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A report on small team clinical ethics consultation programmes in Japan
  1. M Fukuyama1,2,
  2. A Asai2,
  3. K Itai3,
  4. S Bito4
  1. 1
    Department of Nursing, School of Health Sciences, School of Medicine, Kumamoto University, Kumamoto, Japan
  2. 2
    Department of Bioethics, Kumamoto University Graduate School of Medical Science, Kumamoto, Kumamoto, Japan
  3. 3
    Department of Social Medicine, Division of Biomedical Ethics, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
  4. 4
    Division of Clinical Epidemiology, National Hospital Organization, Tokyo Medical Center, Clinical Research Center, Tokyo, Japan
  1. Dr A Asai, Department of Bioethics, Kumamoto University Graduate School of Medical Science, Kumamoto, 1–1–1 Honjo, Kumamoto, 860–8556, Japan; aasai{at}


Clinical ethics support, including ethics consultation, has become established in the field of medical practice throughout the world. This practice has been regarded as useful, most notably in the UK and the USA, in solving ethical problems encountered by both medical practitioners and those who receive medical treatment. In Japan, however, few services are available to respond to everyday clinical ethical issues, although a variety of difficult ethical problems arise daily in the medical field: termination of life support, euthanasia and questions about patient autonomy.

In light of these conditions, a group of 17 volunteer educators and researchers from the area of biomedical ethics, including the authors, have formed the Clinical Ethics Support and Education Project, and began providing Japan’s first small team clinical ethics consultation service in October, 2006. Members include scholars of biomedical ethics, scholars of philosophy and ethics, legal professionals and legal scholars, nurses and doctors, consisting of five women and 12 men. Consultation teams, made up of a small number of members, were organised each time a request for consultation was received.

Over approximately 15 months (October 2006–December 2007), the programme received 22 consultation requests from medical practitioners and medical institutions, and three from the families of patients. In this paper, we will discuss the status of our consultation service and examples of consultation cases we have handled. In addition, we will examine the process of evaluating small team clinical ethics consultation services, as well as the strengths and weakness of such programmes.

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  • Additional data (Members of the clinical ethics support and education project) are published online only at

  • Funding: This study was supported by the grant from the Ministry of Health, Welfare and Labor, Scientific Research Expenses for Research on Clinical Decision Making and Quality Assessment and Improvement for Vulnerable Elderly and Terminal Patients (2004–2006 fiscal year, Principal Investigator: SB). The authors thank two reviewers for their valuable comments on the early draft of our paper.

  • Competing interests: None

  • Ethics approval: Kumamoto University Ethics Committee (Ethics No. 175: 6 September 2006).