Contemporary issues concerning informed consent in Japan based on a review of court decisions and characteristics of Japanese culture

BMC Medical Ethics

Atsushi Asai¹  Hiroko Ishimoto¹  Sakiko Masaki¹ 

[1]Department of Bioethics, Kumamoto University Graduate School of Life Science, Kumamoto, Japan

关键词: Healthcare professionals;    Misuse;    Ethical issues;    Ethical principles;    Japanese culture;    Informed consent;   

Others  :  799594
DOI  :  10.1186/1472-6939-15-8

 received in 2013-07-07, accepted in 2014-01-06,  发布年份 2014

【 摘 要 】

Background

Since Japan adopted the concept of informed consent from the West, its inappropriate acquisition from patients in the Japanese clinical setting has continued, due in part to cultural aspects. Here, we discuss the current status of and contemporary issues surrounding informed consent in Japan, and how these are influenced by Japanese culture.

Discussion

Current legal norms towards informed consent and information disclosure are obscure in Japan. For instance, physicians in Japan do not have a legal duty to inform patients of a cancer diagnosis. To gain a better understanding of these issues, we present five court decisions related to informed consent and information disclosure. We then discuss Japanese culture through reviews of published opinions and commentaries regarding how culture affects decision making and obtaining informed consent. We focus on two contemporary problems involving informed consent and relevant issues in clinical settings: the misuse of informed consent and persistence in obtaining consent. For the former issue, the phrase "informed consent" is often used to express an opportunity to disclose medical conditions and recommended treatment choices. The casual use of the expression "informed consent" likely reflects deep-rooted cultural influences. For the latter issue, physicians may try to obtain a signature by doing whatever it takes, lacking a deep understanding of important ethical principles, such as protecting human dignity, serving the patient’s best interest, and doing no harm in decision-making for patients.

There is clearly a misunderstanding of the concept of informed consent and a lack of complete understanding of ethical principles among Japanese healthcare professionals. Although similar in some respects to informed consent as it originated in the United States, our review makes it clear that informed consent in Japan has clear distinguishing features.

Summary

Japanese healthcare professionals should aim to understand the basic nature of informed consent, irrespective of their attitudes about individualism, liberalism, and patient self-determination. If they believe that the concept of informed consent is important and essential in Japanese clinical settings, efforts should be made to obtain informed consent in an appropriate manner.

【 授权许可】

   
2014 Masaki et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Beauchamp TL, Childress JF: Rinciples of biomedical ethics. 6th edition. New York: Oxford Press; 2009.
• [2]Akabayashi A, Slingsby BT: Informed consent revised. Japan U.S.A JOB 2006, 6:9-14.
• [3]Bito S (Ed): Guidance of informed consent. Sharing the knowledge about informed consent(Pamphlet); 2008-2011. Tokyo: Tokyo Iryo Center; 2011.
• [4]UNESCO: Casebook on human dignity and human rights, bioethics core curriculum casebook series, no.1. Paris: UNESCO; 2011.
• [5]UNESCO: Casebook on human dignity and human rights, bioethics core curriculum casebook series, no.2. Paris: UNESCO; 2011.
• [6]Inaba N: We want to know about medical lawsuit. Tokyo: Nikkei BP Press; 2010.
• [7]Kuwahara H: Kono 10 nen-no Iryou Sosyou no trend (The trend of a medical lawsuit in the past 10 years) (in Japanese). Tokyo: Nikkei BP Press; 2010.
• [8]Asai A, Aizawa K, Kadooka Y, Tanida N: Death with dignity is impossible in contemporary Japan. Eubios J Asian Int Bioethics 2012, 22:49-53.
• [9]Asai A: Curious about "sufficient explanation and consent", Kumamoto Nichinichi newspaper. Kumamoto: Kumamoto Nichinichi Shinbun Company; 2013.
• [10]Izawa M: Gyaku-setsu no Nippon Rekisshikan (A paradoxical Japanese historical view)(in Japanese). Shyogakkann Bunko: Tokyo; 2005.
• [11]Matsuda I: Bioethical concern based on the Japanese consideration of culture and value⇀care of critically ill newborn. Jpn Perinat Period Newborn Infant Med Congress Mag 2010, 46(4):924-932.
• [12]Asai A, Aizawa K: Genba de Yakuni tatu Rinri Kiso-ron (Ethics basic theory which is helpful at workplace) (in Japanese). Palliat Med Study 2009, 11(1):34-39.
• [13]Asai A, Fukuyama M: Toward successful bioethics education, in Asia-pacific perspectives on bioethics education. Bangkok: UNESCO; 2008.
• [14]Asai A, Sakamoto S: Self-determination of death in Japan: a review and discussion. Eubios J Asian Int Bioethics 2007, 17:35-41.
• [15]Tanida N: ‘Bioethics’ is subordinate to morality in Japan. Bioethics 1996, 10:201-211.
• [16]Sasaki Y, Yamaguchi Y: Kouresya no Jiko Kettei wo sasaeru Kanngoennjyo ni tuite (About the nursing assistance supporting elderly people's self-determination) (in Japanese). Hosp Home Care 2010, 18:2-8.
• [17]Tamura C: The family-facilitated approach could be dangerous if there is pressure by family dynamics. Am J Bioeth 2006, 6:16-18.
• [18]Davis A, Gallager A, Midou T: Nursing ethics. Tokyo: Igaku Eizo Kyoiku Center; 2007.
• [19]Davis AJ, Tschudin V, Raeve L: Learning and educating nursing ethics. Tokyo: Japan Nursing Association Publication Meeting; 2008.
• [20]Doi T: The anatomy of dependence. Kodansha International: Tokyo; 1973.
• [21]Miyashita M, Sanjo M, Morita T, et al.: Good death in Japanese cancer care: a nationwide quantitative study. Ann Oncol 2007, 18:1090-1097.
• [22]Japanese Nursing Associations: Nursing ethics of the ethical consideration and correspondence under a notice and informed consent deployment. http://www.nurse.or.jp/rinri/basis/kokuchi/index.htm webcite
• [23]Nakamura S: Pocket guideline about breast cancer. Tokyo: Igaku Shyoin; 2010.
• [24]For doing the informed consent. http://www.dokkyomed.ac.jp/hosp-m/guide/63.html webcite
• [25]Beauchamp F: Encyclopedia of bioethics volume 3. 3rd edition. Edited by Stephen G. New York: Stephan G. Thompson and Gale; 2004:1271-1280.
• [26]Tanida N: Informed consent. NPO Iyaku Bijiransu Center: Osaka; 2006.
• [27]LaFleur WR: More information, broader dissent on informed consent. Am J Bioeth 2006, 6:15-16.
• [28]Nippon Ronen Igakkai: Japanese old age medical society position manifestation. Tokyo: Nippon Ronen Igakkai; 2012.
• [29]Sato R: Problems of informed consent in solo dementia patients (in Japanese). Old-Age Psychiatry Mag 2008, 19(2):179-179.
• [30]Ministry of Health, Labour and Welfare: The guideline on the determination process in terminal care. Tokyo: Ministry of Health; 2007.
• [31]Asai A: Iryo-syoku no tameno Rinnsyou Rinri no kotoba 48 (48 words of clinical ethics for Healthcare workers) (in Japanese). Tokyo: Japan Nursing Association Publication; 2011.
• [32]Fuscaldo G, Russell S, Delany C: Enhancing cross-cultural understanding of ethical issues in medical education. AJOB Prim Res 2010, 1(1):28-33.