ISSN 2433-8443

CBEL
REPORTInterdisciplinary Bioethics Research in Japanese and English

Volume 3
Issue 2

CBEL Report Volume 3, Issue 2
By The University of Tokyo Center for Biomedical Ethics and Law

All contents are OPEN ACCESS.

CBEL Report Volume 3, Issue 2: Contents
研究論文 -Regular Articles[1] Public Health and Ethical Consideration on the Quarantine of Diamond Princess
Reina Motegi, Junko Kiriya and Masamine Jimba

短報 –Letters[12] 遠隔医療の普及における信頼の重要性
木下翔太郎[14] ジャーナルインフォメーション（日本語＆英語）

CBEL Report Volume 3, Issue 2: Contents
Regular Articles (in English)
Public Health and Ethical Consideration on the Quarantine of Diamond Princess
Reina Motegi, Junko Kiriya and Masamine Jimba

Letters (in Japanese)
The Importance of Reliability in the Diffusion of Telemedicine
Shotaro Kinoshita

Journal Information (in Japanese & English)

Public Health and Ethical Consideration on the Quarantine of
Diamond Princess

CBEL Report Volume 3, Issue 2

Regular Article

Public Health and Ethical Considerations on the Quarantine of
Diamond Princess
Reina Motegi (The University of Tokyo)
Junko Kiriya (The University of Tokyo)
Masamine Jimba (The University of Tokyo)

Abstract:
Japan experienced a sharp increase of coronavirus disease 2019 (COVID-19) patients with the case of the cruise
ship Diamond Princess docked at Yokohama. The Japanese government decided to take the massive quarantine
measure to prevent the spread of the coronavirus in the country. However, the quarantine measure must be justified
with an ethical point of view since it imposed the threat to human rights. We used an analytic tool for public healthethics to discuss the case with ethical considerations, focusing on burdens of people on board and ways to minimize
them. Although the quarantine on the ship was proved to be effective in controlling the virus, it is important to further
discuss and seek the intervention that is evidence based, fairly implemented and socially acceptable.

Keywords:
public health ethics, ethics framework, COVID-19, quarantine, Diamond Princess

1. Introduction

1-2. Overview of Diamond Princess Cruise Ship Case

1-1. Background

The first case Japan faced this disease was a

The outbreak of novel coronavirus infectious

luxurious travel ship, called Diamond Princess thatdisease (COVID-19) caused by SARS-CoV-2 started incame back to Yokohama port with a number of

Wuhan, China, in December 2019 (Wu, Leung andpassengers infected with SARS-CoV-2. The cruise ship

Leung 2020), and it has spread all over the world. As ofembarked on a trip from Yokohama city, Japan on

September 1st, 2020, the total 25892040 people haveJanuary 20th, 2020 and had a total of 3711 people

been infected worldwide and 860322 of whom died ofonboard, 2661 of whom were passengers and 1045 were

the disease. Japan has confirmed the total 68392 cases

crews, from 57 countries. During the journey, awith more than 1200 death cases (Johns Hopkins

passenger, who got off in Hong Kong on January 25th,

Coronavirus Resource Center 2020).

had respiratory symptoms on the ship, and was tested
positive for COVID-19 on February 1st. The

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CBEL Report Volume 3, Issue 2

Reina Motegi, Junko Kiriya & Masamine Jimba

information was notified to Japan next day and an

which power can be right fully exercised over any

anchorage quarantine measure was initiated. All

member of a civilized community, against his will, is topassengers and crew members then underwent theprevent harm to others” (Mill 1977: 223). Thus, in theinitial health evaluation, the infection tests and theircontext of quarantine, the authority must clarify theclose contacts records were collected from February 3rd

situation that people who may have the virus are likely

to 5th and they found 10 positive cases (The Ministry of

to harm the uninfected individuals. It is also important

Health, Labour and Welfare 2020). After a course of

to note that they must justify the liberty violation of

inspections, the government adopted a mandatory

people in quarantine. However, to date, little is known

quarantine measure on the ship from February 5th toabout the extent to which the Japanese government

19th. On February 7th, thermometers were distributed

exercised COVID-19 quarantine on the ship with ethicalto all passengers and crews to self-monitor their bodyconsiderations.

temperature twice a day. The Fever Call Center (FCC)This article paid attention to quarantine on thewas also established on the cruise ship dedicated to calls

cruise ship from the ethical perspective becausefrom anyone who had suspicious symptoms. Finally,

quarantine imposes a heavy burden on individuals inafter 14 days of quarantine, people who had met theterms of their freedom, thus it requires the ethicalcriteria of disembarkation left the cruise ship.

considerations to justify beyond mere medical

It is important to distinct the technical differences

effectiveness (Wynia 2007).

between the public measure of quarantine and isolation.
Quarantine is defined as “separation and restriction of

