Abstract
This volume introduces an East Asian Confucian ethical perspective on the place of the family for informed consent regarding clinical treatment and biomedical research. It offers a unique perspective on an approach to informed consent salient in East Asia but generally unexplored in English-language literature. By drawing on bioethics scholars from Hong Kong, mainland China, South Korea, and Taiwan, this volume offers a cluster of viewpoints that play a major role in law and healthcare policy in East Asia, although they are nearly unknown in Western bioethical reflection. Contributions from four American scholars are also offered in order to place the East Asian Confucian perspective in a broader context. Even in the West, there has been a move to address issues of dependency, family care, and shared decision-making that have many similarities with the concerns addressed by East Asian scholars. The themes of the five sections designed for this volume range from theoretical reflections on such concepts as autonomy, individualism, rationality, dependence, independence, and interdependence to the practical explorations of issues like end-of-life decisions, organ donation, research participation, truth telling, and the arrangement of advance directives. The focus of the whole volume is on the role that the family ought to play in the proper exercise of informed consent in biomedical practices.
I wish to thank Jeffrey Bishop, H.T. Engelhardt, Jr., Lisa Rasmussen and an anonymous reviewer for their comments on the previous versions of this essay.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
This is not to deny that many patients in the West regularly include families in their health care decision making. However, this volume is making the point that the policies set up in light of the dominant individualist model form barriers to including families in health care decision making in the West. As Nash points out, “Beauchamp and Childress (2009, pp. 106–107) suggest that the practical way to deal with those requesting family-oriented consent is to ask the individual if this is his preference. This, of course, is the application of an individualistic system and already does violence to any family-oriented consent” (Nash 2014, pp. 219–230).
- 2.
Indeed, in this volume the Western reader finds for the first time in English a presentation of the grounds of East Asian approaches to individual autonomy and informed consent and their differences from what have generally prevailed in Western bioethics. Without such an understanding, East Asian practices would to the Western bioethicists appear puzzling at the very least.
- 3.
Here again puzzles regarding East Asian approaches to the bioethics of informed consent can be resolved. These approaches do not discount the individual, but rather appreciate the individual patient within the context of the dependency of illness and the thick social relations that many patients have within their family.
- 4.
Here one has a light shed from the East on the one-sided and incomplete appreciation of general principles as envisaged within some Western accounts of medical decision making within the practice of informed consent. To act freely is always to act in a thick social context. From a Confucian view, only in the constitutive ritual or quasi-ritual practices of the life world (as Confucius disclosed 2500 years ago), can general principles play their secondary regulative function (cf. Fan 2012).
- 5.
Some Western readers may not find Zhao’s example compelling. They may contend that it is one thing to affirm that the wife was well-intended, but quite another to judge whether hiding the truth from the husband was actually in his “best interest”: just because the wife thought it would be in his best interest, doesn’t mean it was so. However, it should be noted that Zhao’s main purpose of addressing this case is to indicate a fundamental cultural difference, which invites Western readers to consider how Chinese people view this situation. As Zhao observes, this case was met with general approval and admiration in mainland China. In addition, it is at least theoretically possible that it was in his best interest—in the same way that the Western physician sometimes invokes the “therapeutic privilege” condition for non-disclosure. Importantly, as Zhao points out, in order to judge best interest, we need to appeal to a particular conception of the good shared in a culture. While she does not offer a full-brown Confucian conception of the good, she emphasizes the Confucian experience that “to be able to rely on one’s family members in the final stage of life is the good thing to do, and it makes the patient happy” (Zhao 2014, pp. 231–244).
- 6.
What is the way of resolving disagreement if one family member thinks differently? This is certainly an inevitable question from Western readers. However, Western readers should be informed of a general Confucian cultural ethos in which people have formed a familist mentality and attitude: family members, since they are from one family, should reach agreement and make one decision about any important matters (such as donating organs after death) confronting any of their family members. This “one-decision” strategy for each family is understood as the basic way of manifesting the integrity and solidarity of the family in the process of protecting the morality and interest of each family member, and all family members, in their life experiences, have been cultivated by Confucian virtues (such as harmony (he) and relevant rituals (such as family meetings) to practice this “one-decision” strategy. Thus, agreement will usually be achieved through familial discussion. Those families that cannot reach agreement will be despised by others as wanting of necessary familial virtue and integrity (Fan 2011; Fan and Chen 2010).
