Vanguard
Linking with Providers for an Integrated, Interdisciplinary Approach to Medical Law and Ethics
Advances in medical technology benefit us enormously,but they also raise new ethical and legal challenges for health-care providers. We spoke with Associate Professor Shoichi Maeda, whose interdisciplinary research grapples with these issues from the perspective of professionals at the front lines of medical care.
MAEDA, Shoichi
Associate ProfessorGraduate School of Health Management
Tackling the Legal and Ethical Challenges
of Advanced Medical Technology
Thanks to dramatic advances in medical
technology in recent years, doctors are able to extend the lives of
patients who formerly would have had no hope of survival. In many
cases, such medical advances bring enormous benefits, but in others,
the real value to the patient of advanced “life-prolonging
treatment” is questionable; it may simply not be what the patient
wants. In these circumstances, we need to ask whether and when it is
permissible to withdraw or withhold medical care. Inasmuch as a death
resulting from suspension of medical care could potentially be deemed
a homicide, such decisions can attract widespread media coverage and
have major repercussions for the treating physicians. In some
instances, the police have even intervened. End-of-life care issues
are not the only dilemmas facing health-care providers today.
Advances in assisted reproductive technology and other fields have
raised a host of new ethical and legal questions that demand careful
study and examination. I have focused my teaching and research
efforts to date on the aspects of medical ethics and law that deal
with these questions.
Merging Legal and Medical Studies
As an undergraduate student I
participated in an American law seminar offered by my university’s
Faculty of Law. I became interested in the legal and ethical issues
surrounding end-of-life care and decided to analyze pertinent US
court cases and laws and assess the status of end-of-life care in
Japan. As I continued to focus on this and similar topics in graduate
school, I began to see that I could not limit myself to an academic
approach circumscribed by the study of law if I wanted to shed real
light on both the legal and ethical issues of medical practice. I
also realized the need to bring to my research a detailed knowledge
of actual health-care settings and a solid grasp of social medicine,
including an understanding of health-care systems. It seemed to me
that the need for such an approach could only increase. I decided to
enroll in the Graduate School of Medical Sciences where I did more
than just learn the basics of medicine; I worked hard (or, more
accurately, was forced to work hard) to learn the methodology of
natural-science research, from epidemiology and statistics to research design. 
While studying law, I rarely had occasion to
approach a topic quantitatively and knew none of the fundamentals of
natural-science research. As a result, my studies at the Graduate
School of Medical Sciences were a struggle, at least at the outset.
The more I continued my research, the more the importance of natural
science research fundamentals became apparent. In the end I pursued
doctoral studies both at the Graduate School of Medical Sciences and
at the Graduate School of Law, and what struck me most forcefully in
both cases was the importance of mastering the methodology of one’s
field if one wants to study a topic rigorously. At the same time, I
became firmly convinced that, in areas like medical ethics, one can
only get so far within the confines of a single discipline. I
realized that an interdisciplinary, integrated approach was
necessary, and further that researchers and practitioners needed to
partner closely in approaching these issues.
Building a National Organization
In graduate school my interests
extended beyond end-of-life care to such topics in medical ethics as
informed consent, as well as management of patient safety and adverse
events. After graduate school, I began teaching at the Graduate
School of Medical Sciences, but I soon found myself involved also in
professional training for health-care personnel. For example, I made
use of the university’s extension-course system to pioneer a
professional development course on management of medical accidents
and issues in clinical ethics. The class, which was held on Saturdays
and Sundays for six months, was designed for a small number (30
students), but we received more than 200 enrollment requests each
time. Enrollees included administrators at major hospitals and
medical school professors. It made me acutely aware that we were
entering a new era. Feeling the need to reward and support those who
were ahead of the curve in their awareness of these issues, and also
to create a kind of national hub for education and research in this
field, I teamed with the graduates of my course to found the Society
of Medical Conflict Management in 2005. Today the society has about
1,100 members and serves as a base for relevant educational and
research activity in Japan.
Developing Problem-Solving Skills
Ever since I began teaching, another
concern of mine has been to incorporate innovative teaching methods
to ensure my students acquire not just knowledge but problem-solving
skills as well. For that purpose I have enlisted the cooperation of
organizations outside the university to provide real-world
educational opportunities. For example, for students in the Graduate
School of Medical Sciences, we conducted a mock trial of a medical
malpractice case at an actual courthouse. At Keio, many of my
projects are still in the planning phase, having recently joined the
faculty, but this academic year we held a mock Diet committee meeting
and Diet session with the help of the House of Councillors
Secretariat. At the mock committee meeting, which was held inside the
National Diet Building, members deliberated proposed legislation to
amend the Minor Drinking Prohibition Act and the Act on Prohibition
of Smoking by Minors. After the committee had considered the
substance of the legislation from an ethical and legal standpoint, a
mock Diet session was held to deliberate and vote on the bill.
Expectations of SFC Students
It seems to me that the research
carried out at SFC demands an integrated, interdisciplinary approach.
Much of it is also research of a highly practical nature, for which
integration with real working environments are of the essence. For
this reason, I want my students to collaborate actively with people
in other fields. However, as I explain on my faculty Web page, when
tackling topics that demand an integrated, interdisciplinary
approach, it is all the more vital to have mastered the fundamentals
of the disciplines involved. I want students to realize that while
those who plan to become practitioners or administrators may tackle
different topics from those aiming for a career in research, there
should be no difference in terms of the depth of their study. Rather
than confine their attention to what goes on inside the university, I
encourage my students to make a point of looking outward to see what
people are doing in other academic and nonacademic organizations, in
Japan and around the world, so they can build on their own relative
strengths, honestly acknowledge and address their weaknesses, and lay
the foundation they will need to become real players farther down the
road. My hope is that they will become front runners and opinion
leaders in their chosen fields.
A Brief Background of Associate Professor
MAEDA, Shoichi
Associate Professor Maeda completed his doctoral studies at the Kyushu University Graduate School of Medical Sciences, earning his Ph.D in medical science. After working as a assistant professor at the Kyushu University Graduate School of Medical Sciences, he joined the faculty of the University of Tokyo Graduate School of Medicine, serving as a project lecturer in the Center for Biomedical Ethics and Law and project associate professor for the Department of Patient Safety & Risk Management (during this time he also served as deputy director of the Patient Relations and Clinical Ethics Center at the University Hospital). In 2009 he joined the Keio University Graduate School of Health Management as associate professor. His specialties are biomedical ethics (medical law, clinical ethics, and research ethics) and medical safety management. He is currently (as of 2010) active on committees within the Common Achievement Tests Organization and the Japan Council for Quality Health Care, as well as a number of clinical societies and medical facilities. His major publications include Byoin rinri iinkai to rinri konsaruteshon (translation of Ethics by Committee: A Textbook on Consultation, Organization, and Education for Hospital Ethics Committees) (Tokyo: Keiso Shobo, 2009), which he co-translated; Iryo jiko shoki taio—Sono riron to jissen [Initial Management of Medical Accidents—Theory and Practice] (Tokyo: Igaku-Shoin, 2008) and Infomudo konsento [Informed Consent] (Tokyo: Igaku-Shoin, 2005), which he edited.
The Society of Medical Conflict Management
(12 December 2010)
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