1-3. Objective

the movement of people who were exposed to aGiven the significance of addressing the publiccontagious disease to see if they become sick.” On thehealth ethics in quarantine on the ship, it is important toother hand, isolation is defined as “separation of sickexamine how the quarantine measure should be

people with a contagious disease from people who are

ethically justified in the public health emergency.

not sick” (Centers for Disease Control and Prevention

Therefore, this article aimed to analyze the response of2017). On the ship, those who were tested positive were

the Japanese government to Diamond Princess Cruisetransferred to hospitals for insolation and care, and theShip case from an ethical perspective.

rest were kept on board for quarantine.
The basic ethical principle for public health is1-4. Analysis Tool

‘Harm Principle,’ and it helps us to address to what

We analyzed the case of Diamond Princess using

extent it is possible to restrict the freedom of individuals

an analytic tool for public health ethics created by Kassto achieve public health goals. The original libertarian,(2001). She suggests a 6-step framework that guides

John Stuart Mill said in his book, “On Liberty”, that the

public health experts or policy makers to choose aharm principle is the notion that “the only purpose forcourse of action that is ethically sound. She has applied2

Public Health and Ethical Consideration on the Quarantine of
Diamond Princess

CBEL Report Volume 3, Issue 2

this framework to the case of avian influenza and2. Ethical Evaluation Based on the Framework

discussed

2-1. Public health goal of the quarantine

theethicalissuesofitspandemic

preparedness program (Kass 2015). This framework

In the context of quarantine, the purpose is to limit

helps them to realize the moral issues surrounding

the spread of the disease by separating those who may

public health work and consider how to respond to them.

carry the virus from uninfected people (Ries 2006).

The first step of the framework is goal

However, the Japanese government did not clearly

identification. Public health work should aim at

explain the purpose of the quarantine measure on the

reducing morbidity or mortality of diseases. Second,cruise ship. According to the Quarantine Act (1951) inpublic health professionals ought to examine if

Japan, quarantine should be done to prevent the inflow

interventions are sufficiently supported by data orof epidemics into Japan. The article 1 of the Quarantine

evidence to reach goals, because the most of public

Act (1951) states that “the purpose of this Act is tohealth programs are based on certain assumptions thatprevent infectious disease-causing pathogens that are

they will achieve their stated goals at the end. Then, thenot native to Japan from entering the country via marine

third step is to identify what kind of burdens or harms

vessels or aircrafts as well as to ensure that necessary

could occur through the public health works. She

measures are taken to prevent other infectious diseases

presents three categories of burdens: risks to privacy

involving vessels

and

self-

quarantine measure ought to aim protecting health ofdetermination and risks to justice. Fourth, it is important

Japanese citizens and minimize the spread of the disease

to consider whether the burdens of interventions can be

as much as possible.

confidentiality,

risks

to

libertyandminimized without reducing its efficacy greatly. The

One

of

the

or

aircrafts.” Ultimately,

possiblereasons

behindthethepenultimate step of the framework is the fair distribution

government’s decision is that they had already predictedof benefits and burdens, which corresponds to the ethic

the spread of the virus within the ship. NIID (2020a)

principle of distribution justice. This asks us to treat

said that SARS-CoV-2 had been already spread in thepeople in a way that does not leave and discriminate

cruise ship before it arrived at Yokohama port on

specific group of people. Finally, it is ethically required

February 3rd, 2020 based on their epidemiologicalto compare whether the expected benefits outbalance

analysis data. One recent study also revealed that thethe burden of people.

COVID-19 outbreak has already expanded to most of

The information of Diamond Princess Cruise Ship

the decks before the arrival and quarantine (Tsuboi, etfor the analysis was collected from the official reports

al. 2020). It may have happened possibly viaof the Ministry of Health, Labour and Welfare and therecreational activities and communal spaces which were

National Institute of Infectious Diseases (NIID).

available to all passengers before quarantine (Rich2020).

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CBEL Report Volume 3, Issue 2

2-2. Effectiveness of the quarantine on achieving its
goal

Reina Motegi, Junko Kiriya & Masamine Jimba

2-3. Known or potential burden of the quarantine
For the quarantine measure, the costs for liberty

Kass (2001: 1778) argues that “as a rule of thumb,and self-governance are the most obvious threat tothe greater the burdens posed by a program the stronger

people during quarantine since it imposes a paternalistic

the evidence must be to demonstrate that the program

compliance (Kass 2001). Their autonomy was

will achieve its goals.” Selgelid (2009) also mentions

threatened during on the board quarantine. Moreover,that authorities should explain public health measuresthey were also exposed to physical and psychologicalwith the higher level of evidence when the basic therisks.

human right is at stake. Here arises another question:

First of all, there was a possibility of getting

what kind of and how much of evidence is enough toinfected by SARS-CoV-2 despite the government’s

justify the quarantine measure?

