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This article has Open Peer Review reports available.

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Contributed equally
BMC Medical Ethics 2014 15 :8

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© Masaki et al.; licensee BioMed Central Ltd.2014

Received: 7July2013

Accepted: 6January2014

Published: 4February2014

Open Peer Review reports

Abstract

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.

Informed consent Japanese culture Ethical principles Ethical issues Misuse Healthcare professionals

Beauchamp and Childress argued that virtually all codes of medical ethics and institutional regulations should require physicians to obtain informed consent from patients prior to substantial interventions, with the protection of patient autonomy as the primary justification for this requirement. They also claimed that informed consent is an individual’s autonomous authorization and postulated seven structural elements[ 1 ], including threshold elements (competence to understand and decide; voluntariness in deciding), information elements (disclosure of material information; recommendation of a plan; understanding of the information and recommended plan), and consent elements (decision in favor of the plan; authorization of the chosen plan)[ 1 ]. We think that these elements are quite clear and comprehensive, and could provide a useful framework for the critical review of various contemporary issues surrounding informed consent acquisition in Japan.

The concept of informed consent received a great deal of attention during the 1980s in Japan. In 1990, informed consent was translated into Japanese as "setsumei to doi" (back-translated as "explanation and consent"). This Japanese translation, however, carries a connotation that informed consent is a duty owed to patients and does not properly purport the notion that informed consent is a patient’s right[ Brinley Co Womens Regular Wide Calf and Extra Wide Calf Ruched Stacked Heel Faux Suede OverTheKnee Boots Wine Ny7uj
]. In other words, the Japanese translation fails to grasp the "consent elements" of the framework described above. Currently in Japan, informed consent is often obtained without the patient’s understanding, physician’s recommendation, or adequate time to think[ 3 ]. In Japan as well as in other countries, many difficult issues regarding patient self-determination and acquisition of informed consent remain even after an ethical norm to obtain informed consent from patients in clinical settings and for research projects has been developed and established. They include compulsive interventions, treatment decisions for incompetent patients or minors, and issues surrounding treatment refusal[ Annie Shoes Womens Bongo Dress Sandal Black jh4YflUMII
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].

In this paper, we discuss current situations and cultural characteristics concerning informed consent in Japan to outline the problems that we think are common and relevant. First, we review five court decisions related to informed consent and information disclosure. Next, we discuss the characteristics of Japanese culture by reviewing published opinions and commentaries. Then, we describe two contemporary issues concerning informed consent in current clinical settings in Japan: misuse of informed consent and persistence in obtaining consent. Finally, we present our opinion on current situations surrounding informed consent in Japan. Our focus is on informed consent in clinical settings; we do not address informed consent in research settings.

In the past three decades, the Japanese Supreme Court has set forth decisions in four cases concerning truth-telling and informed consent, and one district court considered a case about the necessity of disclosure to families of patients. The first case concerned disclosure of a cancer diagnosis. A physician failed to inform a patient that she had gall bladder cancer, but instead told her that she had a gall stone that required inpatient care. However, the patient did not come back to the hospital and, as a result, the physician did not inform either the patient or the patient’s family. In 1995, the Japanese Supreme Court concluded that a physician does not need to disclose a cancer diagnosis on the ground that the physician can overlook a patient’s right to self-determination, if, in their judgment, the actual diagnosis could have an adverse impact on the patient[ 2 ]. In this case, the principle of non-maleficence was prioritized over respect for patient autonomy.

About

Dr. Kim D’Eramo is a board-certified Emergency Medicine physician who trained at Emory University’s Grady Hospital in Atlanta. She completed medical school at University of New England College of Osteopathic Medicine, where she also did fellowship training in Osteopathic Medicine, Medical Gross Anatomy and Neuroanatomy.

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