Entrance examination of the HIGO program, Kumamoto University

Short Essay
Duration of examination

90 minAttention
1. Please check to ensure all pages are present in the correct order. There
are 7 pages (this cover sheet, 4 pages of question sheets and 2 pages ofanswer sheets).
2. There are two questions, I and II. Select either question to be answered.
3. Write the number (I or II) of the selected question and your applicant
number at the top of each answer sheet.

Ｉ

Read the sentences below and answer the following questions

Over the last decade Amartya Sen’s Capability Approach (CA) has emerged as the leading
alternative to standard economic frameworks for thinking about poverty, inequality and humandevelopment generally. In countless articles and several books that tackle a range of economic,
social and ethical questions, Professor Sen has developed, refined and defended a framework thatis directly concerned with human capability and freedom. From the outset Sen acknowledged
strong connections with Adam Smith’s (1776) analysis of “necessities” and living conditions andKarl Marx’s (1844) concern with human freedom and emancipation. While the roots of the CA canbe traced back to Aristotle, Classical Political Economy and Marx, it is possible to identify more
recent links. For example, Sen often notes that Rawls’s Theory of Justice (1971) and his emphasis
on “self-respect” and access to primary goods has “deeply influenced” the CA.
----------------------------------------------------------------------------------------------------The conceptual foundations of the CA can be found in Sen’s critiques of traditional welfare
economics, which typically conflate well-being with either opulence (income, commoditycommand) or utility (happiness, desire fulfillment). Sen distinguishes between commodities,
human functioning/ capability and utility as follows:
Commodity ⇒ Capability (to function) ⇒ Function(ing) ⇒ Utility (e.g. happiness)
He begins by considering income or commodity command. Like Adam Smith, Sen emphasizes
that economic growth and the expansion of goods and services are necessary for humandevelopment. However, like Aristotle, he reiterates the familiar argument that “wealth is evidently
not the good we are seeking; for it is merely useful and for the sake of something else.” In judging
the quality of life we should consider what people are able to achieve. Sen, then, observes thatdifferent people and societies typically differ in their capacity to convert income and commodities
into valuable achievements. For example, a disabled person may require extra resources (wheelchairs, ramps, lifts, etc.) to achieve the same things (moving around) as an able bodied person.
Moreover, a child typically has very different nutritional requirements from a manual laborer,pregnant woman or someone with a parasitic disease. Similarly, the commodity requirements formore complex social achievements (such as “appearing in public without shame” or “entertainingfamily and friends”) typically depend on “cultural” factors such as social convention and custom
or status and class, inter alia.
------------------------------------------------------------------------------------------------------In comparing the well-being of different people, not enough information is provided by looking
only at the commodities each can successfully command. Instead we must consider how wellpeople are able to function with the goods and services at their disposal. Sen also challenges thewelfare or utility approach, which concentrates on happiness, pleasure and desire-fulfillment. (Thechoice based approach is regarded as a “nonstarter” as people do not always choose in accordancewith their own personal interests but often wish to consider wider concerns.

--------------------------------------------------------------------------------------------------------More fundamentally, Sen points out that there is more to life than achieving utility. “Happiness ordesire fulfillment represents only one aspect of human existence.” While it is important to takenote of utility, there are many other things of intrinsic value (notably rights and positive freedoms)that are neglected by the welfare approach. This might not be a serious problem in cases whereutility levels reflect personal circumstances and deprivations. However, Sen indicates that “utility
can be easily swayed by mental conditioning or adaptive expectations.”
Modified from David A. Clark “The Capability Approach: Its Development, Critiques and Recent Advances”
GPRG-WPS-032. An ESRC Research Group

Question1: Explain briefly the differences between Function(ing) and Utility. (within 250 words)
Question2: Indicate the most important nature of Capability Approach in association with boththeoretical and practical aspects. (within 400 words)

II

Read the sentences below and answer the following questions:
Multiple sclerosis*1 is believed to be an autoimmune disease of the central nervous

system. However, according to Italian physician Paolo Zamboni, it is related tocerebrospinal vascular insufficiency. Zamboni claims that MS can be treated byremedying this condition with venous angioplasty*2. This surgery is offered astreatment for MS in various countries―Poland, Bulgaria, and Costa Rica, for example.
But the Medical Board of Quebec, Canada, does not allow its members to perform thesurgery and strongly advises patients against seeking it elsewhere. This opposition isbased on the lack of evidence to support the procedure and the serious risks associatedwith it (including venous thrombosis*3, stroke, and pulmonary embolism*4). As a result,many Canadian MS patients have traveled to other countries to receive the surgery.
Quebec physicians have been reluctant to provide surgical follow-up for patients who
undergo the surgery in other countries due to the lack of information regarding theprocedure. No alternative treatments are effective to partially or completely cure MS,
and so the treatments available in Canada aim only to manage its symptoms.
Jade is a forty-year-old Canadian woman with MS. She is on long-term disability
leave, complains of growing fatigue and muscle stiffness, and has painful sensations in
her limbs. She has been followed by an interdisciplinary team in a specialized hospitalin Quebec for the past twenty years, since she was diagnosed. At her last appointment,
Jade told her physical therapist that she recently underwent the experimental Zamboni
surgery in Poland, despite her physician’s strong recommendation not to. Jade fears her
physician’s reaction, so she asks the physical therapist to keep this information from therest of her medical team.
Jade is shy and tends to distrust health care professionals. It took many years for her
physical therapist to gain her trust and to develop a positive therapeutic relationshipwith her. However, the physical therapist knows that serious complications can occur inpatients who have had Zamboni’s surgery. Not telling Jade’s physician about thesurgery could result in harm; Jade could have complications that are not recognized.
Providing the information to the rest of the team would allow them to adjust her
treatment to respond to the surgery and give her information and postoperativeeducation that she will need. Moreover, keeping this secret could threaten teamcohesion and trust if they find out about it later.
Jade decided to undergo a risky surgery against her doctor’s advice in the hope of
improving her quality of life. This was her autonomous choice. How should the physicaltherapist respond? ( from The Hastings Center Report, Vo.41, No.6, 2011)＊1. multiple sclerosis: common demyelinating disorder of the central nervous system,
causing patches of sclerosis (plaques) in the brain and spinal cord.
＊2. angioplasty : reconstruction or recanalization of a blood vessel.
＊3. thrombosis: clotting within a blood vessel.
＊4.pulmonary embolism: embolism of pulmonary arteries, most frequently by detachedfragments of thrombus from a leg or pelvic vein, commonly when thrombosis has
followed an operation or confinement to bed.

Question1: Explain the relationships between two bioethical principles, i.e.,① Respect for patient’s autonomy and ② Beneficence (Act in patient’s best interest).
(within 300 words)
Question2: Provide an answer to “How should the physical therapist respond?”.
(within 400 words)