attempt to control the disease. Although those who had

While researchers emphasize the importance of the

been infected were sent to hospitals, there was still astrong scientific evidence, the effectiveness ofchance people remained would get infected. NIID

quarantine has not been proved yet. Moreover, the case(2020b) reported that the specimen of SARS-CoV-2 onof Diamond Princess occurred in the early phase of thethe ship was found mostly from the floor and pillows

global COVID-19 pandemic when the available

from passenger cabins. This evidence suggests that the

information in controlling the virus spread as well as thepassengers and crews were exposed to the high-risk

characteristics of the virus was extremely scarce.

environment. In addition, those who had underlying

Although quarantine was implemented in the past

medical conditions were facing the greater danger. Their

pandemics such as AIDS and SARS (Hoffman 2004;

medical supplies such as medications of diabetes or highGostin, et al. 2003), the outbreak on the cruise ship was

blood pressure were running out during quarantine anda unique environment and there was no case of suchsome of them could not receive them for a certain period

quarantine caused by the emerging infectious diseaseof time (The Asashi Shimbun 2020b).

(Tsuboi et al. 2020).

Another burden people under quarantine faced wasWith this situation in mind, the effectiveness ofthat quarantine placed a tremendous psychologicalquarantine depends heavily on outbreak stage and thestrain on the individuals. People on the ship was undertransmission characteristic (Gostin et al. 2020). Eventhe stress of restricted movement and had to bear thethough the high level of evidence is ideal, if the society

fear of SARS-CoV-2. According to the report from thefaces a greater risk, public health officials may have toDisaster Psychiatric Assistance Team (2020), over 100

use lower level of evidence before imposing coercive

people were exposed to the severe stress condition andmeasures, such as quarantine (Selgelid 2009).

they needed to receive psychological care immediately.
The crew members were under the double stressbecause they had a sense of responsibility as a crew and4

Public Health and Ethical Consideration on the Quarantine of
Diamond Princess

anxiety of the infection risk (The Japan Times 2020).

CBEL Report Volume 3, Issue 2

One possible option would be to quarantine on the

In addition to physical and psychological threatsland. However, it is important to remind that Yokohama,being on the ship, medical workers who have engaged

where the cruise ship arrived at, is the second populated

in Diamond Princess response faced on-the-the-job

city in Japan. The other possibility was to order homeharassment (The Japanese Association for Disasterquarantine to those who did not present the symptoms.

Medicine

healthQuarantine at home is a preferred method to control theexamination and inspections of the individuals on

outbreak because it is voluntary participation andaboard, prescription of necessary medications andrequires less liberty restriction (Certon and Landwirth

medical transport of those who were tested positive2005). However, in the case of Wuhan, China during(Anan et al. 2020). Although their works were essential

COVID-19 outbreak, the high transmission to family

to the quarantine management, the Japanese Association

members was reported after the home quarantine started

for Disaster Medicine (2020) reported that some

(Xu, et al. 2020). Therefore, the home might not work

medical workers who were dispatched to the cruise shipas the segregation facility in terms of protecting people

were being discriminated. They said at least one of

who have not been infected the virus.

2020).

They

performed

daily

workers had been called an “infection source” or “germs”

Consequently, in order to minimize burdens ofby their colleagues, and other workers could not go onto

quarantine, it is important to maximize the quality of life

the property of hospitals where they work. On top of(QOL) of the passengers and crew members to assure

them, some of their children were being asked to staytheir rights of reasonable lives. To maximize the QOL,home

the officials must protect passengers and crew members

from

their

kindergartens(The

Japanese

Association for Disaster Medicine 2020).

and ensure that they stay healthy including food, water,
place to rest, good medical care, sanitary facilities and2-4. Minimization of burdens

good hygiene (Nakazawa, et al. 2020).

Kass (2001: 1780) said “if two options exist to

As for the burden of medical workers, it isaddress a public health problem, we are required,important to consider the level of risk that they have to

ethically, to choose the approach that poses fewer risks

take by going into the cruise ship to save lives of others.

to other moral claims, such as liberty, privacy,

This poses the fundamental question in regard to theiropportunity, and justice, assuming benefits are notduties to treat. Even though health care professionals

significantly reduced.” Therefore, in addition to themight have a strong moral obligation to serve and accept

effort of minimizing burdens, the Japanese government

the extraordinary situations like pandemics (Kotalik

is required to consider a measure that is the most2005), it is by no means the society can disrespect the

ethically acceptable. Were there other options in thequality of their lives for the sake of saving the rest ofcase of Diamond Princess case?

citizens (Pahlman, Tohmo and Gylling 2010). The

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CBEL Report Volume 3, Issue 2

Reina Motegi, Junko Kiriya & Masamine Jimba

society should specify the threshold of duty because

resource. The priority of the screening was based on age

risk-taking commitment of health care professionals

and comorbidities because more than 30% ofshould not be taken for granted (Selgelid and Chenpassengers were over 70 years old. Passengers aged2008). If the society requires medical workers to serve

over 80 years prioritize first, followed by those in their

their duties, it is the government that has responsibility

seventies and so on (National Institute of Infectious

to support their works so that they can fully engage in

Diseases 2020a). NIID explained that the elderly andtheir roles without any disadvantages.

