How much involvement can a family have in an individual’s medical matters, particularly when they are not conscious or in a clear state of mind to advocate for themselves? There are a multitude of ethical dilemmas that arise from this, and medical professionals are expected to respond instantaneously to these questions, as their decisions literally determine life or death.
Healthcare for patients who reside, work, or travel overseas can become complicated due to different cultural values, such as the Confucian values of countries such as China and Japan. According to Western standards, patient care comprises disclosure of medical information, patient consent, and voluntary decisions under all circumstances. Furthermore, medical professionals must provide sufficient information regarding risks, benefits, and complications of procedures without coercion. And the patient must understand the disclosed information and decide by free will.
Japanese regulatory agencies have integrated these policies within their healthcare policies. However, Japanese medical professionals prioritize familial consent over individual consent. This is because of a cultural belief that authorities such as families and physicians know better than the patient and thus, can better support them through their treatment. Therefore, familial consent is prioritized when diagnosing and treating brain death.
However, because Western medicine values individual autonomy, physicians are faced with the difficult task of reconciling their Western training with familial consent. So, Asian physicians, particularly senior physicians, face a dilemma: can a physician disregard Western principles and prioritize cultural values, or should they endure cultural repercussions after following Western policies?
Older physicians face increased pressure to follow societal and cultural norms when making decisions related to mortality. Although some younger medical practitioners value individual consent over familial consent, many are expected to conform to Asian medical principles due to parental influence. Therefore, the younger generation of medical practitioners will be navigating more stringent cultural and societal norms. As such, it can be argued that medical professionals often struggle to find a balance between familial and individual consent when declaring brain death.Â