- 7.
The East Asian appreciation of the virtue of filial piety allows one to take what otherwise would be a narrow, rule-based imposition of autonomy in informed consent and see it more amply in terms of a virtue ethics.
References
Beauchamp, T. L., and J. F. Childress. 2009. Principles of biomedical ethics. 6th ed. New York: Oxford University Press.
Bishop, J. 2005. Autonomy and informed consent: A much misunderstood relationship. The Journal of Value Inquiry 38:383–391.
Bishop, J. 2014. Dependency, decisions, and a family of care. In Family-oriented informed consent: East Asian & American perspectives, ed. R. Fan, 27–42. Dordrecht: Springer.
Cai, Y. 2014. On family informed consent in the legislation of organ donation in China. In Family-oriented informed consent: East Asian & American perspectives, ed. R. Fan, 187–199. Dordrecht: Springer.
Callahan, D. 2000. The troubled dream of life: In search of a peaceful death. Washington, D.C.: Georgetown University Press.
Census and Statistics Department of HKSAR. 2012. Thematic report: Single parents. Census and Statistics Department. http://www.census2011.gov.hk/pdf/single-parents.pdf. Accessed 6 Dec 2013.
Chan, J. 1999. A Confucian perspective on human rights on contemporary China. In East Asian challenge for human rights, ed. J. R. Bauer and D. Bell, 212–237. Cambridge: Cambridge University Press.
Chan, H. M., D. M. W. Tse, K. H. Wong, J. C. L. Lai, and C. K. Chui. 2014. End-of-life decision making in Hong Kong: The appeal of the shared decision making model. In Family-oriented informed consent: East Asian & American perspectives, ed. R. Fan, 151–170. Dordrecht: Springer.
Cherry, M. J. 2010. Parental authority and pediatric decision making. The Journal of Medicine and Philosophy 35 (5): 553–572.
Cherry, M. J. 2014. Individually directed informed consent and the decline of the family in the West. In Family-oriented informed consent: East Asian & American perspectives, ed. R. Fan, 43–62. Dordrecht: Springer.
Choi, K. 2014. The ideal of autonomy and its misuse. In Family-oriented informed consent: East Asian & American perspectives, ed. R. Fan, 83–92. Dordrecht: Springer.
Deng, R. 2014. The informed consent of human medical research in mainland China: A family-based binary decision model. In Family-oriented informed consent: East Asian & American perspectives, ed. R. Fan, 203–218. Dordrecht: Springer.
D’Itri, J. 2010. South Korea’s unwed mothers organize. Foreign Policy Blogs. http://foreignpolicyblogs.com/2010/02/25/south-koreas-unwed-mothers-organize/. Accessed 6 Dec 2013.
Engelhardt, H. T. 2002. Morality, universality, and particularity: Rethinking the role of community in the foundations of bioethics. In Cross-cultural perspectives on the (im) possibility of global bioethics, ed. J. Tao Lai Po-wah, 19–38. Dordrecht: Kluwer Academic Publishers.
Engelhardt, H. T. 2010. Beyond the best interests of children: Four views of the family and of foundational disagreements regarding pediatric decision-making. The Journal of Medicine and Philosophy 35 (5): 499–517.
Engelhardt, H. T. 2013. The family: Crucial to and divisive in bioethics. International Journal of Chinese & Comparative Philosophy of Medicine 11 (2): 113–127.
Faden, R., and T. L. Beauchamp. 1986. A history and theory of informed consent. New York: Oxford University Press.
Fan, R. 2010. Reconstructionist Confucianism: Rethinking morality after the West. Dordrecht: Springer.
Fan, R. 2011. Family-oriented surrogate decision making and Confucian bioethics. Bioethical Law & Ethics 5 (2): 1–20.
Fan, R. 2012. Confucian reflective equilibrium: Why principlism is misleading for Chinese bioethical decision-making? Asian Bioethics Review 4 (1): 4–13.
Fan, R., and B. Li. 2004. Truth telling in medicine: The Confucian view. Journal of Medicine and Philosophy 29 (2): 179–193.