people with complications were prioritize because they
were more vulnerable to SARS-CoV-2 and the2-5. Fair implementation of the quarantine

transmission of the virus would cause severe healthThis part of framework corresponds to the notion

conditions.

of ‘Distributive Justice’, which requires the fair

According to “The Difference Principle” proposed

distribution of burdens and benefits in societies (Rawls

by John Rawls in his book, “A Theory of Justice”, those1999). Kass (2001: 1781) said neither public health

who were advantaged least should receive the greatest

burdens

providedadvantage (Rawls 1999: 53). In the case of Diamonddisproportionately, and the unfair distribution has to be

Princess, people who had to stay in the cabins withjustified with the scientific data.

negative result of inspections and crew members who

andbenefitsshouldbe

NIID (2020a) admitted that they could not isolate

were obliged to continue working can be regarded as the

everyone to private cabins, and most people stayed inleast-advantaged in terms of burdens during the

double rooms during quarantine on the cruise ship.

quarantine. Therefore, in order to justify the inequality

Given that the specimens of SARS-CoV-2 were highlyof their rights and liberties, it is also important to further

found in passenger’s cabins (National Institute of

the argument that aims to equally maximize the position

Infectious Diseases 2020b), people who had to use theirof the least advantaged.

shared rooms were at higher risk of infection. Thisshows that the government could not distribute the2-6. Balance between the benefits and burdens of theresources equally, and some people had to sacrificequarantine

more than others. However, at the same time, it was

In a general sense, quarantine must be the last

impossible to provide a single room to every single

resort in response to the public health emergency

people practically considering the number of cabins the

because it requires legal, ethical and logisticalcruise ship owned.

challenges (Gostin, et al. 2020). It is essential to

As for the screening evaluation, the government
could not initially perform COVID-19 testing to all

consider whether benefits of the individuals outweightheir burdens.

members on board due to the capacity limitation. Thus,

In contrast, when the decision has to made in athey had to prioritize some passengers to allocate thesituation like COVID-19 where little is known about its

6

Public Health and Ethical Consideration on the Quarantine of
Diamond Princess

CBEL Report Volume 3, Issue 2

risks, authorities might not have enough time togovernment to maintain, recognizing that somecompare and test the all available options. In fact, theinfringements of liberty and other burdens are

Japanese government had initially limited eligibility for

unavoidable” (Kass 2001: 1781). It opens the discussion

the inspections to those who had the symptoms before

on what benefits a society should gain through a public

the quarantine (The Asahi Shimbun 2020a), but they

health and why it cannot be obtained by other methods.

switched

toperformthesystematic

screeninginspections after the several confirmed cases on the ship.
This suggests that it was difficult for them to evaluate
the possible impact of the outbreak on the ship.

3. Discussion
This article examined the ethical issue on
quarantine in Diamond Princess Cruise Ship by using

There are several researches that have examined

the public health ethic framework. The argument

the efficacy of quarantine aboard (Zhang et al. 2020;highlighted that although the human rights of people

Mizumoto and Chowell 2020; Nishimura 2020; Tsuboi

during quarantine were at stake to some extent, theet al. 2020). Although their results are not precisely

response of Japanese government included the ethicalcorresponding, the overall results suggest that theconsiderations to maximize the benefits of thenumber of confirmed COVID-19 cases on the ship wereindividuals on board with the effort of isolation of

gradually decreased after the initiation of quarantine.

infected people in the early stage, prioritizing those who

Nishimura (2020) said that the movement restriction led

were the most at risk and providing the minimum

to reducing the case of secondary transmissions on

quality of living conditions to passengers. To make theboard. Tsuboi et al. (2020) discussed that the set ofgovernment led intervention better, it is important tocountermeasures such as the early isolation of infected

proceed the highly burdensome measure like quarantine

people, thermometer distribution, the establishment ofon the cruise ship with its transparency and

FCC and the systematic testing may have contributed toaccountability. Moreover, the ethical justification for thethe reduction of transmission.

burdens and benefits of interventions should be

Lastly, Nakazawa et al. (2020) point out that theprioritize including the principle they base on.

importance of ‘Procedural Justice’ in the government’s

This study has limitations. The whole argument

decision of quarantine aboard the ship. Although therelies on one framework. This might have narrowed theepidemiological effectiveness of an intervention wasperspective of the evaluation process. In addition, therevealed retrospectively, the ethical consideration

available data for the analysis was limited, and we could

during quarantine is also significant to make a betternot conduct interviews with those who were involved indecision. The Procedural Justice is a concept that

this case.

