Three Metaethical Arguments about Informed Consent in Japan
Laura Specker SULLIVAN, Kyoto University
This paper analyzes three possible metaethical approaches to understanding informed consent in Japan.
The first metaethical approach would hold that there exists a universal system of objective ethical truths, such that differences in ethical judgments are due to either differences in non-moral facts or mistakes in ethical reasoning. This approach would hold that differences in Japan’s practice of informed consent stem not from a different ethical standpoint but either from a difference in non-moral facts or from mistaken reasoning.
The second metaethical approach would hold that multiple ethical systems exist; they are grounded not in objective truths but rather in ways of life, such that differences in ethical practices derive from differences in attitudinal responses common in these ways of life. This approach would hold that Japan’s justification and practice of informed consent shows genuine ethical disagreement with that of the United States.
The third metaethical approach would question the grounding of the first two metaethical approaches, holding that the distinction between ethics as objective and ethics as relative is a false dichotomy. While there is no objective grounding for ethical judgments this does not mean that ethical judgments must be based on temporally and locally isolated standards of behavior. Rather, ethical action is the result of an individual skillfully ascertaining what is needed in a given situation, and ethical judgment comes from mindfully reflecting on whether or not things went well. This approach would hold that Japan’s practice of informed consent is based on a different conception of ethics altogether.
In conclusion, this paper will present the normative conclusions of these three approaches and their implications for how informed consent is discussed and practiced in the United States and Japan.
Changing Perception of Privacy in Medical Settings in Japan
Franziska KASCH, Osaka University
It is hard to define what privacy exactly is, its meaning, as well as how it is to be protected as opinions differ according to sociocultural context and situations. Japanese people, for example, are often said to lack sensitivity to privacy issues due to their culture, which values the group above the individual. Therefore, it is not surprising that there is no Japanese word for privacy. Rather, the term puraibashii is imported from the West and some claim that its meaning might not always be clear to the Japanese. However, there are indications for a growing awareness of the concept and importance of privacy in Japan.
One result of this changing perception is the Act for Protection of Personal Data, which was enforced in 2005. But privacy does not only concern personal information. It is also connected to confidentiality and security, which are crucial in medical settings. Patients need to be sure that their privacy is protected to feel secure and able to discuss intimate details about their health or treatment. But how this privacy is established is different for each patient, because every patient has its own distinct sociocultural background and values. Thus, there is a potential for conflict, which health care practitioners need to be aware of.
In this presentation, I want to give examples for conflicts regarding privacy between patients and health care practitioners in order to show that the perception of privacy in medical settings is changing in Japan.
A Reconsideration of the Ethical Implication of Informed Consent
Yoshiro MAEDA, University of Occupational and Environmental Health
Since 1960, informed consent (IC) in medicine has been established as a legal principle. But IC has also an ethical implication. It is generally paraphrased as the Transition from “Paternalism of Doctors” to “Self-Determination of Patient”. This interpretation, however, has led to several problems, such as anti-ethical individualism and excessive commercialization of medical practices.
I suggest another interpretation of IC. Medicine has originally two elements: (1) the improvement of patients’ health (Benefit of Patient), and (2) patients’ consent to medical interventions (Will of Patient). Without patient’s consent, doctors can never cut a patient’s body. Medicine needs patient’s consent. Until 20th century, however, the patient’s consent had been hidden behind the patient’s benefit.
In 20th century, circumstances changed. Medical interventions became dangerous. And the legal principle of IC was newly formulated based on the concept of “negligence”. According to this principle, if doctors do not exercise IC, they must pay much money to patients, as compensations to bad outcomes of their medical treatment. IC thus burdens doctors with the legal obligation to respect patients’ will.
We can express this shift as the Transition from “Benefit of Patient > Will of Patient” to “Will of Patient > Benefit of Patient”. This is a matter of the priority rather than a choice between two alternatives. What ethical consequences stem from this interpretation?
First, a doctor must seek the medical benefit of a patient according to patient’s will. In other words, a doctor must respect a patient as a person, and support him as a medical professional. This is a higher style of benevolence. Secondly, doctors don’t have obligation to perform anti-ethical actions having no relationship with medicine, even if patients want them, e.g. positive euthanasia. Thinking in this way, we can correct distortions arising from the accepted view of IC.
Paternalism in Medical Ethics: Re-examining the Concept of Paternalism and its Ethical, Legal and Social Implications
Koichi SETOYAMA, Osaka University
Paternalism has been discussed in various settings in Medical Ethics and it has been mentioned, with a negative connotation, as an infringement of self-determination and autonomy of the patient. However, in present clinical research and medicine, various types of paternalistic arrangement can be observed.
The primary purpose of this presentation is to point out the cases of paternalism and paternalistic arguments on the use of new biotechnology in contemporary clinical research and medicine. Based on theoretical and empirical examination, paternalism and autonomy do not necessarily conflict with each other. Many procedures and guidelines in order to ensure autonomy and informed consent of the patient are arranged based on the motivation of paternalism. In conclusion, I assert that a certain type of paternalism is indispensable to secure autonomy and self-determination.
In these years, a new approach, the so-called “Libertarian Paternalism” which regards paternalism, in a positive way, as an indispensable policy is emerging. In this presentation, ethical, legal and social implications of this new concept and approach of paternalism over the controversial issues in bioethics will be examined.
Proposals for the Future of Informed Consent: Involvement of Mediator and Foundation of Third-party Inspection Organization
Ritsuko YOSHIMURA, Nara Institute of Science and Technology
In Japan, the process of “Informed Consent” (IC) has been established as a rule of clinical practice for the last 45 years. In some cases, however, IC is not implemented appropriately due to inadequate understanding of its basic premises: 1) a sufficient explanation on applicable medical treatments is given by the physician to the patient and then 2) the patient fully understands the explanation and expresses his/her will to accept or refuse the treatment recommended by the physician. Also, it is a well-known fact that not a few patients suffer from unreasonable losses as victims of those inadequate IC cases.
Previous studies on IC-related issues put forward suggestions to remedy them mainly from viewpoints of: 1) revision of the conventional, interactive communication model between a patient and a physician, 2) reexamination of medical-education curriculums and 3) reform of patients’ consciousness of medical care including IC. However, only a few suggestions are realistically applicable in resolving the IC-related issues. This study is the first to extract the underlying factors of these issues by examining problematic IC cases, and then to draw up reform proposals through a comparative review of results from the previous studies, such as: a) the involvement of a mediator in the IC process and b) strengthening support systems with help from mass media and/or local government by which patients autonomously increase their medical awareness.
With a future perspective and from a neutral standpoint, this study extensively discusses the foundation of a third-party inspection organization to evaluate the IC process implemented at each medical facility. Also, it holds the absolute necessity of protecting patients engaged in IC from “mediamorphosis” as well as a skewed exposure to the internet-society.