Fan, R., and X. Chen. 2010. The family and harmonious medical decision making: Cherishing appropriate Confucian moral balance. Journal of Medicine and Philosophy 35 (5): 573–586.
Iltis, A. 2014. Families and medical decisions to assume risks for the benefit of others. In Family-oriented informed consent: East Asian & American perspectives, ed. R. Fan, 171–186. Dordrecht: Springer.
Lee, I. 2014a. Filial duty as the moral foundation of caring for the elderly: Its possibility and limitations. In Family-oriented informed consent: East Asian & American perspectives, ed. R. Fan, 137–148. Dordrecht: Springer.
Lee, S. C. 2014b. Family consent in medical decision-making in Taiwan: The implications of the new revisions of the Hospice Palliative Care Act. In Family-oriented informed consent: East Asian & American perspectives, ed. R. Fan, 125–136. Dordrecht: Springer.
MacIntyre, A. 1999. Dependent rational animals: Why human beings need the virtues. Chicago: Open Court Press.
MacIntyre, A. 2007. After virtue. 2nd ed. Notre Dame: University of Notre Dame Press.
Nash, R. 2014. Toward a shared decision: Against the fiction of the autonomous individual. In Family-oriented informed consent: East Asian & American perspectives, ed. R. Fan, 219–230. Dordrecht: Springer.
Oakeshott, M. 1991. Rationalism in politics and other essays. Indianapolis: Liberty Fund.
Sidgwick, H. 1888. The Kantian conception of free will. Mind 13 (5): 405–412.
Sulmasy, D. P., M. T. Hughes, R. E. Thompson, A. B. Astrow, P. B. Terry, J. Kub, and M. T. Nolan. 2007. How would terminally ill patients have others make decisions for them in the event of decisional incapacity? A longitudinal study. Journal of the American Geriatrics Society 55:1981–1988.
Taiwan Insights. 2012. Singles and single-parent families on the rise. Taiwan Insights. http://www.taiwaninsights.com/2012/12/17/singles-and-single-parent-families-on-the-rise. Accessed 6 Dec 2013.
Taylor, C. 1994. The politics of recognition. In Multiculturalism: Examining the politics of recognition, ed. A. Guttman, 25–74. Princeton: Princeton University Press.
Wang, J. 2014. Family and autonomy: Towards share medical decision-making in light of Confucianism. In Family-oriented informed consent: East Asian & American perspectives, ed. R. Fan, 65–82. Dordrecht: Springer.
Wear, S. 1993. Informed consent: Patient autonomy and physician beneficence within clinical medicine. Dordrecht: Kluwer Academic Publishers.
Wong, H. C. 2014. Towards a good practice of family-oriented consent: Reflections on medical practice in Taiwan. In Family-oriented informed consent: East Asian & American perspectives, ed. R. Fan, 245–256. Dordrecht: Springer.
Yang, Y. 2014. A family-oriented Confucian approach to advance directives in end-of-life decision making for incompetent elderly patients. In Family-oriented informed consent: East Asian & American perspectives, ed. R. Fan, 109–124. Dordrecht: Springer.
Yu, K. P. 2014. The Confucian alternative to the individual-oriented model of informed consent: Family and beyond. In Family-oriented informed consent: East Asian & American perspectives, ed. R. Fan, 93–106. Dordrecht: Springer.
Yung, L. 2014. The East Asian family-oriented principle and the concept of autonomy. In Family-oriented informed consent: East Asian & American perspectives, ed. R. Fan, 109–124. Dordrecht: Springer.
Zhao, W. 2014. A Confucian worldview and family-based informed consent: A case of concealing illness from the patient in China. In Family-oriented informed consent: East Asian & American perspectives, ed. R. Fan, 231–244. Dordrecht: Springer.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Fan, R. (2015). Informed Consent: Why Family-Oriented?. In: Fan, R. (eds) Family-Oriented Informed Consent. Philosophy and Medicine(), vol 121. Springer, Cham. https://doi.org/10.1007/978-3-319-12120-8_1
Download citation
DOI: https://doi.org/10.1007/978-3-319-12120-8_1
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-12119-2
Online ISBN: 978-3-319-12120-8
eBook Packages: Humanities, Social Sciences and LawPhilosophy and Religion (R0)