“requires a society to engage in a democratic process to

Despite the limitations above, this article may

determine which public health functions it wants its

present some insights to the public health work. To our

7

CBEL Report Volume 3, Issue 2

Reina Motegi, Junko Kiriya & Masamine Jimba

knowledge, this is the first article that specificallyfrom

focuses on the quarantine on Diamond Princess Cruise

May 2020]<https://medicine.yale.edu/yjbm/>[24

Ship from an ethical point of view. The authors believe

Disaster Psychiatric Assistance Team (2020) A Reportthat this article provides some insights on quarantine

on DPAT Activities on the Cruise Ship induring pandemics and similar situations where the

Response to the New Coronavirus [online]

society has to balance the benefits and burdens ofavailablequarantine. Nevertheless, the further ethical discussion<https://www.nisseikyo.or.jp/images/news/gyo

is warranted to seek the practical measure to maximize

usei/coronavirus/200304-04.pdf>

the benefits for those who involved the case and2020]

overcome unprecedented challenge of quarantine.

from

[29

May

Gostin, L. O., Bayer, R., and Fairchild, A. L. (2003)‘Ethical and Legal Challenges Posed by Severe

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Emergencies: Restrictions on Liberty’. The

staff members engage in the COVID-19

American Journal of Bioethics 7(2), 1-5. DOI:

response

10.1080/15265160701577603[online]availablefrom<https://jadm.or.jp/sys/_data/info/pdf/pdf00012
1_1.pdf > [21 August 2020]

Xu, J. W., Wang, X. Y., Qin, Z., Song, H. L., Wang, H.,
Luo, H. Y., Ye, L., and Feng, Z. H. (2020) ‘Deep

The Japan Times (2020) ‘Experts in Japan Call for

Thought of COVID-19 Based on Diamond

Easing Burdens on Coronavirus-hit Ship's

Princess's Quarantine and Home Quarantine’.

Crew’. The Japan Times [online] 12 February

European

10

Review

for

MedicalandPublic Health and Ethical Consideration on the Quarantine of
Diamond Princess

CBEL Report Volume 3, Issue 2

Pharmacological Sciences 24(7), 4027-4029.
DOI: 10.26355/eurrev_202004_20872
Zhang, S., Diao, M., Yu, W., Pei, L., Lin, Z., and Chen,
D. (2020) ‘Estimation of the Reproductive
Number of Novel Coronavirus (COVID-19) and
the Probable Outbreak Size on the Diamond
Princess Cruise Ship: A Data-Driven Analysis’.
International Journal of Infectious Diseases 93,
201-204.

DOI:

https://doi.org/10.1016/j.ijid.2020.02.033

Received 10 September 2020
Final version accepted 28 October 202011

⽊下翔太郎CBEL Report Volume 3, Issue 2

Letter

遠隔医療の普及における信頼の重要性

⽊下翔太郎（慶應義塾⼤学医学部）

2019 年からの新型コロナウイルス感染症のパスを導⼊しているのに対し、低所得国では 50％未ンデミック下において、遠隔医療が注⽬されてい満であった 3)。これは、通信環境が脆弱な地域や、

る 1)。遠隔医療では、対⾯診療と⽐較して得られる

ICT 機器が⼿に⼊らない⼈々の間で遠隔医療が活所⾒が限られ、問診によって多くの情報をとる必⽤できていないことを⽰唆している。その他、⾝要があるため、患者との信頼関係が重要となる。

近な事例として、我が国のシェア上位を占めてい患者との信頼関係を規定する要素は様々だが、⼤るオンライン診療システムにおいても、クレジッ

前提として、遠隔医療⾃体への信頼も確保されてトカードでないと決済できないものや、パソコンいる必要がある。

での利⽤ができずスマートフォンでしか利⽤でき

筆者らは、17 の国と地域の研究者を対象に、今ないものなどがあり、事実上のアクセス制限とな

般のパンデミックにおける遠隔医療の規制動向にっている場合がある。このように、遠隔医療が急ついての調査を⾏なった 2)。多くの国で規制緩和

速に拡⼤する中で、インターネットにアクセスでが⾏われ、遠隔医療が普及する⽅向に進んでいる

きない⼈々や ICT 機器を活⽤できない⼈々と、そことが確認できたが、⼀部、パンデミックにおいうでない⼈々との間に⽣じる格差である「デジタて規制の多くが取り払われたにも関わらず遠隔医

ル・ディバイド」のような問題も懸念されている。

療の普及が進んでいないという国があった。これ

こうした倫理的課題に対して政府や医療者などのらの国で遠隔医療が普及しなかった理由として、関係者が取り組もうとする姿勢を⾒せない場合、新しい⽅法を⽤いることへの⼼理的抵抗感、医師

医療インフラとしての遠隔医療への信頼は得られと対⾯で会うことを重視するなどの⽂化的背景なず、普及に向けた動きにブレーキがかかる可能性

どが考えられた。患者や医療者に遠隔医療が受けがある。

⼊れられていくためには、こうした臨床的なツー

遠隔医療を適切に普及させていくためには、遠ルとしての遠隔医療への不信を取り除いていく必

隔医療への信頼を確保していくことが重要であり、要があると考えられる。

普及に伴う倫理的課題についても真摯に向き合い

また、遠隔医療の普及策を検討していく上では、
医療インフラとしての遠隔医療への信頼も重要である。WHO が 130 か国の精神科医療について⾏なった調査によると、今般のパンデミック下において、⾼所得国の 80％以上が遠隔医療・遠隔サービ
12ながら、誰もが平等にアクセスできるよう努めていくべきである。

