Abstract The nature of doctor-patient relationships (DPRs) and decision-making style (DMS) is related to patient satisfaction, clinical outcomes, and the occurrence of disputes. Given the importance of understanding the current state of DPRs, we conducted an exploratory analysis of the current state of DPRs and DMS in clinical settings in China and Japan. We explored similarities and differences between the two countries, as well as influential factors in DPRs and DMS. Twenty doctors in China and 20 doctors in Japan were recruited through the authors’ personal networks as well as snowball sampling, and semi-structured interviews were conducted. Doctors were asked about mainstream DPR models and DMS in current medical practice, and their responses were analyzed using qualitative descriptive methods. Results of the analysis suggest that, in both China and Japan, a diverse mosaic of DPRs and DMS coexists. In both countries, there are paternalistic relationships between doctors and patients, as well as teacher-and-student relationships, but there are also cases in which patients make final decisions and those which adopt shared decision-making. Some doctors referred to DPRs as a friendship. Furthermore, attitudes of individual doctors and patients, the medical environment, trust between the two parties, and national and cultural characteristics strongly impact the formation of DPRs. Our findings highlight the importance of carefully monitoring the current state and various influencing factors of DPRs in order to realize effective human relationships in clinical settings.

In this paper, we set out to examine the implications of a Daoist philosophical perspective within the clinical encounter. Specifically, we will explore how the unique and sometimes radical views of the Ancient Daoist philosopher Zhuangzi (and the concepts of ziran "nature" or "spontaneity", the fasting of the "heart-mind" cheng xin , and wuwei "non-action") can invite us to reframe and reconceptualize some of the common assumptions that currently govern the doctor-patient relationship, as well as prompt us to reflect anew upon the proper goals and scope of medical practice itself. We take the view that ethics need not be limited to a set of rules. Ethics can be thought of as a set of skills and abilities that include perspective taking, tolerance and openness to experiences. This allows us to explore and critically engage with Zhuangzi's unique philosophy and appreciate its contribution to the bioethics literature, in particular with its applications in caring for patients with disability and chronic illness. Our analysis leads us to coin the term "reciprocal-emerging" to express the dynamic and transformational of nature of the doctor-patient relationship through a Zhuangzian lens.

Abstract On March 30, 2020, as volunteers of the Biomedical Ethics Study Group, we prepared an article entitled “Recommendations for Establishing a Ventilator Allocation Process during the COVID-19 Pandemic,” which was published on the group’s website and subsequently received various criticisms in Japan. In this current study, we categorized these criticisms into two types: those directed at the recommendations as a whole and those concerning the individual contents presented. We then examined the criticisms’ validity and highlighted the issues that need to be addressed in the future. These issues included measures to limit situations wherein triage is applied, the impact of the triage flowchart on the sense of responsibility among medical and nursing careworkers, a law approach to protect these healthcare providers and medical institutions implementing triage, criteria for maximizing the number of lives saved, measures to guarantee patients’ voluntary will in withholding or withdrawing treatment for triage, a system for implementing triage in the community, and the appropriate crisis standard of care during a pandemic. Assuming that all ethical, legal, and other issues related to triage must be fully resolved before its implementation, especially in a situation where the timing of an outbreak is uncertain, seems inappropriate. However, to respond as effectively as possible to future pandemics, healthcare institutions need to address these issues and establish a valid system now, even if only incrementally.