate in Japanese was a prerequisite for receiving appropriate healthcare and that hospitals should assume the responsibility of providing language support. While they reported satisfaction with the easy and inexpensive access to advanced medical equipment and specialists in Japan, they also noted challenges in selecting medical institutions and departments, the flow and procedures in the hospital, and building open and direct relationships with doctors. In addition, based on the present study, people with chronic illnesses felt isolated from the community, worried about a lack of privacy, and wanted a primary care physician they could trust. In order to provide appropriate healthcare to foreigners, we require an accurate understanding of their needs, how to address these comprehensively and in a multifaceted manner, and how the communication responsibilities should be shared among the involved parties (i.e., foreign care recipients and Japanese medical professionals).

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.

Neuroenhancement is rapidly re-emerging as a research topic because of the development of minimally invasive brain intervention technologies, including neurofeedback. However, public attitude toward enhancement technologies remains relatively unexplored. To fill this gap in the literature, we conducted an online survey of 1258 people in Japan who were presented with four scenarios depicting minimally and highly invasive enhancement interventions. Approximately 20% of the respondents stated that they were willing to use enhancement technologies, whereas 80% were not. Most respondents were cautious about using enhancement technologies. We used a generalized linear mixed-effects model to study the association between the type of intervention and participants’ willingness to use such technologies. Factors related to willingness to use these technologies included interventions’ degree of invasiveness, as well as participants’ gender, educational attainment, and limit or suppression experiences. We also examined the influence of others’ choices and behaviors, and participants’ tolerance toward others’ use of enhancement technologies. We explored important aspects of policymaking vis à vis enhancement technologies. This study could provide valuable insights for a debate on the ethics and regulation of enhancement technologies.

Abstract 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.

Memory manipulation technology has the potential to disrupt the social value of memory. Although the development of pharmacological interventions aimed at alleviating the fear conditioning that causes post-traumatic stress disorder has been challenging, there has now been significant technical progress in manipulating fear conditioning through the use of neurofeedback technologies. The manipulation of memory is often criticized on the basis of the social value of memory, as well as on the grounds of preservation of personal identity and authenticity. The social value of memory has been overestimated and has normatively hindered the application of memory manipulation technologies. Even if the manipulation of memory interfered with the social value of memory, it would be permissible, provided it was limited. When a memory is related to an illegal or unethical behavior, the preservation of memory's social value should be given priority. The modification of collective memory can also lead to historical revisionism. Recognizing the social nature of memory, and endorsing, preserving, and narrating it, is supererogatory. [ABSTRACT FROM AUTHOR]