遠隔医療の普及における信頼の重要性

CBEL Report Volume 3, Issue 2

参照⽂献

1) 前村叶基. 2020. 「オンライン診療でどのように信頼関係を築くか」 CBEL Report, 3(1): 6975.
2) Shotaro Kinoshita, Kelley Cortright, Allison
Crawford, Yuya Mizuno, Kazunari Yoshida, Donald
Hilty, Daniel Guinart, John Torous, Christoph U.
Correll, David J. Castle, Deyvis Rocha, Yuan Yang,
Yu-tao Xiang, Pernille Kølbæk, David Dines,
Mohammad

ElShami,Prakhar

Jain,

Roy

Kallivayalil, Marco Solmi, Angela Favaro, Nicola
Veronese, Soraya Seedat, Sangho Shin, Gonzalo
Salazar de Pablo, Chun-Hung Chang, Kuan-Pin Su,
Hakan Karas, John M. Kane, Peter Yellowlees,
Taishiro

Kishimoto.

2020.

Changesintelepsychiatry regulations during the COVID-19
pandemic: 17 countries and regions' approaches toan evolving healthcare landscape. Psychological
Medicine, 1-8. [Epub ahead of print].
3) World Health Organization. 2020. The impact of
COVID-19 on mental, neurological and substanceuse services: results of a rapid assessment,
https://apps.who.int/iris/rest/bitstreams/1310579/retrieve (Accessed 1/16/2021)（2021 年 1 ⽉ 16 ⽇受理／同年 2 ⽉ 1 ⽇掲載決定）

13

CBEL Report Volume 3, Issue 2

ジャーナル・インフォメーション

Journal information《目的と領域 -Aims and Scope-》
CBEL Report は日本における生命倫理・医療倫理研究のますますの発展に資するために創刊された学術雑誌である。当該分野の、新たな研究成果の開かれた発表の場として、また国際的な学問交流の場として、オープンアクセスの形で出版される。アカデミアの専門的研究の活発な知的交流の場を作り出すこと、
およびそれに基づき全ての学問分野の研究者・学生ら、医療従事者、各種倫理委員会の委員、政策担当者、等に対して優れた知見を提供することをその使命とする。

《投稿規定 -Instructions for Authors-》
上述の目的のため、CBEL Report は、ここに広く研究成果を募集するものである。

1. 【投稿形式】投稿形式は以下のように定める：(ア) 字数に応じて以下のように投稿枠を区分する①

短報（letter）：邦語 1,000 字以内、英語 500words 以内②

総説（review）：邦語 20,000 字以内、英語 10,000words 以内③

論文（article）：邦語 20,000 字以内、英語 10,000words 以内※ いずれも抄録、注、文献リストを除いての数字とする(イ) 上記のうち特に論文については、以下の２つの形式を定める①

研究論文（regular article）：新規投稿の論文。他の雑誌との重複投稿は認めない。ただし他学会での学会報告を新たに論文化したものはこの限りではない。

②

翻訳論文（translated article）：他の媒体にすでに投稿した論文を翻訳したもの。英語への翻訳および日本語への翻訳を受け入れる（元の言語については限定を付さない）。投稿にあたっては著作権の許諾を証明する書類を添えること。

2. 【書式】投稿原稿は以下の書式を満たすものでなければならない。
(ア) 和文あるいは英文とする。
(イ) 投稿形式ごと、上記１条（ア）に示された分量を超えないものとする。
(ウ) 提出原稿は、Microsoft Word によって作成した電子ファイルとする。
(エ) 原稿の１ページ目に以下の情報を記入することとする：論文タイトル、投稿区分、著者名、所属、連絡先となる電子メールアドレス。
(オ) 論文の場合には、冒頭に抄録（邦語 450 字以内・英語 200words 以内）およびキーワード（邦14CBEL Report Volume 3, Issue 2

ジャーナル・インフォメーション

語・英語ともに３〜５語）を添えること。
(カ) 注は各ページ下部に記載すること（論文末尾にまとめる形ではなく）。
(キ) 参照文献リストを論文末尾にまとめて記載すること。参照文献の記載形式は特に定めないが、以下の情報が全て含まれているものとする。
①

著作：著者名、発行年、書名、出版社②

論文：著者名、発行年、論文タイトル、媒体、掲載頁数③

新聞記事：新聞名、掲載年、記事タイトル、日付（朝刊・夕刊の別）④

ウェブサイト記事：サイト名、掲載年、ページアドレス、閲覧日※ その他参照に関して疑問がある場合には投稿に際して編集部に問い合わせのこと(ク) 図・表ともに本文に埋め込むこと（字数にはカウントしない）。カラーでも可。
(ケ) 研究資金について所属機関以外の組織・個人から支援を受けている場合には、その旨を論文末尾に必ず記載すること。

3. 【査読】上記の条件を満たした論文に対して、編集委員会あるいは編集委員会が依頼した査読者による査読を行い、採用、条件付き採用、不採用のいずれかの結果を著者に通知する。

4. 【投稿方法】投稿は電子メールにて受け付ける。上記の条件を満たした投稿原稿の電子データを、添付ファイルの形で編集委員会まで送ること（cbelreport-admin@umin.ac.jp）。投稿は随時受け付ける。

5. 【費用】審査料・掲載料は無料とする。

6. 【著作権】掲載論文の著作権は執筆者個人に帰属し、その編集著作権は東京大学大学院医学系研究科・
医療倫理学分野に帰属する。その上で当分野は、当分野の指定する者が運営する電子図書館又はデー
タベースに対し、以下のことを依頼できる。（１）当分野の指定する者が運営する電子図書館又はデータベースが、本誌掲載論文等を掲載すること。（２）当分野の指定する者が運営する電子図書館又はデータベースが、本誌掲載論文等を利用者に提供すること、とりわけ、利用者が当該著作物を参照
し、印刷できるようにすること。

2018 年 8 月 30 日 編集委員会決定
2020 年 3 月 30 日 編集委員会改定

インデックス：Google Scholar, 医中誌、J-STAGE、Medical*Online、CiNii（申請中を含む）

15

CBEL Report Volume 3, Issue 2

ジャーナル・インフォメーション《編集委員会 -Editorial Board-》
創刊編集 Founding Editor

赤林朗、東京大学

編集委員 Board Members

Michael Dunn,
University of Oxford (United Kingdom)

編集主幹 Editors in Chief

瀧本禎之、東京大学
中澤栄輔、東京大学

Ruiping Fan,
City University of Hong Kong (Hong Kong)
Nancy S. Jecker,
University of Washington (United States)

編集補佐 Associate Editors

宇田川誠、東京大学
玉手慎太郎、東京大学

Ilhak Lee,
Yonsei University (Republic of Korea)
Robert Sparrow,
Monash university (Australia)

編集顧問 Consulting Editors

Thomas H. Murray,
The Hastings Center (United States)
Justin Oakley,
Monash Bioethics Centre (Australia)
Julian Savulescu,
University of Oxford (United Kingdom)

Jochen Vollmann,
Ruhr-University Bochum (Germany)
有馬斉、横浜市立大学
稲葉一人、中京大学
荻野美恵子、国際医療福祉大学
高橋しづこ、東京大学
竹下啓、東海大学

加藤尚武、京都大学（名誉）土屋敦、徳島大学

島薗進、東京大学（名誉）筒井晴香、東京大学

髙久文麿、東京大学（名誉）堂囿俊彦、静岡大学

樋口範雄、東京大学（名誉）長尾式子、北里大学
奈良雅俊、慶應大学
林芳紀、立命館大学
林令奈、東京大学
前田正一、慶應義塾大学
三浦靖彦、東京慈恵会医科大学
山本圭一郎、国立国際医療研究センター

16

JOURNAL INFORMATIONCBEL Report Volume 3, Issue 2

Journal information

Aims and Scope
CBEL Report is an academic journal launched for the further development of bioethics and medical ethics in Japan.
The open-access journal offers a public outlet for presenting new research results, creating an international network
for academic exchange within the field of bioethics and medical ethics. The mission of CBEL Report is to lead an
active intellectual discussion for specialized research to provide useful knowledge to researchers and students in all
disciplines, health professionals, members of ethics committees and policymakers etc.

Instructions for Authors
To fulfill the above objectives, CBEL Report calls all authors to share their research results by submitting theirmanuscripts.

[Types of manuscripts] All manuscripts must be supplied in the following style.
(a)Submitted manuscripts are categorized according to the word count as follows.
(1)

Letters: Up to 500 words in English or up to 1,000 characters in Japanese(2)

Reviews: Up to 10,000 words in English or up to 20,000 characters in Japanese(3)

Articles: Up to 10,000 words in English or up to 20,000 characters in Japanese*the word count without abstract, notes and reference lists(b)“Articles” are categorized into the following two types.
(1)

Regular articles: Newly published works. We do not accept articles that have been submitted
simultaneously to other journals. However, this does not apply to works that have been previously
presented at an academic conference and turned into papers.

(2)

Translated articles: Articles translated into English or Japanese that have been published in otherpublications. (There are no restrictions for the original language.) Articles must accompany
paperwork granting the copyright.

[Formatting] Submitted manuscripts must adhere to the following format.
(a)Must be in either English or Japanese.

(b)

The word count must not exceed the limit stipulated in Section 1 (a) according to the type of manuscript.

(c)

The manuscript must be presented in an electronic file prepared using Microsoft Word.

(d)

The title, manuscript type, name(s) of author(s), name of institution/department and contact informationsuch as e-mail address must be entered in the first page.

(e)

Articles must include the abstract (up to 200 words in English or 450 characters in Japanese) andkeywords (3 to 5 words for either English or Japanese) in the beginning.
17

CBEL Report Volume 3, Issue 2(f)

JOURNAL INFORMATION

Notes should be provided at the bottom of the page as footnotes (instead of placing them at the end of thearticle).

(g)

Reference list should be included at the end of the article. There are no requirements on reference styles
but all the following information must be included.
(1)

Books: Name(s) of author(s), year of publication, title, name of publisher(2)

Journal articles: Name(s) of author(s), year published, article title, medium, page(s)(3)

Newspaper articles: Name of newspaper, year published, article title, date (morning or evening
paper)(4)

Website articles: Website name, year published, site address, date visited* If you have any other questions regarding the reference list, please contact the editorial board.
(h)Figures and tables should be inserted to the text. They don’t have to be counted in word count. Coloredmaterials are available.

(i)

Acknowledgement of financial support from organizations or individuals other than the affiliatedinstitution, if any, should be included at the end of the article.

3. [Peer review] On the condition that the above requirements are met, articles will be accepted for review bymembers of the editorial board or any other professionals assigned by the editorial board. The authors will be
notified whether their manuscripts are accepted, accepted with conditions or not accepted for publication.

4. [Submission method] Manuscripts must be submitted via email. Make sure the manuscripts are in compliancewith the above requirements. Send the electronic data to the editorial committee as an attachment (cbelreportadmin@umin.ac.jp). Submissions are accepted throughout the year.

5. [Fee] There are no fees for the review or publication.

6. [Copyright] Individual authors own the copyright for the published papers, and the Department of Biomedical
Ethics, The University of Tokyo Graduate School of Medicine owns the compilation copyright. Furthermore, theDepartment can request the designated operators of the electronic library or database to 1) post the articles, etc.
published in this journal in the electronic library or database and 2) allow users to access the articles, etc.
published in this journal, and in particular, to refer to and print the works.

Editorial Committee(Revised March 30, 2020)

18

JOURNAL INFORMATIONCBEL Report Volume 3, Issue 2

Editorial Board
Founding Editor
Akira Akabayashi,
The University of Tokyo (Japan)

Editors in Chief
Yoshiyuki Takimoto,Consulting Editors
Norio Higuchi,
The University of Tokyo (Japan)

Hisatake Kato,
Kyoto University (Japan)

The University of Tokyo (Japan)
Thomas H. Murray,
Eisuke Nakazawa,

The Hastings Center (United States)

The University of Tokyo (Japan)
Justin Oakley,
Associate Editors

Monash Bioethics Centre (Australia)

Udagawa Makoto,
The University of Tokyo (Japan)

Julian Savulescu,
University of Oxford (United Kingdom)

Shintaro Tamate,
The University of Tokyo (Japan)

Susumu Shimazono,
The University of Tokyo (Japan)

Fumimaro Takaku,
The University of Tokyo (Japan)

19

CBEL Report Volume 3, Issue 2

JOURNAL INFORMATION

Board Members
Hitoshi Arima,
Yokohama City University (Japan)

Toshihiko Dozono,
Shizuoka University (Japan)

Masatoshi Nara,
Keio University (Japan)

Mieko Ogino,International University of Healthand Welfare (Japan)

Michael Dunn,
University of Oxford (United Kingdom)

Reina Ozeki-Hayashi,
The University of Tokyo (Japan)

Ruiping Fan,
City University of Hong Kong (Hong Kong)

Robert Sparrow,
Monash university (Australia)

Yoshinori Hayashi,
Ritsumeikan University (Japan)

Shizuko Takahashi,
The University of Tokyo (Japan)

Kazuto Inaba,
Chukyo University (Japan)

Kei Takeshita,
Tokai University (Japan)

Nancy S. Jecker,
University of Washington (United States)

Atsushi Tsuchiya,
Tokushima University (Japan)

Ilhak Lee,
Yonsei University (Republic of Korea)

Haruka Tsutsui,
The University of Tokyo (Japan)

Shoichi Maeda,
Keio University (Japan)

Jochen Vollmann,
Ruhr-University Bochum (Germany)

Yasuhiko Miura,
The Jikei University (Japan)

Keiichiro Yamamoto,
National Center for Global Health and Medicine

Noriko Nagao,
Kitasato University (Japan)

20(Japan)CBEL Report
Volume 3, Issue 2
発行日 2021年3月20日
発行者 東京大学生命・医療倫理教育研究センター（ウェブサイト：cbel.jp）

Founding Editor : Akira Akabayashi
Editors in Chief : Yoshiyuki Takimoto,
Eisuke Nakazawa
Associate Editors : Makoto Udagawa
Shintaro Tamate